Risk factor of interim failure and early detection of the high-risk patients with functional single ventricle after Blalock-Taussing shunt.
OBJECTIVE
The purpose of this study was to identify the risk factor of interim failure and to consider the method for detecting high-risk patients after Blalock-Taussing shunt.


METHODS
Between 1990 and 2004, 64 patients with functional single ventricle and low pulmonary flow underwent Blalock-Taussing shunt. We evaluated risk factors of interim failure by Logistic regression. Furthermore, assessments by catheterization and echocardiography were compared between Group Completion (Group C; 36 patients who had completed the Fontan operation or were Fontan candidates) and Group Failure (Group F; 20 patients who died before the Fontan operation or dropped out from Fontan candidate).


RESULTS
In Group C, the survival at 10 years was 93%. The risk factor of interim failure was a systemic ventricular end-diastolic volume (SVEDV) of more than 250% of normal after shunt. The ventricular volume by echocardiography in Group C had been maintained between 190% and 200% of normal. By contrast, the ventricle in Group F had been significantly dilated after postshunt short term.


CONCLUSIONS
The risk factor of interim failure was postshunt ventricular dilation, and the dilation was identified after postshunt short term. We recommend volume study within two to three months after shunt, and bidirectional cavopulmonary anastomosis should be immediately indicated to patients with ventricular dilation.
Department of Cardiovascular Surgery, Chiba Children's Hospital, Chiba, Japan. nishibas@cnmc.org
Nobuyuki
N
Ishibashi
Mitsuru
M
Aoki
Manabu
M
Watanabe
Hiromichi
H
Nakajima
Hiroyuki
H
Aotsuka
Tadashi
T
Fujiwara
D000714:Anastomosis, Surgical / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000473:pathology / Q000601:surgery*; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011651:Pulmonary Artery / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014463:Ultrasonography