Cerebral oximetry-guided pulmonary artery banding for end-stage heart failure in a child with left ventricular noncompaction cardiomyopathy: a case report

Pulmonary artery banding (PAB) may reduce the need for left ventricular assist devices and heart transplantation in children with end-stage heart failure. However, excessive banding may increase the right ventricular afterload, leading to worsening of heart failure. The estimated right ventricular pressure and the shifting of the interventricular septum by transesophageal echocardiography (TEE), pulmonary artery pressure, right atrial and ventricular pressure, percutaneous oxygen saturation, and mixed venous oxygen saturation are utilized to determine the optimal circumference for PAB. Here, we report the case of a 5-month-old patient with end-stage heart failure due to left ventricular noncompaction cardiomyopathy (LVNC), with a gene mutation of MYH7, who underwent successful PAB. The exact PAB placement was additionally guided by using cerebral regional oxygen saturation (rSO(2)) measurement to achieve a tolerable and optimal PAB effect. We monitored rSO(2) and other hemodynamic parameters while surgeons banded the pulmonary artery to achieve both highest rSO(2) levels and stable hemodynamics. rSO(2) was 68% before banding, and increased and remained at over 90% after the banding at same FiO(2). Patient’s heart failure improved gradually, and the child was discharged home at 6 months after PAB. The rSO(2) is a simple and non-invasive monitor for the measurement of oxygen delivery to the brain tissue. rSO(2) alone would not be able to guide PAB placement in the vulnerable DCM patients, but it may be of one further monitoring value for the optimal pulmonary artery circumference while patients are undergoing PAB.