The Possible and Extended Indication of Bilateral Pulmonary Banding for the Neonates with HLHS Compatible, Especially with Small for date

  • Yoshito Maehata, Division of Congenital Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan, Japan
  • Kyoichi Nishigaki, Division of Congenital Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan, Japan
  • Yoichi Kawahira, Division of Congenital Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan, Japan
  • Yosuke Murakami, Division of Congenital Cardiology, Osaka City General Hospital, Osaka, Japan, Japan
  • Eiji Ehara, Division of Congenital Cardiology, Osaka City General Hospital, Osaka, Japan, Japan
  • Tsugutoshi Suzuki, Division of Congenital Cardiology, Osaka City General Hospital, Osaka, Japan, Japan
  • Yuki Ozawa, Division of Congenital Cardiology, Osaka City General Hospital, Osaka, Japan, Japan

    • OBJECTIVE: The aim of this study is to evaluate bilateral pulmonary banding (BPAB) in neonates as a first palliative procedure for the patients with HLHS compatible, especially with small for date (SFD).
    PATIENTS & METHODS: From April 2003 to October 2008, BPAB was performed in 20 patients at 3.3±2.9 days after birth. Their body weight (BW) at the procedure was 2.7±0.7 kg (range:0.9-3.6). Diagnosis was HLHS (n=8), CoA complex (n=5), AA+VSD (n=4) and others. BPAB was performed by bold silk suture and with a circumference of 9.5±0.6 mm (range:8-11).
    RESULTS: BPAB decreased SpO2 from 87.7±3.8 to 77.8±5.2 % and improved BP from 43.8±12.4 to 59.2±14.1 mmHg. Serum lactate was decreased from 102.0±94.9 to 12.1±3.2 mg/dl (p<0.05). One patient needed ASD creation under CPB. There were 2 operative deaths. The remaining 18 patients had no accident in hemodynamics immediately after BPAB. At 3 months (90.9±29.3 days) after the procedure, 16 patients (80%) had received second one; Norwood type procedure (n=11), EEDA±VSD closure (n=3) and others. Their BW gained to 4.0±0.9 kg (range:2.6 to 5.2) at the time. As a sequential disease after BPAB, there were left pulmonary artery stenosis in 7 patients (44%) and left PA thrombosis in 1 patient. They needed additional PTA or AP shunt for the growth of the lung.
    CONCLUSION: BPAB would be effective as a choice of the first palliative procedure for HLHS compatible. Especially, the patients with SFD were considered to have possibility that they could be performed each first open cardiac surgery safety.