Pediatric Heart Expert Forum
O2 saturations gradually increasing after PAB?
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O2 saturations gradually increasing after PAB?

My 6 month old daughter (heterotaxy with C-AVC, d-tga, mild PS, TAPVR etc. etc.) had a pulmonary artery band placed on Nov. 25th for pulmonary overcirculation (qp to qs ratio 8:1) leading to high o2 saturations (96% on average) and failure to thrive.

Her postoperative course was complicated by multiorganism sepsis, but from a cardiac perspective did well. The band was placed very tightly, decreasing her PA width to 2.5mm and decreasing her qp to qs ratio of 2:1, and giving her a pulmonary gradient of 80.

For the first three weeks post surgery, her O2 saturations were consistently in the 76-82 range, but in the past 10 days they have been slowly trending upwards. Starting a few days ago she will consistently saturate in the low-to-high 90s, I've seen her as high as 98-99%.

Is this a typical trend upwards as the body adjusts to PA banding? I wasn't expecting to see O2 rates *higher* post PA band than we saw pre-PA band.
773637_tn?1327450515
Dear Rjthkids,

This is not a typical or normal finding that occurs after a pulmonary artery band is placed.  In fact, over time with growth, the oxygen saturations fall as the child outgrows the effective pulmonary blood flow.  There are a few different potential reasons for what you are seeing in your daughter, and, in consultation with my colleagues, these have been seen:
1.  When the band is placed, the pulmonary artery is partially compressed.  In the healing process, the compression resolves, and the effective diameter of the pulmonary artery increases.  This increased effective diameter allows for more blood flow across the band.
2.  If the ductus arteriosus was not ligated, it could have reopened, allowing more blood flow into the pulmonary arteries.
3.  There could be aorto-pulmonary collateral vessels that shunt blood into the pulmonary arteries.

These options can be assessed by an echocardiogram or MRI.  You can discuss this further with your child's cardiologist.
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