Telemetric adjustable pulmonary artery banding for pulmonary hypertension in infants with congenital heart defects

The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Telemetric adjustable pulmonary artery banding for reducing pulmonary hypertension in infants with congenital heart defects, in November 2014.

January 2018: The device linked to this guidance (FloWatch) is no longer available. NICE would consider whether to issue new guidance on Telemetric adjustable pulmonary artery banding for pulmonary hypertension in infants with congenital heart defects should evidence using an appropriately CE marked device become available.

Description

Congenital heart defects with a left-to-right shunt and excessive pulmonary blood flow can result in pulmonary hypertension and congestive heart failure in the neonatal period. The usual treatment is surgical correction of any defect when the infant is big enough. The most common defects needing this type of treatment include functionally univentricular hearts, transposition of the great arteries and atrioventricular or multiple septal defects. The symptoms include fatigue, dyspnoea, tachypnoea and failure to thrive if the lungs are not protected. Infants may develop a condition of irreversible pulmonary hypertension because of hypertrophy of the pulmonary arterioles.

Pulmonary artery banding (PAB) is a palliative procedure that is used as part of staged treatment before definitive surgical correction of congenital heart defects. The aim of PAB is to reduce the diameter of the main pulmonary artery, decreasing blood flow and reducing pulmonary artery pressure. Improvement of systemic pressure, cardiac output and ventricular function can also be expected in patients with a large left-to-right shunt. Risks of the procedure include lowering of systemic oxygen saturation, ventricular hypertrophy, subaortic obstruction, and pulmonary branch and valve distortion. The conventional technique of PAB involves surgical placement of a (not telemetrically adjustable) band around the main pulmonary artery. Different techniques using a variety of materials (such as strips of polytetrafluoroethylene, polydioxanone or nylon) and sutures are used. In non-adjustable PAB methods, reoperation is often needed to adjust the tightness of the band.

Coding recommendations

L12.1 Application of band to pulmonary artery