Objectives

The optimal tightness of bilateral pulmonary artery banding (BPAB) is considered to balance not only systemic-to-pulmonary blood flow but also each pulmonary blood flow, which is still challenging. To achieve them, we adopt the end-diastolic velocity (EDV) to the peak systolic velocity (PSV) ratio at BPAB with intraoperative epicardial echocardiography. We evaluated the usefulness of the EDV to PSV ratio and the patient outcomes.

Methods

34 patients underwent BPAB with this indicator and using a looped polytetrafluoroethylene suture. The PSV and the EDV to PSV ratio with echocardiography were measured in the intraoperative, early postoperative and late postoperative period. Lung perfusion scintigraphy was performed to quantify flow to each lung.

Results

There were 3 early deaths (< 30 days). Two patients required re-BPAB due to hypoxia. The intraoperative EDV to PSV ratios in the right and left were almost equal (0.50 ± 0.07 versus 0.51 ± 0.06, P = 0.73). There was no significant difference in the right and left EDV to PSV ratios throughout the postoperative course. The right PSV was smaller than the left PSV due to the Doppler angle intraoperatively (2.78 ± 0.57 versus 3.02 ± 0.50, P = 0.030). In addition, the PSV changed significantly until the late postoperative period (P < 0.001). Lung perfusion scintigraphy revealed only two patients had perfusion abnormalities.

Conclusions

Our clinical outcomes are satisfactory with low early mortality and a low rate of re-BPAB. The EDV to PSV ratio can be a reliable indicator to assess flow distribution to each lung and may be a valuable adjunct to achieve balanced systemic to pulmonary flow.

中文翻译：

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一种有价值的超声心动图指标，用于双侧肺动脉束带的最佳紧密度

目标

双侧肺动脉束带（BPAB）的最佳紧密度被认为不仅可以平衡全身到肺的血流，还可以平衡每个肺的血流，这仍然具有挑战性。为了实现它们，我们采用术中心外膜超声心动图检查 BPAB 的舒张末期速度 (EDV) 与收缩期峰值速度 (PSV) 的比值。我们评估了 EDV 与 PSV 比值和患者预后的有用性。

方法

34 名患者使用该指标并使用环状聚四氟乙烯缝合线接受了 BPAB。在术中、术后早期和术后晚期测量 PSV 和超声心动图的 EDV 与 PSV 比值。进行肺灌注闪烁扫描以量化流向每个肺的流量。

结果

有 3 例早期死亡（< 30 天）。两名患者因缺氧需要重新 BPAB。右侧和左侧的术中 EDV 与 PSV 比率几乎相等（0.50 ± 0.07 对 0.51 ± 0.06，P  = 0.73）。在整个术后过程中，左右 EDV 与 PSV 的比率没有显着差异。由于术中多普勒角，右侧 PSV 小于左侧 PSV（2.78 ± 0.57 对 3.02 ± 0.50，P  = 0.030）。此外，PSV 变化显着直到术后后期（P  < 0.001）。肺灌注闪烁扫描显示只有两名患者出现灌注异常。

结论

我们的临床结果令人满意，早期死亡率低，再 BPAB 率低。EDV 与 PSV 的比率可以是评估每个肺的流量分布的可靠指标，并且可能是实现平衡的全身流量到肺流量的有价值的辅助手段。