Outcome of Systemic-to-Pulmonary Shunts in Cyanotic Congenital Heart Disease-A 9-year Experience

Department of cardiovascular Surgery, Shahid Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran
Acta medica Iranica 01/2009; 47(2).


The aim of this study is to evaluate early and late results of surgery in children with congenital heart disease and decreased pulmonary blood flow, who underwent a palliative systemic-to-pulmonary shunt. During the past 9 years, 157 systemic-to-pulmonary artery shunts were performed in 130 patients (69 males, 61 females) with ages from 1 day to 31 years old. They had been evaluated for their clinical effectiveness, the need for a repeat operation and the mortality and morbidity. There were 101 (77.7%) modified Blalock-Tausig (BT) shunts, 19 (14.6%) modified Waterston shunts, 8 (6.2%) Central shunts, 1 Waterston shunt, and 1 Glenn shunt created throughout the study. Tetralogy of Fallot comprised the majority of cases (113; 86.9%) while the remaining 17 (13.1%) included transposition of the great arteries with pulmonary stenosis, tricuspid atresia, pulmonary atresia, atrioventricular septal defect (canal) with pulmonary stenosis, and univentricular heart complex. Early mortality was 12.3% (16 patients). Second shunts were created in 25 (19.2%) patients. Forty patients (30.8%) have undergone subsequent intracardiac repair 37.7 ± 17.8 months after original shunt procedure. There were four (3%) late deaths. Follow-up was achieved in 105 of 114 early survivors for a pe-riod of 3 to 117 months (mean 31.7 ± 19.4 months). Modified BT shunt was performed most frequently in our service; it was associated with less closure and mortality than other types of shunt and had excellent clinical palliation and patency rates.

Download full-text


Available from: Farzad Kakaei, Oct 04, 2015
1 Follower
30 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Between April, 1975, and December, 1979, 99 modified Blalock-Taussig shunts (MBTSs) were carried out at The Hospital for Sick Children, Great Ormond Street. The operation consists of interposing between the subclavian artery and the pulmonary artery a prosthesis of greater diameter than that of the subclavian artery. The first 13 operations were performed with a prosthesis of woven Dacron. Conduits of expanded polytetrafluorethylene (PTFE) were used for 86 MBTSs, and these form the basis of this report. Forty-four (51.1%) shunts were performed in infancy, 25 in patients under the age of 1 month (29.0%). Prostheses of 4 mm were used in 34 cases, 5 mm in 14, and 6 mm in 38. There were five shunt failures (5.8%) documented at postmortem or angiocardiographic investigation. Including two late deaths for which postmortem examinations were not obtained, the overall failure rate was 8.1% (seven patients). All these patients were operated upon in infancy, four of them in the neonatal period. Although a longer follow-up is necessary to assess the validity of these shunts, the early results are encouraging. We believe we can now recommend MBTS as an alternative when the classical Blalock-Taussig shunt is considered unsuitable.
    Journal of Thoracic and Cardiovascular Surgery 02/1981; 81(1):112-9. · 4.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Thirty-six of 87 modified Blalock-Taussig shunts done with expanded polytetrafluoroethylene (Gore-Tex) were restudied angiocardiographically. In 7 patients the study was carried out within 1 month of the shunt operation because the patients failed to make satisfactory clinical progress. Two shunts were occluded and 1 ws stenosed; all 3 were in neonates. The remaining 29 patients were reinvestigated electively between 5 and 29 months postoperatively and had a 97% shunt patency rate. Because of the rather high incidence of irregular or stenosed shunts among neonates with 4 mm conduits, we now prefer to use a larger conduit even in this age group.
    The Annals of Thoracic Surgery 09/1980; 30(2):137-45. DOI:10.1016/S0003-4975(10)61230-1 · 3.85 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Fifteen of 194 patients (7.7%) with tetralogy of Fallot operated upon since January 1, 1972 under a protocol of routine primary repair despite young age died in-hospital. Most deaths were from low cardiac output. Young age and smallness of size increased the risk of operation. No deaths occurred among patients older than 4 years. High hematocrit was also a risk factor. Transannular patching has an independent effect in increasing risk. The post-repair ratio of peak pressure in the right ventricle to that in the left did not exert an independent effect. To project current risks of a two-stage approach, we determined that five of 158 patients (3.2%) died in-hospital after secondary intracardiac repair after a previous Blalock-Taussig or Waterston anastomosis between 1967--1978. Using these data and those we have published on the risk of shunting, we project that except in very small babies, the risks of hospital death of a two-stage approach are not less than those of primary repair done without a transannular patch, except when body surface area is less than about 0.35 m2. When a transannular patch is used in the primary repair, the two-stage approach is projected to be safer when the child has a body surface area of about 0.48 m2 or smaller.
    Circulation 09/1979; 60(2):373-86. DOI:10.1161/01.CIR.60.2.373 · 14.43 Impact Factor
Show more