Pulmonary Artery Banding


The application of pulmonary artery banding (PAB) is today the exception since, whenever possible, primary correction is the preferred aim. PAB is therefore reserved for complex defects with overcirculationpulmonary flooding in preparation for biventricular correction with multiple muscular VSDs, unbalanced AVSD and in L-TGA to train the LV, functionally single ventricle, for which it can be the first palliative step, tricuspid atresia without pulmonary stenosis, and bilateral PA banding e.g. for HLHS with contraindications for the Norwood operation. In this case the blood flow to the lung is reduced in preparation for a Glenn or Fontan operation.


  • by echocardiography: anatomy of the heart defect, especially number, position and size of the VSDs, position and diameter of the large vessels, valve function.
  • by heart catheterization: in particular cases of complex heart defects to assess the hemodynamics, development of the pulmonary vessel bed, PA resistance.


Exposure of the pulmonary artery main stem centrally and equidistant to the pulmonary valve annulus and PA bifurcation. Wrapping with 3 mm silicon bands for approx. 21 + body weight (kg) in mm. A reduction in the oxygen saturation to about 80%, an increase in the arterial pressure of about 10 mmHg and a gradient across the band of 30- 40mmHg indicate adequate banding.

Recommendations for Further Treatment

The operation reduces the pulmonary overcirculation so that the pulmonary vessel bed is protected for the planned palliation in accordance with the Fontan principle.

With functional single ventricle a bidirectional upper cavopulmonary anastomosis (modified Glenn operation) should be performed at the age of 5-6 months. A heart catheter examination at the age of 4-5 months evaluates whether the preconditions for this anastomosis are given (adequate development of the pulmonary vessel bed, good function of the single ventricle). Definitive palliation (total cavopulmonary anastomosis with extracardiac conduit) takes place at the age of 2-3 years (weight 12- 15 kg).

We recommended this two-step treatment (first Glenn, then Fontan operation) even if the oxygen saturation and physical thriving would allow the operation to be postponed until the age of 1-2 years, since it enables early volume relief of the systemic ventricle. This is advantageous for the long-term function of the single ventricle and the exertion tolerance at school age (Mahle WT et al. JACC 1999).

Planning of biventricular correction

Should the oxygen saturation values remain below 70% at rest or the child fail to thrive (weight increase < 50g/week, signs of volume strain due to pulmonary overcirculation) the child should be presented again in our Department of Cardiology.

Endocarditis prophylaxis should be given for the known indications. The STIKO (Standing Committee on Vaccination) inoculations should be given from 6 months postoperatively. Seasonal Synagis® vaccination is recommended.