A staged expanding pulmonary artery band

Interleukin 22 and its association with neurodegenerative disease activity

It is worth noting that neuroinflammation is well recognized as a symptom of neurodegenerative diseases (NDs). The regulation of neuroinflammation becomes an attractive focus for innovative ND treatment technologies. There is evidence that IL-22 is associated with the development and progression of a wide assortment of NDs. For example, IL-22 can activate glial cells, causing them to generate pro-inflammatory cytokines and encourage lymphocyte infiltration in the brain. IL-22 mRNA is highly expressed in Alzheimer’s disease (AD) patients, and a high expression of IL-22 has also been detected in the brains of patients with other NDs. We examine the role of IL-22 in the development and treatment of NDs in this review, and we believe that IL-22 has therapeutic potential in these diseases.

Expandable Valves, Annuloplasty Rings, Shunts, and Bands for Growing Children

In congenital heart surgery, the surgeon must constantly consider how a palliative or corrective procedure could be impacted by the child's somatic growth. Within pediatric valve surgery, existing valve repair techniques lack growth-accommodating prostheses. Valve replacement options are fixed in size and unable to grow with the child, thus subjecting children to repeated valve reoperations. When creating a systemic-to-pulmonary artery shunt, replacing a branch pulmonary artery or conduit, creating an extracardiac Fontan pathway, or banding the pulmonary artery, the implant size must factor in both the child's current size and his or her anticipated growth. A variety of growth-accommodating technologies have been developed to fill this unmet need. Some devices have reached the clinical arena, while several are in preclinical development. The purpose of this review is to characterize the clinical need for growing device technology, and then review established and developing technologies for growth accommodation in congenital heart surgery.

A new technique of percutaneously adjustable pulmonary artery banding

OBJECTIVE

Pulmonary artery banding is associated with a high morbidity and mortality. We describe a new technique of adjustable pulmonary artery banding to prevent these problems.

METHODS

Between December 2003 and May 2005, 32 patients aged 18 days to 2 years (mean age, 2.5 +/- 0.5 months) and weighing 2.1 to 6.3 kg (mean, 3.6 +/- 1.3 kg) underwent adjustable pulmonary artery banding.

RESULTS

All patients survived the operation. There were 2 deaths, one caused by meningitis and another caused by aspiration pneumonitis. Satisfactory band gradients were achieved between 3 and 10 days (7.2 +/- 2.6 days) in 3 to 6 sittings. Mean follow-up was 7.5 +/- 3.8 months (1-16 months). One patient required reoperation for unsatisfactory band gradient 2 weeks after discharge. There were no late deaths. Follow-up computed tomographic angiograms (n = 4) demonstrated proper band placement and ruled out distortion of the pulmonary arteries. Four patients underwent uneventful definitive operations after an interval of 7 to 13 months.

CONCLUSION

This technique of percutaneously adjustable pulmonary artery banding is simple and inexpensive and allows easy band adjustments without the need for multiple reoperations.

Remote control of pulmonary blood flow: initial clinical experience

OBJECTIVE

After positive experimental results were obtained with the FloWatch-R-PAB (EndoArt S.A., Lausanne, Switzerland), an implantable device for pulmonary artery banding with telemetric control, it was tested in a prospective, multicenter clinical trial.

METHODS

From June to September 2002, 6 patients with a mean age of 10.6 months (1-31 months) and a mean weight of 6.5 kg (3.5-11 kg) underwent pulmonary artery banding with the implantation of the FloWatch-R-PAB device through median sternotomy (4 patients) or left thoracotomy (2 patients). The diagnoses were the following: univentricular heart (2 patients), complete atrioventricular septal defect (2 patients), ventricular septal defect (1 patient), and multiple ventricular septal defects with double aortic arch (1 patient). The associated procedures were atrioseptostomy with cardiopulmonary bypass (2 patients), closure of patent ductus arteriosus (2 patients), and division of double aortic arch (1 patient).

RESULTS

In a mean follow-up of 7 months (6-9 months), there were no early or late deaths, reoperations, or device-related complications. A mean of 5 regulations per patient (range 2-14) were required to adjust the tightening of the pulmonary artery banding, 50% (15/30) within the first postoperative week, 20% (6/30) during the second week, and 30% (9/30) within 8 months after surgery. In 70% (21/30) of the cases, the regulation was required to further narrow the pulmonary artery, and in 30% (9/30) of the cases, the regulation was required to release the pulmonary artery.

CONCLUSIONS

The initial trial confirmed the adequate functioning of the FloWatch-R-PAB device as telemetrically adjustable pulmonary artery banding. Repeated pulmonary artery banding adjustments, dictated by the clinical need in all patients even weeks after surgery, were accomplished without need for reoperation or invasive procedures. In children requiring pulmonary artery banding, the therapeutic strategies can be expanded by this promising technology. This device should be particularly indicated in patients with transposition of the great arteries requiring left ventricular retraining.

