Pulmonary artery banding
Clinical Procedure
 
Aliases:
PA Banding
PAB

Topic aliases are alternate phrasings for a particular topic.


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Considerations as for pediatric cardiac-surgery

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May be performed to help prepare inadequately sized left ventricles in patients with D transposition-of-the-great-arteries (d-TGA) who will be undergoing a delayed arterial switch procedure.

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If there has been a delay between performing the diagnostic echocardiogram and surgery, consider repeating the echo to rule out spontaneous closure of the muscular VSD.

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An arterial line will be required to managed haemodynamics related to the patient's underlying condition, and measure systemic pressures at the time of banding.

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Maintain FO2 and pCO2 at near normal physiological levels to replicate the patient's normal balance of pulmonary vs systemic blood flow, and allow the surgeons to accurately determine the degree of band tightness required.

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Approach via a sternotomy is more common than via a thoracotomy.

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Turn of any volatile anaesthetic agent at the time of the banding to minimise the reduction these agents will cause in the systemic vascular resistance.

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Direct needle pressure measurements will be taken from the RV and PA before and after placement of the band to determine adequacy of new pressure gradients.

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If indeterminate need for a band intraoperatively, perform a Qp/Qs to determine the shunt fraction. A Qp/Qs of greater than ~1.8 is an indication for a PA band. #ref

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Cross-match and have blood available if this is a redo sternotomy #NM

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Historically, detecting when the band was too tight was done by auscultating the heart with a precordial stethoscope and listening for diminishing heart sounds to tell you when it was too tight. [video]
#video #KB

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