Pediatric Heart Expert Forum
PA Debanding
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PA Debanding

Hi all,

My daughter had a severe coarctation of Aorta and large VSD. She had a closed heart surgery to repair the COA and they did PA Banding in one month old (Sep 2010). After that I have done periodic reviews with Pediatric Cardiologist. Now she is 2 years old. During recent review on June 2012, Doctors have told that now VSD is very small. But we need to do PA Debanding and +/- VSD closure within 6 months to one year.
I am having two options. One we need to do the second operation in the month of Sep'2012 to Oct' 2012. Second option is to do the same in the month of March 2013. Both the options are with in the limit prescribed by the cardiologist. But I am praying god that the small VSD needs to be closed on its own.Then the second operation is only for PA Debanding.

Please suggest me when should i do the second operation (Sep'2012 or Mar 2013). Also please let me know what will happen if there is a delay in PA Debanding?
773655_tn?1340656399
It sounds like your daughter has had a very nice result from the coarctation repair and pulmonary artery banding.  Whe it comes to reoperation, it depends upon the size of the VSD, whether there is any cyanosis (blueness) and if there are any clinical symptoms. From your posting I am not sure if you are saying that he doctor is suggesting to do the PA debanding separately from the VSD closure?  If so, it may be that they cannot decide if the residual VSD is big enough to warrant closure, since a small residual VSD would not compromise the function of the heart.  In general, the 2 things would be done togther, if the size of the VSD warrants it.  So if you and your doctor feel that the additional months of growth might allow the VSD to close further, and there are no other strong reasons to do the debanding soon, then waiting until March 2013 may be a good option.  If the VSD does not require closure, it makes the next operation shorter.  But if the hemodynamic effect of the residual VSD is still unclear, then closure at the time of PA debanding is likely warranted, and saves her another operation at a later time.  Delaying a pulmonary artery debanding is only a problem if the child has limited exercise tolerance and blueness now.  At the time of surgery, they usually have to put a patch on the pulmonary artery where it was narrowed by the band, so a few extra months really makes no difference there.  Good luck.
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Jeffrey R Boris, M.D.Blank
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