Jaros Maria, Ohain Jelena Pabst von, Fischer Marcus, Haas Nikolaus Alexander
Kinderkardiologie und Pädiatrische Intensivmedizin, LMU Klinikum Abteilung für Kinderkardiologie und Pädiatrische Intensivmedizin, Munich, Germany.
Sektion für Chirurgie angeborener Herzfehler und Kinderherzchirurgie der Herzchirurgischen Klinik, Ludwig Maximilian University of Munich, Munchen, Bayern, Germany.
Thorac Cardiovasc Surg Rep. 2025 Jun 10;14(1):e19-e23. doi: 10.1055/a-2564-2280. eCollection 2025 Jan.
Cardiomyopathy is the leading indication for transplantation in children. Mechanical cardiac support systems play a significant role in treating severe pediatric heart failure for cardiomyoptahy or myocarditis either for recovery or as bridge to transplant. In most cases of chronic heart failure extending over the acute inflammatory phase transplantation is necessary. Organ shortage results in a necessity for further treatment options in terminal heart failure. A new and controversially discussed approach to treat failing (left) ventricles includes pulmonary banding; In some observational studies pulmonary artery banding was performed in patients with severe (left) heart failure and adequate function of the right ventricle. The effect is postulated by improving the contra-lateral (left) ventricular function with intraventricular cross-talk and subsequent myocardial changes. Whereas selected patients may however benefit from PA banding with subsequent training of the left ventricle, nevertheless this strategy is controversially discussed.
A 3-year-old girl with inflammatory myocarditis required left ventricular assist device (LVAD, Berlin Heart)) support. After repetitive weaning failure, pulmonary artery (PA) banding was performed during LVAD support that resulted in an improvement of the left ventricular function and finally LVAD explantation.
Selected patients may benefit from PA banding with subsequent training of the left ventricle even in the setting of LVAD.This case here is the first reported case where PA banding was successful in the weaning process of a child on mechanical circulatory support (MCS). This principle of pulmonary banding to improve left ventricular function in severe heart failure can apparently also be applied to patients on left ventricular assist devices (LVAD).
心肌病是儿童心脏移植的主要适应症。机械心脏支持系统在治疗因心肌病或心肌炎导致的严重小儿心力衰竭以促进恢复或作为移植桥梁方面发挥着重要作用。在大多数慢性心力衰竭病例中，超过急性炎症期就需要进行移植。器官短缺导致终末期心力衰竭需要更多的治疗选择。一种新的且存在争议的治疗衰竭（左）心室的方法包括肺动脉环扎术；在一些观察性研究中，对严重（左）心力衰竭且右心室功能正常的患者进行了肺动脉环扎术。其效果被认为是通过心室间相互作用和随后的心肌变化来改善对侧（左）心室功能。然而，尽管部分患者可能从肺动脉环扎术及随后的左心室训练中获益，但这种策略仍存在争议。
一名3岁患炎性心肌炎的女孩需要左心室辅助装置（LVAD，柏林心脏）支持。在多次撤机失败后，于LVAD支持期间进行了肺动脉（PA）环扎术，这导致左心室功能改善，最终成功撤除LVAD。
即使在使用LVAD的情况下，部分患者可能从肺动脉环扎术及随后的左心室训练中获益。此病例是首例报道的在机械循环支持（MCS）下肺动脉环扎术成功用于儿童撤机过程的病例。肺动脉环扎术改善严重心力衰竭患者左心室功能的这一原理显然也可应用于使用左心室辅助装置（LVAD）的患者。
