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Congenital heart disease in the neonatal period
Published in Janet M Rennie, Giles S Kendall, A Manual of Neonatal Intensive Care, 2013
Janet M Rennie, Giles S Kendall
If the baby is severely hypoxic, start a prostaglandin infusion. Treatment with diuretics is unwise until the degree of obstruction at the level of the atrial septum has been determined. If there is a restrictive ASD, an atrial septostomy must be performed. The surgical approach depends upon the anatomy. Reduced pulmonary blood flow is managed with an aortopulmonary shunt. If the pulmonary blood flow is high, pulmonary artery banding may be required. In the older child definitive treatment by a Fontan procedure (right atrial to pulmonary artery conduit) may be possible. In reality, only about 50% of patients survive to have a Fontan procedure, and the long-term prognosis for survivors of surgery is uncertain.
Transposition of the great arteries
Published in Jana Popelová, Erwin Oechslin, Harald Kaemmerer, Martin G St John Sutton, Pavel Žáček, Congenital Heart Disease in Adults, 2008
Jana Popelová, Erwin Oechslin, Harald Kaemmerer, Martin G St John Sutton, Pavel Žáček
In adults, ‘ate arterial switch’is still considered experimental. This type of reoperation necessitates a prior left (subpulmonary) ventricular reconditioning to systemic pressures, using pulmonary artery banding and conversion as a second step months later. Operative mortality is high and this type of operation is currently performed only in a few centers worldwide.
Congenital heart disease: addressing the need for novel lower-risk percutaneous interventional strategies
Published in Expert Review of Cardiovascular Therapy, 2023
N Linnane, DP Kenny, ZM Hijazi
Pulmonary artery banding has been performed for many years in multiple conditions, and is relatively cheap and straightforward [71]. However, it has its limitations, primarily due to needing an extra procedure for placement and also complications of damage to the pulmonary artery or valve, migration of the band, and pseudoaneurysms [72]. Multiple modifications have been suggested with telescopic modifiable bands [73] or percutaneously modifiable bands [74] but neither could demonstrate superiority over standard bands. Dilatable bands have been demonstrated to be a safe and effective option but specific and often bespoke bands are made by surgeons in these reports, thus limiting the use on a global scale [71,75,76]. While there have been reports of percutaneous pulmonary artery de-banding [77,78], there is a concern for pulmonary artery rupture when using high-pressure balloons to dilate traditional pulmonary artery bands.
Pulmonary artery banding in patients with functional single ventricle associated with pulmonary hypertension
Published in Clinical and Experimental Hypertension, 2021
Gang Li, Han Zhang, Xiangming Fan, Junwu Su
The proportion of patients with functional single ventricle and pulmonary hypertension is not high, and the treatment was difficult, such patients generally needed to staged surgery. It is essential to reach balance between systemic and pulmonary blood flow. The pulmonary artery banding (PAB) was the first step performed in all patients, it would provide reliable source of pulmonary blood flow and predictable pulmonary vascular protection, and followed by Glenn and Fontan operation. Generally, PAB is recommended to be performed at least within 6 months (1). But in some areas of China, due to a lack of adequate medical resources, there are many patients have missed the optimal timing for surgery. Older than 24 months are usually considered to have irreversible pulmonary vascular lesions, and single ventricle repair cannot be performed (2). In recent years, we had successively performed surgical treatment for the patients at older ages. Therefore, the aim of the present study was assess the impact of our surgical strategy for the treatment of patients with functional single ventricle and pulmonary hypertension, especially in patients>24 months old.
Atypical presentation of Cat Eye Syndrome in an infant with Peters anomaly and microphthalmia with cyst
Published in Ophthalmic Genetics, 2020
Benjamin Katz, Jennifer Enright, Steven Couch, George Harocopos, Andrew R. Lee
Because the patient was not medically stable for general anesthesia, topical phenylephrine 2.5% twice daily was initially used to pharmacologically dilate the left pupil and create a clearer visual axis. Following recovery from a successful pulmonary artery banding at 2 months, the patient’s prognosis was considered sufficiently optimized to undergo general anesthesia. At 5 months, she underwent an optical iridectomy of the left eye and a concurrent right orbitotomy with excision of the cystic mass. Intraoperatively, the cyst was noted to extend posteriorly from the right lower eyelid towards a remnant globe in the orbital apex. The cyst itself was a well-encapsulated, irregularly shaped purple-brown mass measuring 1.7 cm x 1.3 cm x 0.6 cm and was excised (Figure 2). Following orbital resection, a hydrophilic orbital expanding implant was inserted into the conjunctival fornix for orbital expansion.