Pulmonary artery banding is not contraindicated in double inlet left ventricle with transposition and aortic arch obstruction

It has been widely stated that pulmonary artery banding (PAB) iscontraindicated in the setting of double inlet left ventricle withtransposition of the great vessels (DILV/TGA), especially if aortic archobstruction is present. We postulated that the poor results for thiscondition reflect the tendency to leave the band in place long- termwithout early recognition and relief of subaortic stenosis (SAS).Short-term PAB with early relief of SAS remains an attractive optioncompared to a neonatal "Norwood" strategy. We reviewed our results applyingthis approach to 18 consecutive infants presenting since 1980 with DILV/TGAand an obstructive anomaly of the aortic arch (coarctation 16, interruptionor atresia 2). Four of the infants (22%) were considered to have importantSAS at presentation. One underwent neonatal aortopulmonary connection anddied. The remaining 17 patients underwent arch repair with PAB (median age1.4 weeks; range 2 days-22 weeks) with one early death. The 16 survivorshave been followed for 5.6 +/- 3.7 years. All but one ultimately developedSAS. Relief of SAS was performed in 15 patients (median age 8 months) usinga proximal aortopulmonary anastomosis. There were two early deaths, and onelate death. Thirteen of the 18 patients (72%) are alive and well, and 12have achieved Fontan repair or bidirectional superior cavopulmonaryanastomosis (BCPA) with persistent relief of SAS. Most patients withDILV/TGA and aortic arch obstruction will tolerate temporary PAB withadequate protection of the pulmonary vascular bed. Our current approach (inthe absence of severe SAS at presentation) is PAB at the time of archrepair, followed by careful surveillance for, and early relief of, SAScombined with BCPA in infancy.