Background and Goal of Study: Bilateral pulmonary artery banding (PAB) is used to treat congenital heart disease in some high-risk neonates. Until recently, the appropriate PAB size depended on pulmonary artery pressures, partial pressure of oxygen in the arterial blood (PaO2), and stable hemodynamics. However, high reoperation rates exist due to insufficient or excessive restriction of pulmonary blood flow. Doppler echocardiography is effective in quantitatively evaluating pulmonary blood flow. We hypothesized that the pulmonary venous velocity time integral (PV-VTI) in transesophageal echocardiography (TEE) during bilateral PAB surgery can predict the need for reoperation.

Methods: From January 2011 to September 2016, 22 patients with congenital heart diseases underwent bilateral PAB at our hospital. We investigated PV-VTI before PAB (pre-VTI) and after PAB (post-VTI) from the intraoperative TEE record. The primary outcome was reoperation within 3 months after the initial PAB surgery. Patients who underwent reoperation due to excessive pulmonary blood flow restriction were in the debanding group. Patients who underwent reoperation due to insufficient pulmonary blood flow restriction were in the rebanding group. We compared the two groups to a no-reoperation group. We retrospectively examined the association between the PV-VTI ratio (post VTI / pre VTI) and incidence of reoperation. Continuous variables were evaluated using the Student’s t-test, and categorical variables were evaluated using Fisher’s exact test for statistical analysis. P < 0.05 was considered statistically significant.

Results and Discussion: In the no-reoperation group, the pre-VTI was 64.7 ± 22.3 cm, and the post-VTI was 36.5 ± 10.7 cm. In the debanding group, the pre-VTI was 70.0 ± 20.4 cm, and the post-VTI was 29.7 ± 10.7 cm. In the rebanding group, the pre-VTI was 60.5 ± 23.9 cm, and the post-VTI was 46.1 ± 12.5 cm. In the debanding group, the PV-VTI ratio was significantly reduced (debanding [0.41 ± 0.07] vs. no-reoperation [0.57 ± 0.12], p = 0.01). In the rebanding group, the PV-VTI ratio showed a tendency to increase (rebanding [0.78 ± 0.10] vs. no-reoperation [0.57 ± 0.12], p = 0.05). This study suggests that the PV-VTI ratio may be useful to determine the optimal PAB size in bilateral PAB surgery.

Conclusions: Intraoperative Doppler echocardiographic PV-VTI ratios using TEE during bilateral PAB surgery, is effective in predicting the need for reoperation.


05 / Intraoperative Doppler echocardiography of pulmonary venous flow is useful in predicting reoperation in pulmonary artery banding