Diminution and closure of large ventricular septal defects after pulmonary artery banding

In a period of 15 years (1957-1972), 114 infants (51 males, 63 females) with the diagnosis of ventricular septal defect and congestive heart failure underwent pulmonary artery banding at The Children's Hospital Medical Center in Boston. A second study performed in 55 of these revealed the left-to-right shunt through the ventricular septal defect to be greatly diminished in seven and completely closed in three.

Pulmonary artery banding proved clinically beneficial to all patients restudied. Important hemodynamic changes, documented at the second study in all ten patients, included a significant decrease in left-to-right shunt and a drop in pulmonary arteriolar resistance to normal range. The right ventricular pressure, post banding, ranged from suprasystemic levels in those with muscular defects to half systemic levels in the majority of those with membranous defect.

The muscular ventricular septal defects closed by muscular tissue, the membranous defects by aneurysm formation at the "exit" of the left-to-right shunt on the right ventricular septal surface.

There is a surprisingly high closure rate (19%) in these large ventricular septal defects after pulmonary artery banding noted. Hemodynamic mechanisms to account for closure are proposed.

Experimental bacterial endocarditis in the pig

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Appraisal of surgical atrial septectomy for transposition of the great arteries

The results of surgical atrial septectomy alone, septectomy with pulmonary artery banding, and septectomy with shunting procedures in 105 patients are reported. There were 82 survivors with eight deaths directly related to surgery, seven related to specific preoperative complications, and eight resulting from associated cardiac malformations. Excellent improvement in arterial oxygen saturation was achieved and maintained over an extended period of time in the majority of survivors.

Although balloon septostomy has proved to be a helpful palliative maneuver in patients with TGA, 34 children who had this procedure later required surgical septectomy.

A late fall in arterial oxygen saturation was often indicative of diminishing pulmonary blood flow on the basis of increasing pulmonary stenosis or pulmonary vascular obstructive disease.

Ascending aorta-right pulmonary artery shunt in infants and older patients with certain types of cyanotic congenital heart disease

A side-to-side anastomosis between the ascending aorta and the right pulmonary artery was created in 80 infants (less than 1 year of age) and in 61 older children with a variety of cyanotic cardiac abnormalities in which there is pulmonary stenosis or atresia. Seventy-one per cent of the infant group and 90% of patients over 1 year of age were long-term survivors (up to 6 years).

Tetralogy of Fallot was the most commonly encountered anomaly in all 141 patients (66%); transposition of the great vessels and pulmonary stenosis occurred in 18%; and tricuspid atresia with pulmonary stenosis in 10%.

The presence of an excessively large shunt anastomosis (55% of deaths) and additional (unrecognized) other anomalies (26%) were major causes of postoperative deaths.

In patients in whom a systemic-pulmonary artery anastomosis is required, this operation is the procedure of choice in infants under 1 year of age. It is also of value in older patients if a Blalock-Taussig shunt cannot be performed.