Successful Weaning Off LVAD Support in an Infant by Pulmonary Artery Banding to Train the Right Ventricle

Background: Cardiomyopathy is the leading indication for transplantation in children. Ten percent of the cases are caused by myocarditis, and its most common causes are viral infections (i.e., parvovirus, etc.). A new and controversially discussed approach to treat failing (left) ventricles includes pulmonary banding; its effect is postulated by improving the contralateral (left) ventricular function by geometrical changes, intraventricular cross-talk, and subsequent myocardial changes.

Methods: A 3-year-old girl with biopsy-proven inflammatory myocarditis required left ventricular assist device (Berlin Heart) support. Multiple weaning efforts failed. Pulmonary artery banding was performed on a left ventricular assist device-supported heart which resulted in a significant improvement of the left ventricular function and finally left ventricular assist device explantation.

Results: In most cases of chronic heart failure extending over the acute inflammatory phase, transplantation is necessary. The waiting times in the United States are significantly shorter than in European countries like Germany. Therefore, mechanical cardiac support systems play a significant role in treating severe pediatric heart failure. Organ shortage results in a necessity for further treatment options to improve patient survival. In some observational studies pulmonary artery banding was performed in patients with severe (left) heart failure and adequate function of the right ventricle. This case here is however the first reported case where pulmonary artery banding was successful in the weaning process of a child on mechanical cardiac support.

Conclusion: Selected patients benefit from pulmonary artery banding with subsequent training of the left ventricle. This principle can apparently also be applied to patients on left ventricular assist devices.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
11 February 2025