Pulmonary Artery Banding

BANDING of the pulmonary artery has been proposed as a therapeutic procedure for patients with a large left-to-right shunt and pulmonary artery hypertension not amenable to complete correction. It was theorized that by increasing the resistance to outflow from the right ventricle, and thus lowering the pulmonary artery pressure, the size of the left-to-right shunt would diminish, the high output failure state would improve, and the pulmonary arterioles might be protected from developing progressive intimal changes. The original proposal by Muller and Dammann was reported in 1952,1 at a time when surgery with the pump oxygenator was not available. It had been assumed that, with the introduction of cardiopulmonary bypass, this palliative procedure would be outmoded and discarded, and all left-to-right shunts would be repaired in a one-step open-heart procedure.2 The experiences of the past few years have demonstrated, at least to us, that despite the technical progress, the pulmonary artery banding procedure is still applicable in patients who have a ventricular septal defect under these specific situations: (1) young infants with large left-to-right shunts and intractable congestive heart failure who are too small to be operated upon by means of cardiopulmonary bypass; (2) children with left-to-right shunts and severe obstructive pul-