Progress of patients with pulmonary atresia after systemic to pulmonary arterial shunts.
Between February 1980 and June 1987, 42 shunts were placed in 39 infants with pulmonary atresia: 33 were modified Blalock-Taussig shunts with polytetrafluoroethylene (PTFE) and 9 were classic Blalock-Taussig shunts. There were four hospital deaths not related to the shunts. The remaining 35 patients were followed up for 1.6 months to 6.3 years (mean, 24.7 +/- 18 months). Repeat cineangiocardiographic studies revealed stenosis or distortion of the pulmonary arteries related to the site of the shunt in 11/22 patients (50%) with PTFE shunts and in 1/6 (17%) with classic Blalock-Taussig shunts; the stenosis was severe in only 1 patient. Mean increase in the pulmonary arterial index in the group with classic Blalock-Taussig shunts was 117 +/- 52 mm2/m2 (not significant) and in the group with PTFE shunts, 158 +/- 21 mm2/m2 (p less than 0.001). Late shunt occlusion occurred in 1 patient 23 months postoperatively. Thereafter, shunt patency rate remained at 94% +/- 6%. At the end of 1 year 81% +/- 7% of patients were judged to have adequate palliation, but between 2 and 3 years, only 60% +/- 10%. Univariate analysis showed that after 2 years the ranking order for successful palliation was classic Blalock-Taussig, 5-mm PTFE, and 4-mm PTFE shunts, but differences did not achieve statistical significance.
Calder
A L
AL
Department of Cardiology, Green Lane Hospital, Auckland, New Zealand.
Chan
N S
NS
Clarkson
P M
PM
Kerr
A R
AR
Neutze
J M
JM
D000015:Abnormalities, Multiple / Q000401:mortality / Q000601:surgery; D000714:Anastomosis, Surgical / Q000009:adverse effects; D000790:Angiocardiography; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000401:mortality; D001807:Blood Vessel Prosthesis; D002932:Cineangiography; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010166:Palliative Care; D011138:Polytetrafluoroethylene; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D011664:Pulmonary Valve / Q000002:abnormalities* / Q000601:surgery; D012086:Reoperation; D013348:Subclavian Artery / Q000601:surgery*; D015996:Survival Rate; D014654:Vascular Patency
D011138:Polytetrafluoroethylene