PULMONARY ARTERY BANDING - MEDICAL ANIMATION 3D

Описание: PULMONARY ARTERY BANDING MANUSCRIPT
Pulmonary Artery Banding was first reported by Muller and Dammann in 1952 for children with a large left-to-right shunt or single ventricle and excessive pulmonary blood flow.
Pulmonary artery banding in a child with normally related great vessels can be performed either through a left lateral thoracotomy or a median sternotomy incision.
Although the left thoracotomy was historically the preferred approach, many surgeons now prefer the median sternotomy approach.
Both the approaches has its pros and cons, but of late median sternotomy technique has gained some popularity because of the advantage of ease of access, especially in the setting of complex great vessel arrangements, minimal interference with the ventilation at the time of banding, and one surgical incision for subsequent staged procedures.
After median sternotomy, thymus dissection and superior two-thirds of the anterior pericardium is opened.
A patent ductus arteriosus or ligamentum arteriosum is always ligated.
After making the desired marking points on the strip of PTFE 0.6 mm. membrane or as per the case, by using 5/0 or 6/0 polypropylene sutures, this strip is passed through the Transverse sinus around both the aorta and pulmonary artery, using right-angled Denis Browne dissector.
Then, the space between the aorta and main pulmonary artery is dissected out. Care must be taken to avoid or to coagulate the small vein that runs between the two vessels.
Now by Subtraction Technique, using right-angled clamp or dissector is passed around the aorta (not the pulmonary artery) and the free end of the band is grasped. The band is pulled through the space between the aorta and pulmonary artery and by subtraction technique encircles the pulmonary artery.
The band is then sequentially tightened by placing multiple Ligaclips. A catheter or Intra-venous cannula 20 G/22 G on a rubber-guard is placed in the distal pulmonary artery to monitor the distal pulmonary artery pressure in comparison with the aortic (radial) pressure as the band is being tightened.
Once the band has been tightened to the desired degree, the band is fixed to the proximal pulmonary artery with several interrupted sutures to prevent distal migration of the band and encroachment on the right pulmonary artery.
PA Banding is also done to prepare and retrain the left ventricle of a patient with transposition of the great arteries for the arterial switch procedure either
a) following late presentation after 4 weeks of age,
OR
b) following prior atrial repair.
Here, the catheter or intra-venous rubber-guard is placed in the proximal pulmonary artery, adjoining the LV cavity to retrain the left ventricle in case of corrected transposition (cc-TGA) patients.​


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