Takei Tetsuri, Kaneko Yukihiro, Kondo Ryoichi, Morisaki Naho, Achiwa Ikuya
Division of Cardiovascular Surgery, National Center for Child Health and Development, Tokyo, Japan.
Kitatama Hospital, 4-1-1, Chofugaoka, Chofu, Tokyo, 182-0021, Japan.
Gen Thorac Cardiovasc Surg. 2025 May 14. doi: 10.1007/s11748-025-02156-9.
We aimed to establish the most predictive echocardiographic indicator of appropriate tightness of bilateral pulmonary artery banding (BPAB).
In part A of the study, we retrospectively analyzed the peak flow velocity (PV) and nadir flow velocity (NV) across the band and the ratio of NV to PV (velocity ratio: VR) to determine appropriate band tightness. In part B, we prospectively studied the utility of the best predictive indicators.
Thirty-one patients undergoing BPAB were enrolled in part A and identified as having appropriate pulmonary blood flow (APF), high pulmonary blood flow (HPF), or low pulmonary blood flow (LPF) during the postoperative period. The areas under the receiver operating characteristic curve (AUC) for HPF were 0.92 for PV, 0.99 for NV, and 0.99 for VR; the velocity thresholds were 2.47, 1.15, and 0.45 m/sec, respectively. For LPF, the AUCs were 0.63 for PV, 0.78 for NV, and 0.81 for VR, and the velocity thresholds were 2.70, 1.59, and 0.58 m/sec, respectively; thus, VR best indicated band tightness. In part B, we performed BPAB in 34 patients, adjusting the bands to achieve VRs between 0.45 and 0.58. The prevalence of HPF was significantly lower in part B than in part A, whereas those of LPF did not differ.
In BPAB, we consider the optimal range of VR at banding site is between 0.45 and 0.58.
我们旨在确定最能预测双侧肺动脉束带术（BPAB）合适松紧度的超声心动图指标。
在研究的A部分，我们回顾性分析了束带处的峰值流速（PV）和最低流速（NV）以及NV与PV的比值（流速比值：VR），以确定合适的束带松紧度。在B部分，我们前瞻性地研究了最佳预测指标的效用。
A部分纳入了31例行BPAB的患者，术后确定为有合适肺血流量（APF）、高肺血流量（HPF）或低肺血流量（LPF）。HPF的受试者操作特征曲线下面积（AUC），PV为0.92，NV为0.99，VR为0.99；流速阈值分别为2.47、1.15和0.45米/秒。对于LPF，AUC，PV为0.63，NV为0.78，VR为0.81，流速阈值分别为2.70、1.59和0.58米/秒；因此，VR最能表明束带松紧度。在B部分，我们对34例患者进行了BPAB，调整束带使VR在0.45至0.58之间。B部分HPF的发生率显著低于A部分，而LPF的发生率无差异。
在BPAB中，我们认为束带部位VR的最佳范围在0.45至0.58之间。
