title: Side-to-side aorto-GoreTex central shunt warrants central shunt patency and pulmonary arteries growth.
abstract: BACKGROUND
  Central shunts may be associated with a high rate of thrombosis and pulmonary artery distortion.
  
  
  METHODS
  Between January 2000 and April 2010, 68 consecutive patients underwent side-to-side aorto-Gore-Tex central shunts (W.L. Gore & Associates, Flagstaff, AZ). Median age at surgery was 31 days (8 to 122). Cardiac morphologies were tetralogy of Fallot (33), pulmonary atresia with collateral dependent lung circulation (20), and other (15). Shunt sizes ranged from 3 to 6 mm. The procedure was performed on cardiopulmonary bypass in 43 patients (63%).
  
  
  RESULTS
  Six patients died during hospital stay (9%) of low output syndrome (3), sepsis (2), and stroke (1). Only one shunt needed early redo. Follow-up was 100% complete. After a median follow-up of 236 days (116 to 340), there were 7 late deaths related to sudden death (3), sepsis (2), reoperation (1), and lack of growth of pulmonary arteries with a patent shunt (1). Repair was completed in 42 patients and still pending in 12. Only one patient needed a late redo shunt (221 days). A larger shunt was performed in 5 patients after a median of 139 days (130 to 258). In the 45 patients who had serial assessment of pulmonary arteries sizes, Nakata index increased from 83 ± 62 mm(2)/m(2) to 153 ± 83 mm(2)/m(2) over a median period of 227 days (146 to 330), with equal growth observed in both pulmonary arteries (p < 0.001).
  
  
  CONCLUSIONS
  Central shunts can be performed in neonates and children with minimal risk of shunt occlusion. Side-to-side aorto-Gore-Tex anastomosis seems to reliably warrant shunt patency and harmonious growth of pulmonary arteries.
authors.affiliation: Royal Children's Hospital, Melbourne, Australia.
authors.forename: Luca
authors.initials: L
authors.lastname: Barozzi
authors.forename: Christian P
authors.initials: CP
authors.lastname: Brizard
authors.forename: John C
authors.initials: JC
authors.lastname: Galati
authors.forename: Igor E
authors.initials: IE
authors.lastname: Konstantinov
authors.forename: Lyubomyr
authors.initials: L
authors.lastname: Bohuta
authors.forename: Yves
authors.initials: Y
authors.lastname: d'Udekem
mesh_terms: D000714:Anastomosis, Surgical; D001013:Aorta, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D006085:Graft Survival; D006330:Heart Defects, Congenital / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000639:trends; D008297:Male; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000254:growth & development* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*; D014739:Victoria / Q000453:epidemiology
chemical_list: D011138:Polytetrafluoroethylene