Pulmonary artery banding for ventricular septal defect.

It is well known that there is a very high mortality in children with ventricular septal defect, who develop heart failure in early infancy (Marquis, 1950; Boesen and Vendel, 1955). Morgan, Griffiths, and Blumenthal (1960) reviewed 125 children up to 14 years of age with ventricular septal defect. Of these, 17 developed heart failure in the first six months of life, 10 dying before their first birthday. None of the remaining 115 children died from their cardiac disease during the period of observation. Lynfield et al. (1961) reported serial catheter studies on children with ventricular septal defect. They found that if symptoms were present in the first year of life, the prognosis was bad, and they demonstrated that some of these children developed a progressive increase in pulmonary vascular resistance and an increasing pulmonary artery pressure. Kaplan et al. (1963) confirmed these findings. In an attempt to reduce the high mortality of ventricular septal defect causing heart failure in infancy, Muller and Dammann (1952) employed surgical constriction of the main pulmonary artery. The objectives were to reduce the high blood flow to the lungs, and to protect the pulmonary vasculature from the high pulmonary artery pressure which might develop in the untreated children. Muller and Dammann based their treatment upon previous experimental work in which a band or tape had been used to constrict the pulmonary artery in dogs (Reid, 1924; Holman and Beck, 1926; Gerbode and Selzer, 1948). They initially produced the constriction by excising a segment of artery (Hufnagel, Roe, and Barger, 1951). Their later experience with the technique demonstrated the value of the operation in infants aged from 5 weeks to 2 years. Pulmonary hypermmia due to left-to-right shunts was alleviated