Pediatric Cardiology and Cardiac Surgery
Vol.25 No.1 2009 (39-44)
Takako Nishino, 1) Shunji Uchita, 1) Kiyohiro Takigiku, 2) Satoshi Yasukochi, 2) Gengi Satomi, and 2) and Yorikazu Harada1)
Departments of 1)Cardiovascular Surgery, and 2)Cardiology, Nagano Chirdren’s Hospital, Nagano, Japan
Background: In recent years, there have been an increasing number of reports on bilateral pulmonary artery banding (bPAB) as the first-stage operation for hypoplastic left heart syndrome (HLHS). In our institute, bPAB has been performed as the first-stage procedure for HLHS patients since 2003. In this paper, we report our experience and problems in patients who underwent this procedure.
Methods: bPAB was performed on 9 infants with HLHS as the first-stage operation, and balloon atrial septostomy (BAS) was performed to keep interatrial communication open. Prostaglandin E1 was administrated to maintain ductal patency. We performed reconstruction of the aortic arch (Norwood procedure) and bidirectional Glenn procedure (N + G) for the second-stage operation, and total cavo-pulmonary connection (TCPC) for the final-stage operation.
Results: All patients survived the postoperative period and completed N + G, and 4 patients completed TCPC. Between bPAB and N + G, 2 of the 9 patients required stent implantation of the arterial duct, and after N + G, 4 patients had pulmonary artery occlusion and stenosis requiring catheterization or surgical intervention.
Conclusions: Our results suggest that bPAB was a good option for the surgical treatment of HLHS. However, the complications of pulmonary artery occlusion and stenosis after stent implantation indicate that it is necessary to discuss further the procedure of aortic arch reconstruction and pulmonary arterioplasty.