Heart Surgery

My nephew (7 years) has been operated for PA banding surgery (MAX Devi Devki Heart Hospital, New Delhi). Year after he was again operated telling us that hole are being closed now and band will be corrected (meaning thereby total correction surgery). Now he is 9 year old, very thin, growth is not proper, gaining less weight. Sometimes he feels pain in chest. Pressure on lungs is very high.

He is taking Sildenafil (10 mg or qty. changed by doctors time to time) four or six times in a day.

Now doctors are suggesting for angiography, after a machine will be installled to control the pressure of blood on lungs.

kindly suggest what we do now. we are in very much trouble.

[Jeffrey R Boris, M.D.]

Dear Sachin,

Unfortunately, you do not tell me why your nephew got a pulmonary artery (PA) band, so it is difficult to be able to help you.  I presume that he had a ventricular septal defect that, for some reason, he was not able to undergo primary repair, which should have been the original goal.  Based on your description at this point, it sounds as if he may have secondary pulmonary hypertension.  This is a condition in which there has been too much blood flow and blood pressure across the pulmonary arteries for too long, leading to scarring and thickening of the smaller pulmonary arteries and arterioles.  Ordinarily, the pressure on the right side of the heart is only 20 to 25% of the pressure on the left side of the heart.  A pulmonary artery band can be placed to prevent that extra blood flow from recirculating through the lungs which can lead to pulmonary hypertension.  However, once the child gets big enough to close the defect, the band should be removed and the defect closed.  I don’t know the exact information about your nephew’s anatomy, and don’t exactly understand the timing of his various interventions, so I do not know how best to help.  If I am reading this correctly, it appears that he had a PA band placed at age 7 years, which sounds as if the damage to the pulmonary blood vessels may have already been done and placement of a PA band may have been too late.  Angiography, or taking pictures of the arteries, can be helpful in demonstrating the anatomy as well as the physiology (normal or abnormal) and in subsequent decision making.  I am not sure what you mean by a machine to control the lung blood pressure, however.  At this point, I recommend that he be evaluated and treated by someone who is familiar with pulmonary hypertension and congenital heart defects.  That said, based on your description of him, the damage that has been done may be permanent and there may be nothing else that can be done for him.