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Systemic-pulmonary shunts in infants and children. Early and late results
Insights
This study compared four systemic-pulmonary artery shunts in 44 children with reduced pulmonary blood flow. The Great Ormond Street shunt is preferred due to low risk, predictable patency, and ease of use.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Surgical Palliation
Background:
- Cyanotic infants and children often require surgical intervention to improve pulmonary blood flow.
- Systemic-pulmonary artery shunts are a common palliative strategy for reduced pulmonary blood flow.
Purpose of the Study:
- To evaluate the outcomes of four different types of systemic-pulmonary artery shunts in pediatric patients.
- To identify the preferred shunt type based on safety, efficacy, and technical considerations.
Main Methods:
- A retrospective review of 44 cyanotic infants and children who underwent systemic-pulmonary artery shunting between 1978 and 1983.
- Comparison of four shunt types: classic Blalock-Taussig, central polytetrafluoroethylene, interposition modified Blalock-Taussig, and Great Ormond Street modified Blalock-Taussig.
- Analysis of operative mortality, shunt revision rates, and late mortality.
Main Results:
- Overall operative mortality was 2.3% (1/44).
- Four shunts required early revision due to thrombosis, kinking, undersizing, or oversizing.
- Two late deaths were possibly shunt-related.
- All shunt types provided good palliation, with 100% patency for the Great Ormond Street type.
Conclusions:
- The Great Ormond Street type of modified Blalock-Taussig shunt is recommended.
- This preference is based on its low operative risk, excellent and predictable patency, minimal distortion of pulmonary arteries, and ease of surgical management.
- Systemic-pulmonary artery shunts remain a valuable palliative option for complex congenital heart disease.
Abstract:
From September, 1978, to January, 1983, 44 cyanotic infants and children underwent a systemic-pulmonary artery shunt for the treatment of reduced pulmonary blood flow. Age ranged from 18 hours to 4 years (mean age = 0.49 years). Weight ranged from 1.7 kg to 13.2 kg (mean weight = 4.9 kg). There were 12 classic Blalock-Taussig shunts, five central polytetrafluoroethylene shunts, six interposition modified Blalock-Taussig shunts, and 21 Great Ormond Street type of modified Blalock-Taussig shunts. No direct aorta-pulmonary artery anastomoses were performed. There was one postoperative death (1/44 = 2.3%) in a 1,700 gm neonate born with pulmonary atresia and intact ventricular septum (shunt patent). Four shunts required early revision: one thrombosed central shunt, a kinked patent interposition Blalock-Taussig shunt, a small but patent Blalock-Taussig shunt, and one excessive Great Ormond Street type of Blalock-Taussig shunt. Two late deaths were probably shunt-related: one Blalock-Taussig and one central. All four types of shunts provided good palliation, but the Great Ormond Street type of Blalock-Taussig shunt is our preferred shunt because of (1) low operative risk, (2) predictable patency (100% in our series), (3) lack of distortion of pulmonary arterial anatomy, and (4) technical ease of insertion as well as takedown.