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Pulmonary Artery Banding in Post-tricuspid Congenital Cardiac Shunting Defects with High Pulmonary Vascular Resistance

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Abstract

Reports of “treat and repair” of cardiac shunting lesions with inoperably high pulmonary vascular resistance (PVR) mostly concern pre-tricuspid defects; post-tricuspid lesions are different. We report our experience with pulmonary artery (PA) banding ± targeted pulmonary hypertension medications in five patients with a large VSD and inoperably high PVR, and review previous reports of PA banding with post-tricuspid defects. Three of our 5 patients had mean PAP > 50 mmHg after banding and no or only a transient fall in PVR. Two patients had mean PAP < 50 mmHg and lower PVR after banding; they had closure of their VSDs but have since had a progressive increase in PVR (follow-up after closure, 3.5 and 7.7 years). Previous reports have also documented difficulty in achieving sufficient band gradient. Of previously reported patients, only one became operable only after banding and targeted therapy, and was repaired; follow-up after repair was short-term (16 months). Our and previous experience demonstrate the difficulty in placing a PA band sufficiently tight to substantially reduce PA pressure. Reported attempts to “treat and repair” post-tricuspid defects are few and have met with limited success, and we found that PVR may increase significantly over time after repair. But more information is needed. Accurate interpretation of experience with “treat and repair” requires: careful characterization of the pulmonary circulation prior to “treating”; considering spontaneously reversible factors at pre-treatment catheterization before ascribing reduction in PVR to medical therapy; and long-term observation of PVR in patients who have had defect closure.

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References

  1. Dammann JF Jr, Mc EJ, Thompson WM Jr, Smith R, Muller WH Jr (1961) The regression of pulmonary vascular disease after the creation of pulmonary stenosis. J Thorac Cardiovasc Surg 42:722–734

    PubMed  Google Scholar 

  2. Beghetti M, Galie N, Bonnet D (2012) Can “inoperable” congenital heart defects become operable in patients with pulmonary arterial hypertension? Dream or reality? Congenit Heart Dis 7(1):3–11. https://doi.org/10.1111/j.1747-0803.2011.00611.x

    Article  PubMed  Google Scholar 

  3. Therrien J, Rambihar S, Newman B, Siminovitch K, Langleben D, Webb G, Granton J (2006) Eisenmenger syndrome and atrial septal defect: nature or nurture? Can J Cardiol 22(13):1133–1136

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bradley EA, Chakinala M, Billadello JJ (2013) Usefulness of medical therapy for pulmonary hypertension and delayed atrial septal defect closure. Am J Cardiol 112(9):1471–1476. https://doi.org/10.1016/j.amjcard.2013.07.027

    Article  PubMed  Google Scholar 

  5. Kijima Y, Akagi T, Takaya Y, Akagi S, Nakagawa K, Kusano K, Sano S, Ito H (2016) Treat and repair strategy in patients with atrial septal defect and significant pulmonary arterial hypertension. Circ J 80(1):227–234. https://doi.org/10.1253/circj.CJ-15-0599

    Article  CAS  PubMed  Google Scholar 

  6. Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, Hanna BD, Rosenzweig EB, Raj JU, Cornfield D, Stenmark KR, Steinhorn R, Thebaud B, Fineman JR, Kuehne T, Feinstein JA, Friedberg MK, Earing M, Barst RJ, Keller RL, Kinsella JP, Mullen M, Deterding R, Kulik T, Mallory G, Humpl T, Wessel DL, American Heart Association Council on Cardiopulmonary CCP, Resuscitation, Council on Clinical C, Council on Cardiovascular Disease in the Y, Council on Cardiovascular R, Intervention, Council on Cardiovascular S, Anesthesia, the American Thoracic S (2015) Pediatric pulmonary hypertension: guidelines from the american heart association and american thoracic society. Circulation 132(21):2037–2099. https://doi.org/10.1161/CIR.0000000000000329

  7. Hunt CE, Formanek G, Levine MA, Castaneda A, Moller JH (1971) Banding of the pulmonary artery. Results in 111 children. Circulation 43(3):395–406

    Article  CAS  PubMed  Google Scholar 

  8. Mocellin R, Buhlmeyer K (1975) Late banding operation in children with ventricular septal defect and pulmonary arterial hypertension. Eur J Cardiol 3(3):205–211

    CAS  PubMed  Google Scholar 

  9. Wagenvoort CA, Wagenvoort N, Draulans-Noe Y (1984) Reversibility of plexogenic pulmonary arteriopathy following banding of the pulmonary artery. J Thorac Cardiovasc Surg 87(6):876–886

