Surgical strategy for pulmonary coarctation in the univentricular heart.
OBJECTIVE
The placement of a modified Blalock-Taussig shunt in patients suffering from pulmonary coarctation can result in the aggravation of uneven pulmonary blood flow. This may subsequently obviate the possibility of future performance of the Fontan procedure. The objective of this study was to evaluate mid-term results in patients with pulmonary coarctation who had undergone the placement of a modified Blalock-Taussig shunt, coupled with a pulmonary artery angioplasty.


METHODS
We retrospectively reviewed the records of 13 patients who had undergone the placement of a modified Blalock-Taussig shunt, coupled with concomitant pulmonary angioplasty, between September 1998 and August 2002. All patients received follow-up angiographic evaluations.


RESULTS
On the ipsilateral side of the modified Blalock-Taussig shunt, we observed a significant increase in the pulmonary artery index during a mean follow-up period of 11+/-5 months (preoperative 82+/-37 mm2/m2, follow-up 129+/-57, p=0.03). On the contralateral side, we also observed a significant increase in the pulmonary artery index (preoperative 90+/-56 mm2/m2, follow-up 137+/-56, p=0.047). There was one late death. During the follow-up period (mean 23+/-18 months), 10 patients received either a bidirectional or total cavopulmonary shunt and five of these patients underwent extracardiac Fontan operations.


CONCLUSIONS
Our study demonstrated that the placement of a modified Blalock-Taussig shunt, with concomitant pulmonary artery angioplasty, constitutes a good initial surgical strategy in cases of univentricular heart with pulmonary coarctation.
Kim
Hyun Koo
HK
Department of Thoracic and Cardiovascular Surgery, Pediatrics, Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea.
Kim
Woong-Han
WH
Kim
Soo-Cheol
SC
Lim
Cheong
C
Lee
Chang Ha
CH
Kim
Soo-Jin
SJ
D000714:Anastomosis, Surgical / Q000295:instrumentation; D017130:Angioplasty / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000295:instrumentation; D004867:Equipment Design; D006330:Heart Defects, Congenital / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011138:Polytetrafluoroethylene; D011651:Pulmonary Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011652:Pulmonary Circulation / Q000502:physiology; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene