Sternotomy approach for modified Blalock-Taussig shunt: is it a safe option?
Central aorta-pulmonary artery shunts have fallen into disfavor because of shunt thrombosis and congestive heart failure, and a modified Blalock-Taussig shunt via thoracotomy can lead to pulmonary artery hypoplasia and distortion. We reviewed the outcomes of a modified Blalock-Taussig shunt by a sternotomy approach in 20 infants from July 2007 to October 2009. Their mean age was 5.79 months, and median weight was 5.4 kg. A 4-mm graft was placed in 11 patients, a 5-mm graft in 8, and a 3.5-mm graft in 1. There was no incidence of sepsis, seroma, or phrenic nerve palsy. There was one hospital death. The mean hospital stay was 10.4 +/- 4.3 days (range, 8-15 days). The mean oxygen saturation at discharge was 89% (range, 81%-93%). The sternotomy approach is technically easier to perform, cosmetically preferable, and probably hemodynamically superior. Correction of branch pulmonary stenosis is easily incorporated into this procedure. The theoretical disadvantage of this method is a potential technical difficulty with sternal reentry for subsequent procedures.
Kandakure
Pramod Reddy
PR
Department of Pediatric Cardiac Surgery and Cardiac Anesthesiology, Innova Children's Heart Hospital, Tarnaka, Secunderabad, India. drpramodreddy@yahoo.com
Dharmapuram
Anil Kumar
AK
Ramadoss
Nagarajan
N
Babu
Vivek
V
Rao
Ivatury Mrityunjaya
IM
Murthy
Kona Samba
KS
D001011:Aorta / Q000503:physiopathology / Q000601:surgery*; D058366:Blalock-Taussig Procedure / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome