الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 129 |  |  |
| | | from | 129 | | |
Abstract
Pulmonary artery banding (PAB) remains a useful surgical palliation for small neonates and early infants with excessive pulmonary blood flow who are unable or difficult to withstand an open heart surgery using cardiopulmonary bypass or in developing countries where the facilities not suitable for primary corrective surgery in those infants (Nagashima, 2011).
Recently especially in developed countries with increase of cardiac surgeon experience and possibility of Cardiopulmonary bypass (CPB) in very young infant with low birth weight and also better postoperative care, many of children that previously had to tolerated initially PA Banding procedure before corrective surgery, today have a chance for total corrective surgery with good result and success and low mortality (Hoseinikhah et al., 2016).
Trusler and Mustard (1972) advocated that the adequate circumference of the PAB using a 4-mm-wide tape in infants without cyanosis was (20 mm + 1 mm for each kg of the infant BW) (Nagashima, 2011).
In our current study we aimed to study clinical pathway of cases underwent PAB at ASU hospital pediatric cardiac surgery department with discussion of different causes of mortality and morbidity.
Study done by data collection retrospectively of 50 patients underwent pulmonary artery banding in the period from January 2018 to December 2019 who fulfilling the inclusion criteria with evaluation of different clinical pathways for the outcome mainly morbidities and mortality.
Most of cases had VSD or multiple VSDs (28 cases) followed by single ventricle (11 cases) which included also cases of DORV (3ases) , DILV(3 cases) , TA( 1 case) and CAVC (4 cases ) those patients were in high risk for total repair complaining of recurrent chest infections.
We found that the major risk factors of mortality in cases underwent PAB in ASU hospitals includes:
1. Low preoperative so2 ≤85
2. Ventilation is high risk factor for mortality so it is recommended to extubate those patients on table or shortly after discharge to ICU as soon as possible
3. Duration of intubation: the longer the duration of intubation, the higher the mortality
4. Postoperative PG across band ≤45.that indicator for a loose band with still persistent pulmonary overflow.
5. Re-intubation
6. Post operative morbidities are highly associated with mortality, 7 mortality cases suffered from postoperative complications (100 % of mortality cases) that includes Poor chest condition, Stroke, Postoperative convulsions, Pulmonary hemorrhage
These morbidities result in prolonged intubation and prolonged ICU stay.
Postoperative follow up for 3-6 months is recommended especially in developing countries to avoid interstage death between palliative PAB and corrective surgery and to determine the appropriate time for total repair procedure .with postoperative echo to exlude occurance of PA banding complications.