[Analysis of the intraoperative shunt flow and its effect on late prognosis after Blalock-Taussig shunt in single ventricle].
Single ventricle (SV) seems to likely to develop congestive heart failure after Blalock-Taussig shunt (BT), particularly when the regurgitation of atrioventricular valve (AVVR) is combined. Analysis of the relation between operative result and intraoperative BT shunt flow is made in order to draw a safety limit or shunt flow in SV. Twenty-six patients (pts) with SV who underwent BT had shunt flow measurement at surgery, 20 pts showed right ventricular (RV) type of SV, 5 had left ventricular (LV) type, and 1 undivided type. The common atrioventricular valve was associated in 19 patients. The age at operation ranged from 6 days to 14 years of mean 3.2 years and the flow ranged from 6 to 146 of mean 49 ml/min/kg. Seven developed congestive heart failure at late follow-up with 4 late deaths. The average flow in this group (poor result) was 68 +/- 40 (mean +/- SD) ml/min/kg, and the remaining pts with favorable results (n = 16) had a mean flow of 41 +/- 22 ml/min/kg (p less than 0.05). In the group of LV type (n = 5), there was one late death caused from apparently excessive shunt flow (146 ml/min/kg). In the group of RV type without AVVR (n = 10), three pts of poor result had flow over 50 ml/min/kg. In those with AVVR (n = 8), pts with poor result were found with flow below 50 ml/min/kg.(ABSTRACT TRUNCATED AT 250 WORDS)
Miura
T
T
Department of Surgery, Osaka University Medical School, Japan.
Matsuda
H
H
Nakano
S
S
Shimazaki
Y
Y
Sano
T
T
Ogawa
M
M
Kawashima
Y
Y
D000293:Adolescent; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications; D011379:Prognosis; D011651:Pulmonary Artery / Q000601:surgery*; D011652:Pulmonary Circulation; D013348:Subclavian Artery / Q000601:surgery*