Twelve year experience with the modified Blalock-Taussig shunt in neonates.
Between 1978 and 1990, 53 consecutive modified Blalock-Taussig (MBT) shunts were performed on 51 neonates with cyanotic congenital heart disease using 3 mm-5 mm Gore-Tex grafts. Only 4 of these children had uncomplicated tetralogy of Fallot. The remainder had more complicated pathology requiring urgent intervention. Retrospective analysis of the acute and long term results was performed with 100% follow-up, ranging from 1 month to 12 years (mean 3 years). There were 3 (6%) early deaths (within 30 days of operation) and 17 (33%) late deaths. Of the late deaths, 2 died after further palliation, 2 died after total correction and 13 died suddenly at home. Post mortem examination of the 13 sudden deaths revealed blocked shunts in only 3. Actuarial survival at 2 years was 58%. Shunt patency at 12 months was 87% and at 2 years, 62%. No patient used their initial MBT shunt for more than 40 months. Although this shunt provides good initial palliation, there is a high incidence of late sudden death. We are also concerned about the limited life span of the shunt which partly (3/13) explains the sudden deaths. Therefore we have adopted an aggressive approach to re-study by angiography within 3 months of surgery.
Fermanis
G G
GG
Department of Cardiac Surgery, Wessex Cardiothoracic Centre, Southampton General Hospital, UK.
Ekangaki
A K
AK
Salmon
A P
AP
Keeton
B R
BR
Shore
D F
DF
Lamb
R K
RK
Monro
J L
JL
D000206:Actuarial Analysis; D001013:Aorta, Thoracic / Q000601:surgery; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000401:mortality / Q000601:surgery; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011651:Pulmonary Artery / Q000601:surgery; D012086:Reoperation; D015996:Survival Rate; D013771:Tetralogy of Fallot / Q000401:mortality / Q000601:surgery*
D011138:Polytetrafluoroethylene