Use of transesophageal echocardiography guidance for pulmonary artery banding in a cat with ventricular septal defect.

Pulmonary artery banding (PAB) is a long-term palliative treatment option for hemodynamically significant ventricular septal defects. The goal of PAB is to increase right ventricular afterload and consequently right ventricular systolic pressure, thereby reducing the interventricular pressure gradient and left-to-right systolic shunting flow. Historically, the guidelines for PAB have been formulated to reduce the pulmonary artery (PA) to approximately one-third of its original diameter. More recently, intra-operative monitoring techniques for assessing appropriate banding have been reported, such as intracardiac or distal PA pressure measurements, percentage of hemoglobin oxygen saturation assessment, and transthoracic or transesophageal echocardiography measurements. In this case report, transesophageal echocardiography was successfully used to assess the appropriate degree of banding of the PA in a cat with a hemodynamically significant ventricular septal defect by intra-operative monitoring of shunting flow velocities.