Operative creation of left to right cardiac shunts: pulmonary functional sequelae

The creation of left to right cardiac shunts in neonates is frequently complicated by pulmonary morbidity in the immediate postoperative course. To elucidate the pattern, severity, and cause of lung dysfunction, pulmonary function testing was performed preoperatively and 1, 3, and 7 days postoperatively on 7 neonates undergoing Blalock-Taussig shunting. Pulmonary mechanics (compliance, conductance) were determined with esophageal manometry and pneumotachography, and functional residual capacity was measured by the helium dilution technique. The infants had pulmonary function preoperatively that was similar to that of healthy term neonatal controls. Significant decreases in compliance, conductance, and functional residual capacity were found on the first postoperative day (57%, 21%, and 53% of predicted, respectively). Alterations in conductance were more severe than those in compliance, but both were low through postoperative day 3. Functional residual capacity was the least affected parameter and recovered by postoperative day 3. All parameters were normal by postoperative day 7. These data indicate that shunting is associated with pulmonary morbidity through the third postoperative day that affects the airways more than the lung parenchyma. Pulmonary function studies of these infants may clarify the etiology of pulmonary dysfunction and have an impact on therapeutic strategies used in neonates undergoing cardiac operations.