Systemic pulmonary shunt performed with Shelhigh internal mammary artery: early results.
OBJECTIVE
The purpose of this study was to evaluate early findings for aortopulmonary shunts using bovine internal mammary artery grafting.


METHODS
Bovine internal mammary artery grafts biomodified with glutaraldehyde and the Shelhigh No-React process were used between May 2005 and April 2006 in our clinic for 20 cases of aorta-pulmonary artery shunts. We implanted 2 sizes of grafts, either a graft with 4-mm proximal and 5-mm distal diameters or a graft with 5-mm proximal and 6-mm distal diameters. Patients were between 20 days and 7 years of age, and the sex distribution was 55% female and 45% male. A Blalock-Taussig shunt with left thoracotomy was performed in patients 2 years of age and older, and a central shunt with sternotomy was performed for patients younger than 2 years. Eight patients underwent operation under emergency conditions. Nine patients had tetralogy of Fallot and/or pulmonary atresia (PA); 3 had transposition of the great arteries, ventricular septal defect, and pulmonary stenosis (PS); 3 had tricuspid atresia; 3 had PS and double-inlet left ventricle; and 2 had PA.


RESULTS
After the operation, immediate recovery of oxygen saturation and partial oxygen pressure was observed in all patients. Pulse oximetry measurements showed patient oxygen saturation to be between 84% and 100%. One patient underwent reoperation at the third postoperative hour because of bleeding. Two patients died from causes unrelated to the graft. The hospitalization period was between 7 and 29 days. Echocardiography evaluations showed no shunt obstruction for the early (first postoperative week) or middle (postoperative week 24) period.


CONCLUSIONS
With this study, we assessed the use of the Shelhigh internal mammary artery graft instead of synthetic (polytetrafluoroethylene) tubular grafts in shunt operations for congenital heart diseases with decreased pulmonary blood flow and no evidence of calcification. Further investigation involving a larger number of cases and longer-term results for patency are needed to confirm our findings.
Poyrazoglu
H Hakan
HH
Cardiovascular Surgery Department, Cukurova University, Adana, Turkey. hpoyrazoglu@yahoo.com
Avşar
M Kemal
MK
Tor
Funda
F
Erdem
Sevcan
S
Göçen
Uğur
U
Bayraktar
Ihsan
I
Kayhan
Cem
C
Ozbarlas
Nazan
N
Salih
O Kemal
OK
D000818:Animals; D001011:Aorta / Q000601:surgery*; D016122:Brachiocephalic Trunk / Q000601:surgery; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods*; D010313:Partial Pressure; D011651:Pulmonary Artery / Q000601:surgery*; D013997:Time Factors