Pulmonary Artery Banding (PAB)

Date
August 20, 2025
URL
https://x.com/WithAScalpel/status/1958148133684179433
Categories
Single VentricleAVSDVSDIntensive Care

Pulmonary Artery Banding (PAB)

Pulmonary artery banding (PAB) is a palliative surgical technique designed to reduce pulmonary overcirculation in congenital heart disease. By placing a constrictive band around the main pulmonary artery, pulmonary blood flow is restricted, lowering left-sided volume load and protecting the pulmonary vasculature from long-term injury [1]. Although historically widespread, modern use is selective and often interim, tailored to lesion complexity and institutional pathways [2].

Objectives of PAB

  • Reduce pulmonary overcirculation and alleviate heart-failure symptoms.
  • Protect the pulmonary vasculature from irreversible pressure/flow-mediated injury.
  • Preserve LV geometry and function by limiting volume overload.
  • Provide time for growth or optimization until definitive repair is feasible [1].

Indications

PAB is most often considered in infants with:

  • Large VSD with intractable pulmonary overcirculation.
  • AVSD with excessive pulmonary blood flow.
  • Selected single-ventricle pathways, as staged palliation to balance Qp and Qs [1,2].

Calibration & Targets (practical)

  • For biventricular hearts, many programs target a distal PA pressure ≈30–50% of systemic during band calibration (with attention to saturations, perfusion, and ventricular loading) [3].
  • In single-ventricle pathways, the goal is balanced circulations rather than a fixed pressure ratio; programs individualize targets to achieve acceptable systemic perfusion with controlled Qp (often accepting lower saturations, with plans for early cavopulmonary connection when indicated) [8].
  • Achieving “optimal tightness” is inherently challenging and demands integration of hemodynamics, saturations, ventricular performance, and postoperative trajectory [7].

Contraindications and Limitations

PAB is not suitable when it cannot correct the pathophysiology or would worsen it:

  • Fixed PH (irreversible PVR elevation).
  • Peripheral PA stenosis (distal resistance unchanged).
  • Significant PR (can aggravate retrograde flow).
  • LVOTO (risk of double obstruction).
  • Severe AVVR (afterload increase may amplify regurgitation and impede forward flow). These pitfalls underline the importance of lesion-specific planning and intraoperative assessment [3,4].

Complications

  • Band malposition/migration; over-banding → cyanosis/inadequate PBF; under-banding → persistent overcirculation.
  • PA distortion/branch stenosis and flow turbulence; ventricular hypertrophy with prolonged excessive afterload [4,7].

Technique & Devices (current options)

  • Conventional non-adjustable bands remain common; however, telemetrically controlled adjustable PAB and dilatable PAB systems allow stepwise, catheter-based or remote adjustments, potentially reducing reoperation and improving hemodynamic titration during growth or staged palliation [5,6].
  • In functionally single-ventricle neonates, strategies using tighter initial banding followed by early bidirectional Glenn have shown improved outcomes in selected cohorts, emphasizing protocolized follow-up and timely stage advancement [8].
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References

[1] P. Agasthi, J. Graziano. Pulmonary Artery Banding. 2020.

[2] P. Devlin, A. Jegatheeswaran, B. McCrindle, T. Karamlou, E. et al. Pulmonary artery banding in complete atrioventricular septal defect. Journal of Thoracic and Cardiovascular Surgery. 2020. doi:10.1016/j.jtcvs.2019.09.019.

[3] Rajesh Sharma. Pulmonary artery banding: Rationale and possible indications. Annals of Pediatric Cardiology. 2012. doi:10.4103/0974-2069.93709.

[4] E. Angeli, C. Pace Napoleone, S. Turci, G. Oppido, G. Gargiulo. Pulmonary artery banding. Multimedia Manual of Cardio-Thoracic Surgery. 2012. doi:10.1093/mmcts/mms010.

[5] Antonio F. Corno. Pulmonary artery banding. Swiss Medical Weekly. 2005. doi:10.4414/smw.2005.11081.

[6] R. A. Ligon, L. Latson, M. Ruzmetov, K-C. Chan, I. et al. Dilatable Pulmonary Artery Banding Palliation… World Journal for Pediatric & Congenital Heart Surgery. 2021. doi:10.1177/2150135120975763.

[7] A. S. Valente, F. Mesquita, J. Mejia, I. C. Leite et al. Pulmonary artery banding: a simple procedure? critical analysis in a tertiary center. Rev Bras Cir Cardiovasc. 2009.

[8] N. Kajihara, T. Asou, Y. Takeda, Y. Kosaka, Y. Onakatomi, et al. Pulmonary artery banding for functionally single ventricle: tighter neonatal banding with early BDG. Annals of Thoracic Surgery. 2010. doi:10.1016/j.athoracsur.2009.09.027.