Ghassan Baslaim1. 1. Division of Cardiothoracic Surgery, Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Center, Jeddah 21499, Saudi Arabia. gbaslaim@hotmail.com
Abstract
BACKGROUND: The major difficulty of pulmonary artery banding (PAB) is optimal intraoperative adjustment. In this study, a target intraoperative shunt ratio (Q(p)/Q(s)) was utilised to evaluate a fixed Trusler's formula for the degree of PAB of infants destined for either univentricular or biventricular surgical route. METHODS: Ten consecutive infants (median age, 1.62 months) undergoing PAB through median sternotomy were studied. A fixed Trusler's formula (20mm+1mm/kg body weight) was used to set the initial band size, and subsequent intraoperative adjustment was based on target Q(p)/Q(s) (using oxymetric data). Suitable target Q(p)/Q(s) was set <or=0.5 for the biventricular repair group (six patients) and <or=0.3 for the univentricular palliation group (four patients). RESULTS: In the biventricular group, the target mean Q(p)/Q(s) of 0.4 was achieved according to the fixed formula. However the band size was narrower in the univentricular group by 2.25 mm to achieve the target mean Q(p)/Q(s) of 0.27 instead of a higher level (2.2) with the fixed formula. CONCLUSION: Using the intraoperative Q(p)/Q(s) calculation, the circumference of the band was in agreement with the fixed formula of Trusler for the biventricular repair group, however a narrower band size is recommended for the univentricualr palliation group.
BACKGROUND: The major difficulty of pulmonary artery banding (PAB) is optimal intraoperative adjustment. In this study, a target intraoperative shunt ratio (Q(p)/Q(s)) was utilised to evaluate a fixed Trusler's formula for the degree of PAB of infants destined for either univentricular or biventricular surgical route. METHODS: Ten consecutive infants (median age, 1.62 months) undergoing PAB through median sternotomy were studied. A fixed Trusler's formula (20mm+1mm/kg body weight) was used to set the initial band size, and subsequent intraoperative adjustment was based on target Q(p)/Q(s) (using oxymetric data). Suitable target Q(p)/Q(s) was set <or=0.5 for the biventricular repair group (six patients) and <or=0.3 for the univentricular palliation group (four patients). RESULTS: In the biventricular group, the target mean Q(p)/Q(s) of 0.4 was achieved according to the fixed formula. However the band size was narrower in the univentricular group by 2.25 mm to achieve the target mean Q(p)/Q(s) of 0.27 instead of a higher level (2.2) with the fixed formula. CONCLUSION: Using the intraoperative Q(p)/Q(s) calculation, the circumference of the band was in agreement with the fixed formula of Trusler for the biventricular repair group, however a narrower band size is recommended for the univentricualr palliation group.