Pulmonary artery banding in isolated or complicated ventricular septal defects. Results and effects on growth.

Experience with patients undergoing pulmonary artery banding for control of substantial left-toright shunt associated with large ventricular septal defects has been reviewed in order to assess the effects of banding and the growth patterns of the subjects in relation to changes in cardiac loading. The series covers a periodfrom I960 through I968. All 22 infants studied had large ventricular septal defects with increased arterial pressures and substantial left-to-right shunts. About 50 per cent of the patients had associated cardiac anomalies; 7 had persistence of the ductus arteriosus and 4 coarctation of the aorta. These associated anomalies where possible were dealt with at the time of or before the banding procedure. Generally the band was applied to the limit of tolerance. There were 6 surgical deaths which included 3 patients with stubstantial associated anomalies. Nine patients had a satisfactory immediate response, i had a partial response, while 6 failed to improve after operation. Repeat study in the latter group showed persisting left-to-right shunt despite the band being in position in all except I subject in whom the band had cut through the pulmonary artery. Three patients were rebanded, with i survivor who was satisfactory. The remaining 3 patients were managed medically, with 2 survivors ultimately improving some months later. The growth of the whole group was retarded. Most, in addition, had evidence of intrauterine growth retardation. Cardiac failure was associated with minimal or no growth. After effective banding had controlled the large left-to-right shunt, improvement in growth was generally seen, some patients in addition displaying catch-up growth. Thus, resumption or acceleration ofgrowth