Criterions for selection of patients for, and results of, a new technique for construction of the modified Blalock-Taussig shunt.
BACKGROUND
We describe alternative surgical techniques for construction of systemic-to-pulmonary arterial shunts, and propose criterions for their application in selected patients.


METHODS
We constructed a variety of modified systemic-to-pulmonary arterial shunts, using polytetrafluoroethylene grafts, in 92 selected patients with cyanotic congenital heart disease and anomalies of the aortic arch and systemic veins. Their age ranged from 7 days to 3.6 years, with a mean of 7.08 months. We performed 88 operations through a thoracotomy. Of this cohort, 60 patients underwent a second-stage operation, with 15 receiving a superior cavopulmonary connection, 16 a total cavopulmonary connection, and 29 proceeding to biventricular repair after a mean interval of 15.6 months. We have 21 patients awaiting their second or final stage of palliation.


RESULTS
There were five early (5.4%) and six late deaths (6.8%), two of which were related to construction of the shunts. At a mean follow-up of 45.29 months, the increase in diameter of pulmonary trunk and its right and left branches was uniform and significant (p value less than 0.001). Pulmonary arterial distortion requiring correction at the time of second-stage operation was observed in 5 patients (6.1%). Adequate overall palliation was achieved in 98% of the cohort at 8 months, 91% at 12 months, and 58% at 18 months.


CONCLUSIONS
Patients with a right- or left-sided aortic arch and right-sided descending thoracic aorta, those with anomalies of systemic venous drainage masking the origin of great arterial branches, and those with disproportionately small subclavian arteries, constitute the ideal candidates for our suggested modification of the construction of a modified Blalock-Taussig shunt. The palliation provided by these shunts was satisfactory, with predictable growth of pulmonary arteries, insignificant distortion in the great majority, and easy take-down.
Chowdhury
Ujjwal K
UK
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India. ujjwalchow@rediffmail.com
Venugopal
Panangipalli
P
Kothari
Shyam S
SS
Saxena
Anita
A
Talwar
Sachin
S
Subramaniam
Ganapathy
G
Singh
Rajvir
R
Pradeep
Kizakke K
KK
Sathia
Siddhartha
S
Kumar
A Sampath
AS
D000714:Anastomosis, Surgical / Q000379:methods; D000792:Angiography; D001013:Aorta, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D002675:Child, Preschool; D003657:Decision Making; D004452:Echocardiography; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018579:Patient Selection; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000601:surgery*; D016896:Treatment Outcome; D014684:Venae Cavae / Q000601:surgery*
D011138:Polytetrafluoroethylene