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Does the modified Blalock-Taussig shunt cause growth of the contralateral pulmonary artery?
M Jahangiri1, C Lincoln, E A Shinebourne
1Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, England.
Insights
Modified Blalock-Tausssig shunts promote equal growth of both right and left pulmonary arteries in infants with tetralogy of Fallot. This surgical palliation technique is effective for improving pulmonary artery development before corrective surgery.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Palliation
Background:
- Tetralogy of Fallot (TOF) management varies, with some centers favoring primary correction while others utilize palliative shunts in infants.
- Effective palliation aims to alleviate symptoms and promote pulmonary artery growth, crucial for subsequent corrective surgery.
- While classic Blalock-Tausssig shunt effects on pulmonary artery growth are documented, data on the modified Blalock-Tausssig shunt are less extensive.
Purpose of the Study:
- To investigate the impact of the modified Blalock-Tausssig shunt on the growth of the contralateral pulmonary artery in infants with symptomatic Tetralogy of Fallot.
- To determine if the modified Blalock-Tausssig shunt leads to symmetrical development of the right and left pulmonary arteries.
Main Methods:
- Retrospective analysis of 140 infants with symptomatic Tetralogy of Fallot who underwent a modified Blalock-Tausssig shunt between 1985 and 1995.
- Cineangiography before corrective surgery was used to measure the diameters of the right and left pulmonary arteries and the descending thoracic aorta.
- Ratios of pulmonary artery to descending thoracic aorta diameters were calculated and compared using Student's t-test.
Main Results:
- The study included 140 patients: 114 with left-sided shunts, 20 with right-sided shunts, and 6 with bilateral shunts.
- The mean ratio of the right pulmonary artery to the descending thoracic aorta was 1.10.
- The mean ratio of the left pulmonary artery to the descending thoracic aorta was 0.98, with no statistically significant difference between the two sides.
Conclusions:
- The modified Blalock-Tausssig shunt results in equal growth of the right and left pulmonary arteries without significant distortion.
- This finding supports the continued use of the modified Blalock-Tausssig shunt as a preferred palliative option for select infants with Tetralogy of Fallot.
- The study highlights the importance of pulmonary artery development in palliative strategies for congenital heart defects.
Background:
Although some pediatric cardiology departments have a policy of adopting primary correction of tetralogy of Fallot in all symptomatic infants, we and others still palliate neonates and infants. Effective palliation should ameliorate symptoms and allow growth of the pulmonary arteries. Although studies on the growth of the ipsilateral and contralateral pulmonary arteries after a classic Blalock-Taussig shunt have been reported, pulmonary artery growth after a modified Blalock-Taussig shunt has not been studied as thoroughly. Therefore, we examined whether there is equal growth of the contralateral pulmonary artery after a modified Blalock-Taussig shunt.
Methods:
We retrospectively analyzed the records of 140 patients with symptomatic tetralogy of Fallot who had a modified Blalock-Taussig shunt between October 1985 and October 1995. The median age at the time of the Blalock-Taussig shunt was 1.6 months. All patients had corrective procedures at a median age of 1.7 years. Cineangiography was done before the corrective procedure. From the angiograms the diameter of the right and left pulmonary arteries before their first lobar branches and the diameter of the descending thoracic aorta at the level of the diaphragm were measured. For each patient the ratios of right pulmonary artery to descending thoracic aorta and left pulmonary artery to descending thoracic aorta were determined and compared using Student's t test.
Results:
Of the 140 patients, 114 had a left-sided Blalock-Taussig shunt, 20 had a right-sided shunt, and 6 patients had bilateral shunts. The mean right pulmonary artery to descending thoracic aorta ratio was 1.10 and the mean left pulmonary artery to descending thoracic aorta ratio was 0.98. This difference was not significant.
Conclusion:
We showed equal growth of the right and left pulmonary arteries with no distortion after a modified Blalock-Taussig shunt. If palliation is considered, the modified Blalock-Taussig shunt remains our choice.
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