Лучшие больницы для «Pulmonary Artery Banding» в Хайдарабад, Индия

Pulmonary Artery Banding is a palliative surgical technique in which a calibrated constricting band — typically fashioned from Gore-Tex, silicone-reinforced Teflon tape, or a flow-restrictor device — is placed around the main pulmonary artery (MPA) to deliberately narrow its lumen and reduce left-to-right shunting of oxygenated blood into the pulmonary circulation. In congenital heart defects characterised by unrestricted pulmonary blood flow (Qp:Qs ratio often exceeding 2:1), the pulmonary vasculature is exposed to excessive pressure and volume, driving pathological vascular remodelling characterised by medial hypertrophy, intimal proliferation, and, ultimately, irreversible pulmonary arterial hypertension (Heath-Edwards Grade III–VI). PAB interrupts this cascade by targeting a post-banding distal pulmonary artery pressure of approximately 25–35% of systemic pressure and an oxygen saturation of 75–85% in cyanotic lesions, thereby protecting the pulmonary vascular bed and allowing the infant to grow to a weight and haemodynamic status suitable for complete intracardiac repair.

• ELIGIBLE DIAGNOSES: Large unrestrictive ventricular septal defect (VSD) with pulmonary-to-systemic flow ratio (Qp:Qs) > 2:1; Double-outlet right ventricle (DORV); Complete atrioventricular septal defect (AVSD) in patients with Down syndrome or other contraindications to early complete repair; Hypoplastic left heart syndrome (HLHS) as part of a hybrid Norwood Stage I strategy; Single-ventricle anatomy (double-inlet left ventricle, tricuspid atresia with transposition) prior to bidirectional Glenn procedure; Aortopulmonary window with complex anatomy; Corrected transposition of the great arteries (cc-TGA) with VSD where pulmonary artery banding serves as left ventricular retraining prior to anatomic arterial switch.
• WEIGHT AND AGE PARAMETERS: Most candidates are neonates to infants under 6 months of age or weighing less than 5–6 kg, where primary complete repair carries prohibitive risk; PAB may also be considered in older infants with severe comorbidities (prematurity, lung disease, necrotising enterocolitis sequelae, severe malnutrition).
• REQUIRED PREOPERATIVE DIAGNOSTICS: Transthoracic echocardiography (TTE) with full segmental analysis and colour-flow Doppler — mandatory; Cardiac catheterisation with pulmonary vascular resistance (PVR) calculation when pulmonary hypertension is suspected (PVR > 3 Wood units/m²); High-resolution cardiac CT angiography (CTA) for complex anatomy delineation of MPA, branch pulmonary arteries, and great vessel relationships; Chest X-ray (cardiothoracic ratio, pulmonary plethora grading); Full blood count, coagulation profile (PT, aPTT, fibrinogen), renal and hepatic function panel, blood group and crossmatch; Genetic karyotype (especially in AVSD/Down syndrome population); Preoperative respiratory assessment and optimisation (treat active respiratory infection prior to scheduling).
• CONTRAINDICATIONS: Established irreversible pulmonary arterial hypertension (PVR > 8–10 Wood units/m² unresponsive to vasodilator challenge — Eisenmenger physiology); Anatomy clearly amenable to safe primary complete repair at experienced centre; Active systemic sepsis or uncontrolled coagulopathy; Extremely low birth weight (< 1.5 kg) — relative contraindication requiring individualised multidisciplinary decision.

STANDARD OPEN SURGICAL PAB (PRIMARY APPROACH) Performed via left lateral thoracotomy (most common) or median sternotomy (preferred when simultaneous procedures are planned), the main pulmonary artery is dissected free from the aorta and right pulmonary artery, and a measured band is passed around the MPA proximal to its bifurcation. The procedure is typically performed off cardiopulmonary bypass (off-pump), making it less physiologically stressful than full open-heart repair. Band material options include: (1) PTFE (Gore-Tex) strips — most widely used, inert, reliable; (2) Umbilical tape with silicone sheathing — cost-effective in resource-limited settings; (3) Polyester (Dacron) tape. Intraoperative epicardial echocardiography is now standard in high-volume centres to dynamically guide band tightness. Sutures anchoring the band to the MPA adventitia prevent migration.

HYBRID STAGE I PAB (ADVANCED — FOR HLHS AND SINGLE VENTRICLE) In the hybrid Norwood approach for hypoplastic left heart syndrome, bilateral PAB is combined with ductal stenting via cardiac catheterisation in the same session, avoiding the need for deep hypothermic circulatory arrest in a critically ill neonate. This approach has gained significant adoption at specialised centres in India (e.g., Narayana Health, Amrita Institute) and the UAE (Cleveland Clinic Abu Dhabi, Mediclinic City Hospital Dubai). The catheter-based component uses balloon-expandable stents (typically 4–6 mm) deployed in the arterial duct under fluoroscopic guidance in the hybrid OR.

ADJUSTABLE PAB DEVICES The FloWatch® PAB system (EndoArt SA) and similar devices feature a subcutaneously implanted electromagnetic actuator connected to the band, enabling non-invasive percutaneous tightening or loosening of the band using an external handheld controller — eliminating the need for a second thoracotomy for band adjustment. Available at select high-volume centres in both India and the UAE, this technology is particularly valuable in patients with dynamic haemodynamic requirements or those awaiting significant weight gain before corrective surgery.

VIDEO-ASSISTED THORACOSCOPIC PAB (VATS-PAB) Minimally invasive thoracoscopic pulmonary artery banding — using 3–5 mm ports in neonates — is performed at a small number of pioneering paediatric cardiac centres. Advantages include reduced chest wall trauma, shorter ICU stay, and improved cosmesis. Requires specialised neonatal endoscopic instrumentation and an experienced minimally invasive paediatric cardiac team. Currently available at select centres in India.

PHASE 1 — PRE-ARRIVAL CONSULTATION (2–4 weeks before travel) GAF Healthcare coordinates a telemedicine consultation between the family and the designated paediatric cardiac surgeon. All prior echocardiogram reports, cardiac catheterisation data, genetic results, and clinical summaries are reviewed. The surgical team confirms the diagnosis, proposes the operative strategy, and issues a formal treatment plan with itemised cost estimate. Visa invitation letters and medical documentation are prepared simultaneously.

PHASE 2 — ARRIVAL AND PREOPERATIVE WORKUP (Days 1–3) On arrival, the infant undergoes repeat transthoracic echocardiography at the hospital to confirm anatomy and current haemodynamics. Repeat blood work, chest X-ray, and anaesthetic assessment are completed. A paediatric cardiac anaesthesiologist meets the family to explain the anaesthetic plan and obtain informed consent. The infant is admitted to the paediatric cardiology ward for optimisation: nutritional support (nasogastric feeding if required), diuretics (furosemide, spironolactone) to reduce pulmonary oedema, and prophylactic antibiotics commenced 1 hour before incision.

PHASE 3 — SURGERY (Day 3–5 typically) The procedure takes approximately 1.5–3 hours under general endotracheal anaesthesia with continuous invasive arterial pressure monitoring, near-infrared spectroscopy (NIRS) cerebral oximetry, and intraoperative epicardial echocardiography. The surgeon places the calibrated band, confirms target haemodynamics, and closes the chest. The infant is transferred to the Paediatric Cardiac ICU (PCICU) intubated.