title: Systemic pulmonary shunts in neonates: early clinical outcome and choice of surgical approach.
abstract: BACKGROUND
  Systemic pulmonary shunt remains a major strategy for the palliation of cyanotic lesions in neonates despite the associated morbidity and mortality.
  
  
  METHODS
  Between March 1993 and December 1998, 79 systemic pulmonary shunts were performed in 75 neonates with cyanosis and severely reduced pulmonary blood flow. The mean age was 11.5 days and the mean weight, 3 kg. All neonates were dependent on duct flow and prostaglandin E1 infusion for adequate oxygenation.
  
  
  RESULTS
  The systemic pulmonary shunt was performed through a right thoracotomy in 36 patients, left thoracotomy in 6, and median sternotomy in 33 patients. The 30-day mortality was 3 patients (4%). Univariate and logistic regression analyses revealed a weight less than 2 kg (p = 0.039) and preoperative mechanical ventilation (p = 0.008), to be predictors of early mortality, whereas pulmonary hypoplasia (p = 0.55), diagnostic group (p = 0.79), shunt size (p = 0.2), and surgical approach (p = 0.5) were not. There were seven episodes of shunt-related complications that required early intervention.
  
  
  CONCLUSIONS
  Systemic pulmonary shunt remains an effective palliative measure in cyanotic neonates despite specific complications. Both low weight and preoperative ventilation represent significant risk factors for early mortality.
authors.affiliation: Service de Chirurgie, Marie Lannelongue Hôpital, Université Paris Sud, Le Plessis-Robinson, France. abdulalkh@talk21.com
authors.forename: A M
authors.initials: AM
authors.lastname: Alkhulaifi
authors.forename: F
authors.initials: F
authors.lastname: Lacour-Gayet
authors.forename: A
authors.initials: A
authors.lastname: Serraf
authors.forename: E
authors.initials: E
authors.lastname: Belli
authors.forename: C
authors.initials: C
authors.lastname: Planché
mesh_terms: D000527:Alprostadil / Q000008:administration & dosage; D000714:Anastomosis, Surgical; D019917:Blood Vessel Prosthesis Implantation; D016122:Brachiocephalic Trunk / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008722:Methods; D010166:Palliative Care; D011651:Pulmonary Artery / Q000601:surgery*; D012307:Risk Factors
chemical_list: D000527:Alprostadil