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Criterions for selection of patients for, and results of, a new technique for construction of the modified Blalock-Taussig shunt

Published online by Cambridge University Press:  20 September 2006

Ujjwal K. Chowdhury
Affiliation:
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Panangipalli Venugopal
Affiliation:
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Shyam S. Kothari
Affiliation:
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
Anita Saxena
Affiliation:
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
Sachin Talwar
Affiliation:
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Ganapathy Subramaniam
Affiliation:
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Rajvir Singh
Affiliation:
Department of Biostatistics, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Kizakke K. Pradeep
Affiliation:
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Siddhartha Sathia
Affiliation:
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
A. Sampath Kumar
Affiliation:
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India

Abstract

Background: We describe alternative surgical techniques for construction of systemic-to-pulmonary arterial shunts, and propose criterions for their application in selected patients. Patients and methods: We constructed a variety of modified systemic-to-pulmonary arterial shunts, using polytetrafluroethylene grafts, in 92 selected patients with cyanotic congenital heart disease and anomalies of the aortic arch and systemic veins. Their age ranged from 7 days to 3.6 years, with a mean of 7.08 months. We performed 88 operations through a thoracotomy. Of this cohort, 60 patients underwent a second-stage operation, with 15 receiving a superior cavopulmonary connection, 16 a total cavopulmonary connection, and 29 proceeding to biventricular repair after a mean interval of 15.6 months. We have 21 patients awaiting their second or final stage of palliation. Results: There were five early (5.4%) and six late deaths (6.8%), two of which were related to construction of the shunts. At a mean follow-up of 45.29 months, the increase in diameter of pulmonary trunk and its right and left branches was uniform and significant (p value less than 0.001). Pulmonary arterial distortion requiring correction at the time of second-stage operation was observed in 5 patients (6.1%). Adequate overall palliation was achieved in 98% of the cohort at 8 months, 91% at 12 months, and 58% at 18 months. Conclusions: Patients with a right- or left-sided aortic arch and right-sided descending thoracic aorta, those with anomalies of systemic venous drainage masking the origin of great arterial branches, and those withdisproportionately small subclavian arteries, constitute the ideal candidates for our suggested modification of the construction of a modified Blalock-Taussig shunt. The palliation provided by these shunts was satisfactory, with predictable growth of pulmonary arteries, insignificant distortion in the great majority, and easy take-down.

Type
Original Article
Copyright
© 2006 Cambridge University Press

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Criterions for selection of patients for, and results of, a new technique for construction of the modified Blalock-Taussig shunt
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