The Southern Thoracic Surgical Association 50th anniversary celebration: the impact of STSA pediatric cardiothoracic surgery manuscripts on surgical practice

BACKGROUND

Members of the Southern Thoracic Surgical Association (STSA) have presented important pediatric cardiothoracic surgery papers at the annual meetings over the last 50 years. In order to determine the influence of these presentations on the practice of surgery, a review was undertaken. Early papers were characterized by emerging advances in open-heart surgery, anatomic congenital heart studies, and electrophysiologic discoveries that extended life with pacemakers. Later years were characterized by innovative myocardial preservation methods, improved cardiopulmonary bypass techniques, expanded homograft availability, emphasis on accurate repairs, intraoperative transesophageal echocardiography, and cardiopulmonary transplantation.

METHODS

All but one of the scientific programs of the annual meetings (that of 1964) were located. The programs were reviewed and 180 presentations were identified on topics in congenital heart disease, pediatric thoracic disease, and pediatric thoracic wall abnormalities. Of those 180 oral presentations, 155 manuscripts (86%) were eventually published or in press and available for critical review and analysis. Manuscripts were grouped by diagnosis or therapeutic intervention. We determined a "cumulative citation frequency" (CCF), which measures the number of times an article is cited in the bibliography of related papers in the universe of participating journals. The selected manuscripts were compared with the historic landmark contributions and the existing trends at the time, and the number of articles both by individual authors and from institutions were tallied.

RESULTS

Grouping by authors and institutions showed that 100 of 155 pediatric cardiothoracic manuscripts (65%) originated from 13 institutions. The CCF for the 20 leading articles ranged from 26 to 93.

CONCLUSIONS

This historical STSA 50-year record of pediatric cardiothoracic advances was accomplished in a milieu of collegial respect and camaraderie. Our annual meetings over the years have provided a venue for thoracic surgeons to share their ideas, innovations, and scientific inquiry. These contributions have significantly affected the practice of pediatric cardiothoracic surgery. The STSA has worked for 50 years and we trust that it will work for another 50 years and beyond.

Dilatable banding of a Blalock-Taussig shunt

Dilatable banding has been used in various situations. Sometimes Blalock-Taussig shunt banding is performed to prevent pulmonary overcirculation. Recently several reports have described dilatable pulmonary artery banding. We modified these methods for flow control of a Blalock-Taussig shunt. We report the case of a neonate with truncus arteriosus in which this technique was used.

A new strategy for the surgical treatment of aortic coarctation associated with ventricular septal defect in infants using an absorbable pulmonary artery band

OBJECTIVES

We propose a new strategy using coarctation repair together with a polidioxanone absorbable pulmonary artery banding to limit operative risk and to spare infants with aortic coarctation subsequent operations.

BACKGROUND

The alternative for the surgical management of aortic coarctation associated with ventricular septal defect (VSD) is single-stage repair versus coarctation repair with or without banding of the pulmonary artery.

METHODS

Eleven infants (mean weight 2,560 +/- 1,750 g, range 1,320 to 3,800 g) underwent a coarctation repair with a polydioxanone banding. Seven had a trabecular and four a perimembranous VSD. The mean size of the VSD was 5 +/- 0.7 mm (range 4 to 7 mm). The systolic pulmonary pressure was >80% of the aortic pressure in all. The pulmonary band was tightened until the systolic pulmonary pressure fell below 50% of the aortic pressure.

RESULTS

There were no hospital deaths. The reabsorption of the banding was complete after 5.7 months in all patients (3 to 6.5 months). The VSD closed completely in four infants and partially in six, in whom the pulmonary artery pressure was normal without evidence for significant left-to-right shunt. One patient with a large trabecular VSD underwent surgical closure of his defect after four months. Finally, a subsequent open-heart surgery could be avoided in 91% (10/11) of patients.

CONCLUSIONS

Provided the VSD belongs to types prone to close spontaneously, this policy may reduce the number of surgical procedures per infant as well as in-hospital mortality and morbidity rates. It should be proposed as an alternative to more complex procedures.

Banding of the pulmonary trunk in preparation for a Fontan operation

Banding of the pulmonary trunk is an important surgical procedure for patients who have congenital cardiac malformations with unrestricted pulmonary flow. We propose a new concept for determining in such circumstances the most appropriate length of the band used to constrict the pulmonary trunk in preparation for a Fontan operation. We studied 14 patients undergoing banding of the pulmonary trunk and measured the following parameters: diameter of aorta, diameter of pulmonary trunk, length of pulmonary arterial band and maximum flow velocity across the banded segment. We calculated an index from our original parameter based on the formula; length of band/(diameter of aorta diameter of pulmonary trunk). The diameter of aorta was 9.5 +/- 1.4 mm, and that of the pulmonary trunk was 9.6 +/- 2.3 mm. The length of the band was 16.5 +/- 3.4 mm, giving a calculated index of 0.188 +/- 0.038. The maximum flow velocity was 4.02 +/- 0.46 m/s. No correlation was found between the length of the band and body weight, and also no correlation was found between the length of the band and maximum flow velocity. The calculated index had a negative correlation with the maximum velocity of flow across the band (y = -8.13x +/- 5.56, R = 0.74, p < 0.01). We believe that the proposed index is a useful guide in determining the length of a pulmonary band when preparing patients for a Fontan operation.

Absorbable pulmonary artery band

Absorbable pulmonary artery banding may be a useful method of avoiding further operation or angioplasty in patients whose underlying lesion has a natural history of resolution. We report 2 cases of absorbable pulmonary artery banding using braided Dexon. In both cases the bands functioned well initially and were completely resorbed after 2 years and 6 months, respectively.