title: Hybrid approach to surgical correction of tetralogy of Fallot in all patients with functioning Blalock Taussig shunts.
abstract: BACKGROUND
  In total surgical correction of tetralogy of Fallot (TOF) with functioning Blalock Taussig shunts (BTS), shunt take down increased surgical time, bleeding, and might injure phrenic and recurrent laryngeal nerve and thoracic duct.
  
  
  OBJECTIVE
  A routine hybrid approach using transcatheter BTS closure immediately before total surgical correction of TOF in all patients might reduce these problems. We analyze the safety and feasibility of this approach.
  
  
  METHODS
  Transcatheter BTS closure was achieved using single or multiple stainless steel embolization coils, Amplatzer vascular plugs, or duct occluders. When coils were released without control by bioptome forceps, coil migration in larger shunts was prevented by proximal or distal balloon occlusion.
  
  
  RESULTS
  This routine hybrid strategy was followed in 22 consecutive patients aged 1-13 years over 4-year-period and 21 procedures were successful. Among the 16 patients attempted with coils, 13 had successful closure, 2 needed Amplatzer duct occluder devices, and 1 sent for surgical shunt takedown due to acute angulation of the shunt. New Amplatzer vascular plugs were used in six patients. Bioptome was used in six patients and proximal or distal balloon occlusion of flow was used in three patients. Four patients had closure of associated aortopulmonary or chest wall collaterals.
  
  
  CONCLUSIONS
  Hybrid approach using routine transcatheter closure of all BTS immediately before surgical correction of TOF shunts with coils/plugs/devices is safe, feasible, and reproducible.
authors.affiliation: Department of Pediatric Cardiology, Apollo Hospital, Colombo, Srilanka. drkumarsiva@hotmail.com
authors.forename: Kothandam
authors.initials: K
authors.lastname: Sivakumar
authors.forename: Prasad
authors.initials: P
authors.lastname: Krishnan
authors.forename: Rajeeva
authors.initials: R
authors.lastname: Pieris
authors.forename: Edwin
authors.initials: E
authors.lastname: Francis
mesh_terms: D000714:Anastomosis, Surgical; D021721:Balloon Occlusion / Q000009:adverse effects / Q000295:instrumentation; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003326:Coronary Circulation; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation; D005240:Feasibility Studies; D006801:Humans; D007223:Infant; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D013348:Subclavian Artery / Q000000981:diagnostic imaging; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome