Elsevier

International Journal of Cardiology

Volume 386, 1 September 2023, Pages 160-166
International Journal of Cardiology

Late left ventricular myocardial remodeling after pulmonary artery banding for end-stage dilated cardiomyopathy in infants: an imaging study

https://doi.org/10.1016/j.ijcard.2023.05.040Get rights and content
Under a Creative Commons license
open access

Highlights

  • PAB has been reinvented as an alternative surgical option for DCM in children.

  • We examined 7 PAB responders using a structured echocardiographic and CMRI protocol.

  • Left ventricular remodeling process starts early (30–60 days) after PAB, and ventricular function normalize at about 4-6 months.

  • 1.5-year follow-up CMRI shows sustained favorable left ventricular remodeling.

  • Areas of myocardial fibrosis were detected by CMRI in all patients.

Abstract

Background

Understanding the macroscopic biventricular changes induced by pulmonary artery banding (PAB) in children with dilated cardiomyopathy (DCM) represents the first step to unraveling the regenerative potential of the myocardium. We herein investigated the phases of left ventricular (LV) rehabilitation in PAB responders, using a systematic echocardiographic and cardiac magnetic imaging (CMRI) surveillance protocol.

Methods

We prospectively enrolled all patients with DCM treated with PAB from September-2015 at our institution. Among 9 patients, 7 positively responded to PAB and were selected. Transthoracic 2D echocardiography was performed before PAB; and 30, 60, 90, and 120 days after PAB; and at the last available follow-up. CMRI was performed before PAB (whenever possible) and one year after PAB.

Results

In PAB responders, LV ejection fraction showed a modest 10% increase 30–60 days after PAB, followed by its almost complete normalization after 120  days (median of 20[10–26]% vs 56[44.5–63.5]%, at baseline and 120 days after PAB, respectively). Parallelly, the LV end-diastolic volume decreased from a median of 146(87–204)ml/m2 to 48(40–50)ml/m2. At the last available follow-up (median of 1.5 years from PAB), both echocardiography and CMRI showed a sustained positive LV response, although myocardial fibrosis was detected in all patients.

Conclusions

Echocardiography and CMRI show that PAB can promote a LV remodeling process, which starts slowly and can culminate in the normalization of LV contractility and dimensions 4 months later. These results are maintained up to 1.5 years. However, CMRI showed residual fibrosis as evidence of a past inflammatory injury whose prognostic significance is still uncertain.

Keywords

Pulmonary artery banding
Dilated cardiomyopathy
Magnetic resonance imaging
Myocardial remodeling

Abbreviations

CMRI
cardiac magnetic resonance imaging
DCM
dilated cardiomyopathy
IQR
interquartile range
LGE
late gadolinium enhancement
LV
left ventricle
MCS
mechanical circulatory support
MV
mitral valve
PAB
pulmonary artery banding
RV
right ventricle
TAPSE
tricuspid annular plane systolic excursion
TV
tricuspid valve

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1

This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.