Pulmonary Artery Banding (PAB) is a surgical method for treating specific congenital heart defects. It is typically used as a temporary measure to treat newborns and infants for pulmonary over-circulation. Its purpose is to reduce circulation in the artery long enough for the child to get older, stronger, and larger before having to undergo major heart surgery. It is also used to slow the progression of congestive heart failure.
The use of pulmonary artery banding has declined; however, it is still a preferred palliative method when immediate surgery is not an option. In some cases, patients are placed on mechanical ventilators in conjunction with the procedure to reduce or prevent pulmonary edema. The banding should not be used as a cure, but should be seen as a temporary hold until a surgical cure is possible.
Pulmonary artery banding places a band-shaped material around the artery, reducing its size. This size reduction slows the amount of blood flowing through the artery. When blood overflows or flows too forcefully through an artery, it can cause problems with blood pressure, heart rate, or artery wall stability. Banding slows the flow to an acceptable amount and speed.
This procedure cannot be used with patients whose atrial arteries do not work well together for a variety of reasons. Most patients are pediatric and have either over-circulation and left-to-right shunting, or are pediatric patients with great artery transposition (reversal). In the case of transposition, the banding is used to start training the left ventricle before an arterial switch surgery is done.
In the majority of cases, pulmonary artery banding is left in place for a few weeks to a few months, after which corrective surgery occurs. While waiting to schedule corrective surgery, medical workers provide treatment for any infections, monitor patient weight, and record vital signs. The surgery is performed by a pediatric surgeon.
Patients with single ventricle defects are at an increased risk of developing complications from the banding. This risk increases if aortic lesions are also present. Ventricular hypertrophy can result from pulmonary banding in these cases, so pediatric surgeons proceed with caution when performing the banding. In many such cases, the banding is not done, and the surgery date is moved up.
