Pulmonary Atrial Banding in Babies with Large Ventricular Septal Defects

IN 1952 Muller and Dammann showed that the production of pulmonary stenosis in an infant seriously ill from large ventricular septal defect resulted in palliation of many of the symptoms.' Civin and Edwards2 had a few years earlier suggested that this might be the case, reasoning from their observations of the life history and pulmonary vasculature of individuals with large ventricular septal defect and moderate pulmonary stenosis. The important paper by Hunt and his colleagues in this issue of Circulation of the results of this procedure from the University of Minnesota documents in a valuable way the benefits from pulmonary artery banding. The large experience from Great Ormond Street Hospital in London has recently been published by Stark and associates.3 Some restrained enthusiasm for the procedure is in evidence in both papers, and I should like to comment on this specifically with regard to babies with large ventricular septal defect. In such individuals hospital mortality was less than 5% in both series. However, obviously intensive postoperative care is required, including often tracheostomy and respiratory assistance. This suggests that the procedure, although surgically simple, requires great expertise and is not suitable for use in institutions without this expertise. Occasionally ventricular septal defects close