日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

In the modern era, advances in open-heart surgery as the first choice for treating many congenital cardiac defects have decreased markedly as indications for palliative procedures. However, palliative surgery is still needed for the selected patients. Furthermore, the indications for palliative procedures have expanded far beyond the original concept. The main goals of palliation are to alter the hemodynamic physiology, i.e., to control the pulmonary blood flow, particularly the normally high neonatal pulmonary vascular resistance. Implantation of a systemic-pulmonary artery shunt (SP shunt) and pulmonary artery banding (PAB) are the two primary methods of palliation. The physiology of circulation incorporating an SP shunt is complex, particularly lesions within a single ventricle. Consequently, the SP shunt is still associated with a significant incidence of adverse outcomes. A clear understanding of the anatomy and physiology is important. PAB also continues to occupy an important place in surgical treatment for very young infants for whom cardiopulmonary bypass is associated with a great risk. The role of PAB is to reduce pulmonary blood overflow to prevent or reverse cardiac failure and to provide long-term protection against irreversible pulmonary hypertension. Moreover, several cardiac defects can benefit from early PAB, especially when preparation and training of the left ventricle is necessary. Bilateral PAB is also an attractive and effective method for the control of pulmonary blood flow in ductal-dependent lesions.