What is Pulmonary Artery Banding?
Pulmonary artery banding is a part of a larger surgical procedure which treats severe cases of ventricular septal defect. This congenital condition causes the blood in the left and right ventricles of the heart to flow abnormally. The blood flows from the left ventricle, through a hole in the septum, and into the right ventricle, rather than into circulation. This results in poor blood circulation throughout the body and inadequate oxygenation of the muscles. For many puppies, the hole closes before the puppy matures. However, for severe cases in which the hole in the septum is large, ventral septal defect can increase the risk of heart failure. It then becomes a life-threatening condition that warrants emergency treatment at a specialist facility.
Pulmonary Artery Banding Procedure in Dogs
Pulmonary artery banding is often one part of a larger surgical procedure to correct ventricular septal defect. The procedure steps for pulmonary artery banding, not including additional techniques or procedures, are as follows:
- Before surgery, an ECG and blood work will be taken to identify the hole and ensure it is safe to anesthetize the dog.
- General anesthesia is administered. The operative area is shaved, cleaned, and clipped.
- The surgeon will perform a fourth intercostal thoracotomy to access the heart. This involves incising the skin and muscles between the ribs.
- The surgeon will open the pericardium and suture it to the initial thoracotomy incision.
- The pulmonary artery is dissected from the aorta.
- A specialized Teflon tape is passed tightly around the pulmonary artery.
- A catheter will be inserted into the pulmonary artery wall to monitor pulmonary artery pressure. With the help of the catheter, the surgeon can determine how tightly the band should be applied. It should reduce the diameter of the pulmonary artery by 33% to 66%.
- After the surgeon has determined the best degree of constriction, the band is tied.
- The surgeon will likely begin the open procedure to repair the septum at this time.
- The dog will be hospitalized after the procedure to ensure no immediate postoperative complications occur.
Efficacy of Pulmonary Artery Banding in Dogs
The efficacy of this procedure is unclear, as there is little information on the procedure in current veterinary literature. This is primarily a palliative procedure – done to relieve pain rather than cure the underlying condition – and its efficacy will largely depend on the health of the dog at the time of the procedure. If successful, the procedure will reduce symptoms and optimize circulation. Pulmonary artery banding also carries a high risk of complications. Unlike many surgical procedures, postoperative complications may occur long after the surgery. The cardiac surgeon will discuss the benefits and risks of this procedure with owners prior to treatment.
Pulmonary Artery Banding Recovery in Dogs
Owners should follow their veterinary surgeon’s recovery instructions very carefully to prevent additional complications. A bandage may be applied to the chest until the sutures are removed within two weeks of surgery. This bandage should be changed frequently and kept clean and dry. Checking the suture site each day is vital. If owners notice swelling, discharge, or bleeding near the surgery site, they should contact their veterinarian immediately. X-rays will be taken each year to monitor the band, check for signs of congestive heart failure, and ensure no other complications have occurred.
Signs of the complications pulmonary hypertension and severe tricuspid regurgitation include:
- Exercise intolerance
- Shallow, rapid, or difficult breathing
- General weakness
If owners notice any of these signs, they should seek emergency treatment for their pet.
Cost of Pulmonary Artery Banding in Dogs
The cost of pulmonary artery banding in dogs will vary based on standards of living and additional costs incurred. The price of pulmonary artery banding ranges from $1,000 to $8,000, with a national average cost of $4,000.
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Dog Pulmonary Artery Banding Considerations
Though pulmonary artery banding carries a low intraoperative mortality rate, complications are possible, and may include:
- Overtightening of the band during the procedure
- Progressive tightening of the band over time
- Progressive tricuspid regurgitation: A condition in which the blood flows backward through the tricuspid valve in the right ventricle.
If the band is overtightened, this may reverse the direction of blood flow, which can cause serious, life-threatening complications. Additionally, few facilities in the US offer heart surgery for canines.
Pulmonary Artery Banding Prevention in Dogs
Because it is a congenital condition, ventricular septal defect is impossible to prevent in dogs. Even though there is not a strong link between genetics and the development of this condition, dogs that have been diagnosed with and treated for ventricular septal defect should not be bred.