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

1. Anesthesia: General anesthesia is administered.
2. Incision: A small incision is made in the chest to access the heart.
3. Band Placement: A specialized band is placed around the pulmonary artery and adjusted to restrict blood flow to an appropriate level.
4. Monitoring: Blood flow and pressure are continuously monitored to ensure optimal band tightness.
5. 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.