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1、Indications of pulmonary artery banding (PAB) in congenital cardiac surgery,Fu Wai Cardiovascular Disease Hospital Pediatric Surgical Center ShouJun Li,History,1952 Muller and Dammann firstly introduced the PAB operation Initially for treatment of congenital anomalies with pulmonary hypertension Pri
2、mary repair has replaced PAB in treatment for PH,Current Indications of PAB in Advanced Countries,Staged palliation for physiological single ventricle with unobstructed pulmonary flow 3-4 weeks Two-stage arterial switch operation Beyond the neonatal period,Clinical Data,1997-2003 Total: 32 cases Mal
3、e 19, Female 13 Age: 2 months - 24 years, mean: 33.78month Body weight (BW): 3.25-41kg, mean: 10.7kg,Indications,Physiological single ventricle Other anomalies with unrestricted pulmonary flow Beyond the neonatal period TGA : left ventricular training,Treatment of Physiological Single Ventricle,Surg
4、ical Management,Staged operation： First Stage: PAB Second Stage: Bidirectional Glenn Simultaneous Operation：Glenn+PAB,(1) Staged Operation,Patients Characteristics,13 cases Age: 3-60 months mean 23.46 months BW: 4-16kg mean 9.23kg SaO2 : 86.28.1%,Patients Characteristics,SV 7 cases TA 3 cases DORV f
5、unctional SV 2 cases MA 1 case,Intraoperative Data,Before PAB PAP: 38.8210.04 mmHg SaO2 :86%20.8% After PAB PAP: 25.926.65 mmHg SaO2 :80.27% 7.7%,Results,PAP decrease satisfactorily : 8 cases Second stage Glenn: 2 cases Second stage Bjork: 1 cases Third stage TCPC: 1 case Operation interval: 1-2 yea
6、rs Waiting for further stage treatment : 4 cases,Results,PAP decrease unsatisfactorily: 5 cases Redo PAB: 1 case Third-time PAB: 1 case Untreated: 3 cases,(2) Simultaneous PAB + Glenn,Patients Characteristics,6 cases Age: 1-24 years BW: 8-41kg ,mean 21.5kg SaO2 : 73 7.0%,Patients Characteristics,DOR
7、V + PS: 3 cases SV + PS: 1 case ECD + C-TGA + PS: 1 case (PAP gradient 70.511mmHg,UCG) TA 1 case (PA=35/20(30)mmHg catheterization),Intraoperative Data,Before PAB PAP: 19.33 4.53 mmH SaO2:89% 6.0% After PAB PAP: 15.50 4.0 mmHg SaO2:87.3% 5%,Results,All these 6 patients recovered uneventfully and wit
8、hout major complication,Discussion,PAP 19mmHg PAB + Glenn simultaneously Postoperative PAP 15mmHg Moderate PH（PAP 38mmHg） Staged PAB followed by Glenn or Fontan No death and major complication in this cohort SV patients,Other Anomalies with Unrestricted Pulmonary Flow,Objective,Restrict pulmonary fl
9、ow Delay the development of PH Seek the possibility for further treatment,Patients Data,10 cases Age: 3-66 months, mean 15.27 month BW: 5-16kg, mean 7.54kg,Patients Characteristics,DORV+PH 6 cases ECD+PH 1 case Truncus Arteriosus 1 case ECD+Truncus 1 case VSD+PH 1 case,Intraoperative Data,Before PAB
10、 AoP: 53.725.44 mmHg PAP: 39.87.43 mmHg After PAB AoP: 58.84 6.7 mmHg PAP: 27.110.24 mmHg,Results,PAP decreased satisfactorily: 3 cases and underwent further repair operation PAP decreased unsatisfactorily: 5 cases Death: 2 cases truncus arteriosus,Discussion,Patients with severe PH PAB could partly
11、 benefit the patients and lower the PAP, provide the chance for further surgical treatment Second-stage repair operation ? Heart lung transplantation,Beyond the neonatal period TGA (left ventricular training),Patients Characteristics,5 cases Age: 2-16 months TGA without VSD Poor left ventricular function,Surgical Management,First-stage: PAB for left ventricular training Second-stage: artery switch operation,Results,No death and major complication,
