Banding of pulmonary artery
CPT4 code
Name of the Procedure:
Banding of Pulmonary Artery
Common Names: Pulmonary Artery Banding (PAB)
Summary
Banding of the pulmonary artery is a surgical procedure aimed at reducing blood flow to the lungs. This procedure involves placing a band around the pulmonary artery, partially restricting blood flow to decrease the pressure in the lungs.
Purpose
Medical Condition:
- Congenital heart defects such as ventricular septal defect (VSD) or transposition of the great arteries (TGA) which cause excessive blood flow to the lungs. ##### Goals:
- To alleviate symptoms caused by high pulmonary pressure.
- To protect the lungs from damage due to over-circulation.
- To stabilize the patient until they are suitable for corrective surgery.
Indications
- Symptoms of congestive heart failure in infants caused by congenital heart defects.
- Signs of pulmonary hypertension and excess blood flow to the lungs.
- Patients not yet ready or stable for complete corrective surgery.
Preparation
- Fasting for 8 hours before the procedure.
- Discontinuation or adjustment of certain medications as advised by the healthcare provider.
- Pre-procedure evaluations such as echocardiogram, chest X-ray, and possibly cardiac catheterization.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: A small incision is made in the chest to access the heart.
- Band Placement: A specialized band is placed around the pulmonary artery and adjusted to restrict blood flow to an appropriate level.
- Monitoring: Blood flow and pressure are continuously monitored to ensure optimal band tightness.
- Closure: The incision in the chest is closed once the band is properly positioned.
Duration
The procedure typically takes about 2 to 4 hours.
Setting
- Performed in a hospital's operating room.
Personnel
- Surgeons: Perform the procedure.
- Anesthesiologists: Administer anesthesia and monitor the patient’s vital signs.
- Nurses: Assist in the procedure and provide perioperative care.
Risks and Complications
- Common risks: Bleeding, infection, and arrhythmias.
- Rare risks: Band migration, residual pulmonary hypertension, or low oxygen levels post-operation.
- Possible complications: Manageable with medications or adjustments during and after the procedure.
Benefits
- Immediate reduction in pulmonary pressure.
- Protection of lung tissue from damage due to high blood pressure.
- Stabilization of the patient's condition, especially in young infants, allowing more time for growth or until further corrective procedures can be performed.
Recovery
- Post-procedure: Close monitoring in the ICU.
- Recovery time: Varies but typically involves several days in the hospital.
- Restrictions: Limited physical activities initially; specific instructions provided upon discharge.
- Follow-up: Regular follow-up appointments to monitor heart function and the effectiveness of the band.
Alternatives
- Medications to manage symptoms of heart failure (less effective for severe cases).
- Early complete corrective surgery (in some cases, not feasible due to patient instability or size).
Patient Experience
- During: The patient will be under general anesthesia and will not feel anything during the procedure.
- After: Some discomfort or pain at the incision site, managed with pain medications.
- Recovery: Close monitoring of heart and lung function; care instructions provided to aid in recovery and minimize complications.