Efficacy of pulmonary artery banding in infants with complete atrioventricular canal.

Total correction in infants less than 1 year old with complete atrioventricular (AV) canal carries a significant operative mortality. However, past reports suggest that the alternative palliative procedure, pulmonary artery banding (PAB), may be contraindicated in the presence of severe mitral insufficiency and/or a large left ventricular to right atrial shunt. Contrary to these previous reports, we report the results in 21 consecutive patients with congestive heart failure who underwent PAB at a mean age of 3.9 +/- 2.8 months and at a weight of 3.6 +/- 0.9 kg. (17/21 less than 6 months). Regardless of mitral valve competency, PAB was performed in conjunction with ligation of a patent ductus arteriosus (11 patients) and coarctation repair (two patients) with one death secondary to gastrointestinal bleeding (4.7% in-hospital mortality); one patient required early band readjustment because of hypoxemia. Repeat cardiac catheterization in 10 patients performed 4 to 41 months after PAB showed significant reduction in pulmonary hypertension and flow with no change in pulmonary vascular resistance. All infants were symptomatically improved after PAB and four have undergone successful total correction. Previous reports since 1977 indicate a significantly higher risk for total repair of complete A V canal before 1 year of age (36/147, 24%) than the risk for PAB in this series (p less than .05). Therefore, we believe that PAB is a rational alternative to total repair as the initial surgical treatment for symptomatic infants with complete A V canal, particularly when anatomic variants known to increase operative risk are recognized before cardiotomy.