Dottorato in FISIOPATOLOGIA ED IMAGING CARDIO-TORACO-VASCOLARE

Titolo della tesi: Pulmonary Artery Banding and Atrioventricular Valve regurgitation in Patients with Single and Biventricular Morphology

Introduction: Muller and Dammann described pulmonary artery banding(PAB) for palliation of congenital heart disease(CHD) with pulmonary hypertension (PAH) secondary to increased pulmonary blood flow in 1952, a time when intra cardiac repair was virtually nonexistent. When it did come about, PAB continued to occupy an important place in the surgical treatment of CHD, due to the increased risk of cardiopulmonary bypass (CPB) in the very young infant. The purpose of PAB is to protect the lungs from unrestricted pulmonary flow while allowing corrective surgery to be postponed to a safer future when the cardiac structures of the child was bigger. The most common disease that needs to PAB procedure is Ventricular septal defect (VSD). After VSD, the Atrioventricular (AV) canal and VSD+ Coarctation of the aorta (CoA) and some type of Transposition of the Great Arteries (TGA) also are candidates. single ventricle physiology patients need at some points pulmonary artery banding to protect the pulmonary vascular bed. Methods: All children who underwent PAB at a Prince Sultan Cardiac Center in Qassim between January 2010 and November 2021 were included in the study. The male to female ratio was 1:1, The mean age and weight for or all patients is (92 ± 68) days and (3.4 ± 1) respectively. Trisomy was diagnosed in 50 % of patients. Results: The biventricular repair was aimed in 98 patients (76.5 %), while single ventricle repair was aimed in 29 patients (22%), one and a half repair in one (0.7%). The age at PAB was lower in single ventricle than biventricular pathology 86.66 days ± 13 and 143 days ± 19 ( p-value 0.018) respectively. Comparison between Patients with significant AV valve regurge (Moderate or more), and those with insignificant regurge (Mild or no regurge) revealed no statistically significant difference. The effect of PAB on the AVV regurgitation in single and biventricular groups is variable. Conclusion: Pulmonary artery banding is an old palliative procedure that continues to have a role in the management of pediatric cardiac surgery patients. It can be done with low morbidity and mortality rate. The effect of pulmonary artery banding on the atrioventricular valve regurgitation in both single and biventricular pathologies is variable, where mild insignificant regurgitation can become moderate or severe and vice versa.