161 PULMONARY ARTERY BANDING AS PRIMARY THERAPY FOR COMPLETE ATRIO-VENTRICULAR CANAL

Abstract

Due to the high mortality of early primary correction twenty-five children with complete atrio-ventricular canal less than one year of age have had pulmonary artery (PA) banding during the last twelve years. All patients had congestive heart failure with PA pressure equal to systemic, and a large ventricular septal defect on angiography. Banding was performed at 7 weeks to 11 months of age. Nineteen were less than 6 months of age at surgery. Seventeen of 25 had Trisomy 21.

Early mortality (under 30 days) was 20% and total mortality 40% for the series. Three of the older survivors have had open correction, two successfully. Since 1973 there has been 92% early survival (11/12) and 83% total survival. During this period PA and aortic pressures have been measured post-banding in the operating room with PA pressure aimed at 50% of systemic. Banding has been performed without regard to the angiographic degree of mitral regurgitation (MR). Six of 9 patients without MR have survived, but 6 of 9 with moderate or severe MR have also survived. Degree of MR also failed to correlate with age of presentation.

Pulmonary artery banding is effective palliation for infants with congestive heart failure due to complete atrio-ventricular canal when a large ventricular component causes systemic PA pressure. Intraoperative pressure measurements are useful to determine the gradient from banding. Mitral regurgitation was not a factor in the success of banding.

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