    CAS  PubMed  Google Scholar 

  10. Khan SA, Gelb BD, Nguyen KH (2006) Evaluation of pulmonary artery banding in the setting of ventricular septal defects and severely elevated pulmonary vascular resistance. Congenit Heart Dis 1(5):244–250. https://doi.org/10.1111/j.1747-0803.2006.00043.x

    Article  PubMed  Google Scholar 

  11. Yamaki S, Yonesaka S, Suzuki S, Nagumo K, Ouchi K, Takahashi T (1999) Progressive pulmonary vascular disease after pulmonary artery banding and total correction in a case of ventricular septal defect and pulmonary hypertension. Japan J Thorac Cardiovasc Surg 47(5):229–233

    Article  CAS  Google Scholar 

  12. Mitropoulos FA, Apostolopoulou SC, Kanakis MA, Rammos S, Anagnostopoulos CE (2007) Bosentan treatment in an adult with pulmonary hypertension due to patent ductus arteriosus permits surgical repair. J Heart Lung Transplant 26(12):1345–1346. https://doi.org/10.1016/j.healun.2007.09.001

    Article  PubMed  Google Scholar 

  13. Ussia GP, Mule M, Caruso E, Aiello R, Tamburino C (2007) Combined endothelin receptor antagonist and transcatheter interventional therapy of patent ductus arteriosus with severe pulmonary artery hypertension. Int J Cardiol 116(3):427–429. https://doi.org/10.1016/j.ijcard.2006.03.080

    Article  PubMed  Google Scholar 

  14. Kameny RJ, Colglazier E, Nawaytou H, Moore P, Reddy VM, Teitel D, Fineman JR (2017) Pushing the envelope: a treat and repair strategy for patients with advanced pulmonary hypertension associated with congenital heart disease. Pulm Circ 7(3):747–751. https://doi.org/10.1177/2045893217726086

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kulik TJ (2014) Pulmonary hypertension caused by pulmonary venous hypertension. Pulm Circ 4(4):581–595. https://doi.org/10.1086/678471

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wood P (1958) The Eisenmenger syndrome or pulmonary hypertension with reversed central shunt. Br Med J 2(5099):755–762

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Hoffman JI, Rudolph AM (1965) The natural history of ventricular septal defects in infancy. Am J Cardiol 16(5):634–653

    Article  CAS  PubMed  Google Scholar 

  18. Keith JD, Rose V, Collins G, Kidd BS (1971) Ventricular septal defect. Incidence, morbidity, and mortality in various age groups. Br Heart J 33:Suppl:81–87

    Article  PubMed Central  Google Scholar 

  19. Collins G, Calder L, Rose V, Kidd L, Keith J (1972) Ventricular septal defect: clinical and hemodynamic changes in the first five years of life. Am Heart J 84(5):695–705

    Article  CAS  PubMed  Google Scholar 

  20. Weidman WH, Blount SG Jr, DuShane JW, Gersony WM, Hayes CJ, Nadas AS (1977) Clinical course in ventricular septal defect. Circulation 56(1 Suppl):I56–I69

    CAS  PubMed  Google Scholar 

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Acknowledgements

We acknowledge the expert assistance of Lynne Patkin, MBA, in aiding with preparation of this manuscript.

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Authors and Affiliations

  1. Division of Cardiac Critical Care, and the Pulmonary Hypertension Program, Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115, USA

    Thomas J. Kulik & Mary P. Mullen

  2. Harvard Medical School, Boston, MA, USA

    Thomas J. Kulik & Mary P. Mullen

  3. Cardiovascular Nursing Patient Services, Boston Children’s Hospital, Boston, MA, USA

    Julia E. McSweeney

  4. Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA

    Joseph Tella

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  1. Thomas J. Kulik
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  2. Julia E. McSweeney
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  3. Joseph Tella
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  4. Mary P. Mullen
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Correspondence to Thomas J. Kulik.

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Conflict of interest

T.J. Kulik, J.E. McSweeney, J. Tella, and M.P. Mullen declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This limited case-series study meets criteria for waver by the Institutional Review Board of Boston Children’s Hospital.

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Kulik, T.J., McSweeney, J.E., Tella, J. et al. Pulmonary Artery Banding in Post-tricuspid Congenital Cardiac Shunting Defects with High Pulmonary Vascular Resistance. Pediatr Cardiol 40, 719–725 (2019). https://doi.org/10.1007/s00246-019-02054-x

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  • DOI: https://doi.org/10.1007/s00246-019-02054-x

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