Pulmonary artery banding in infants and young children with left ventricular dilated cardiomyopathy: A novel therapeutic strategy before heart transplantation

Dietmar Schranz, Stefan Rupp, Matthias Müller, Dorle Schmidt, Anna Bauer, Klaus Valeske, Ina Michel-Behnke, Christian Jux, Christian Apitz, Josef Thul, Daphne T. Hsu, Hakan Akintürk

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: Dilated cardiomyopathy (DCM) in childhood has a considerable morbidity and mortality and high incidence of heart transplantation. Pulmonary artery banding (PAB) has been proposed in patients with corrected transposition of the great arteries to retrain the sub-pulmonic left ventricle (LV) and to improve a failing sub-aortic right ventricle. We evaluated the short-term and medium-term effects of PAB in young patients with LVDCM. Methods: A retrospective single-center observational study was performed to evaluate the possible benefits of a dilatable surgical PAB in infants and young children with LVDCM. Results: Reported are 12 patients (10 infants, 2 toddlers) with LVDCM referred for heart transplant who received a surgical PAB. There were no hospital deaths. Clinical functional status improved in all patients. The pressure gradient across the PAB increased within 20 days from 28 ± 7 to 43 ± 15 mm Hg. The LV ejection fraction increased from 14.5% ± 5% pre-PAB to 27% ± 13% at hospital discharge and to 47% ± 10% at 3 to 6 months. The LV end-diastolic diameter (z-score) decreased (p > 0.001) from 46 ± 6.1 (+7.0 ± 1.3) to 35 ± 15 mm (+3.0 ± 1.3) after 3 to 6 months and to 34 ± 15 mm (+1.3 ± 1.14) after a median age of 2 years (maximum 6.6 years), respectively. Plasma B-type natriuretic peptide levels decreased from 3431 ± 2610 to 288 ± 321 pg/ml at discharge and to 102 ± 96 pg/ml 22 months later. Eight children were subsequently de-banded by transcatheter technique and 6 of them are currently at Ross Heart Failure Classification for Children class I. Two patients, both with non-compaction DCM, deteriorated at 5 and 6 months after PAB debanding and finally died. Conclusion: In young children with LVDCM and still-preserved right ventricular function, PAB led to an improvement of LV and mitral valve function by ventricular interaction.

Original languageEnglish (US)
Pages (from-to)475-481
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume32
Issue number5
DOIs
StatePublished - May 2013
Externally publishedYes

Fingerprint

Dilated Cardiomyopathy
Heart Transplantation
Pulmonary Artery
Heart Ventricles
Therapeutics
Right Ventricular Function
Transposition of Great Vessels
Ventricular Function
Brain Natriuretic Peptide
Mitral Valve
Observational Studies
Heart Failure
Morbidity
Transplants
Pressure
Lung
Mortality
Incidence

Keywords

  • children
  • dilated cardiomyopathy
  • infants
  • left ventricle
  • pulmonary artery banding

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Pulmonary artery banding in infants and young children with left ventricular dilated cardiomyopathy : A novel therapeutic strategy before heart transplantation. / Schranz, Dietmar; Rupp, Stefan; Müller, Matthias; Schmidt, Dorle; Bauer, Anna; Valeske, Klaus; Michel-Behnke, Ina; Jux, Christian; Apitz, Christian; Thul, Josef; Hsu, Daphne T.; Akintürk, Hakan.

In: Journal of Heart and Lung Transplantation, Vol. 32, No. 5, 05.2013, p. 475-481.

Research output: Contribution to journalArticle

Schranz, Dietmar ; Rupp, Stefan ; Müller, Matthias ; Schmidt, Dorle ; Bauer, Anna ; Valeske, Klaus ; Michel-Behnke, Ina ; Jux, Christian ; Apitz, Christian ; Thul, Josef ; Hsu, Daphne T. ; Akintürk, Hakan. / Pulmonary artery banding in infants and young children with left ventricular dilated cardiomyopathy : A novel therapeutic strategy before heart transplantation. In: Journal of Heart and Lung Transplantation. 2013 ; Vol. 32, No. 5. pp. 475-481.
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AU - Schmidt, Dorle

AU - Bauer, Anna

AU - Valeske, Klaus

AU - Michel-Behnke, Ina

AU - Jux, Christian

AU - Apitz, Christian

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N2 - Background: Dilated cardiomyopathy (DCM) in childhood has a considerable morbidity and mortality and high incidence of heart transplantation. Pulmonary artery banding (PAB) has been proposed in patients with corrected transposition of the great arteries to retrain the sub-pulmonic left ventricle (LV) and to improve a failing sub-aortic right ventricle. We evaluated the short-term and medium-term effects of PAB in young patients with LVDCM. Methods: A retrospective single-center observational study was performed to evaluate the possible benefits of a dilatable surgical PAB in infants and young children with LVDCM. Results: Reported are 12 patients (10 infants, 2 toddlers) with LVDCM referred for heart transplant who received a surgical PAB. There were no hospital deaths. Clinical functional status improved in all patients. The pressure gradient across the PAB increased within 20 days from 28 ± 7 to 43 ± 15 mm Hg. The LV ejection fraction increased from 14.5% ± 5% pre-PAB to 27% ± 13% at hospital discharge and to 47% ± 10% at 3 to 6 months. The LV end-diastolic diameter (z-score) decreased (p > 0.001) from 46 ± 6.1 (+7.0 ± 1.3) to 35 ± 15 mm (+3.0 ± 1.3) after 3 to 6 months and to 34 ± 15 mm (+1.3 ± 1.14) after a median age of 2 years (maximum 6.6 years), respectively. Plasma B-type natriuretic peptide levels decreased from 3431 ± 2610 to 288 ± 321 pg/ml at discharge and to 102 ± 96 pg/ml 22 months later. Eight children were subsequently de-banded by transcatheter technique and 6 of them are currently at Ross Heart Failure Classification for Children class I. Two patients, both with non-compaction DCM, deteriorated at 5 and 6 months after PAB debanding and finally died. Conclusion: In young children with LVDCM and still-preserved right ventricular function, PAB led to an improvement of LV and mitral valve function by ventricular interaction.

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