title: "Reverse Blalock-Taussig shunt": application in single ventricle hybrid palliation.
abstract: OBJECTIVE
  Retrograde aortic arch malperfusion after ductal stenting can be life-threatening after univentricular hybrid palliation. Arch perfusion can be maintained with a main pulmonary artery to innominate artery shunt placed during the stage I procedure: a "reverse Blalock-Taussig shunt."
  
  
  METHODS
  A retrospective review of 37 infants who underwent hybrid palliation from January 2004 to March 2010 was performed. The infants were divided into 2 groups, those with (group I, n = 16) and those without (group II, n = 21) a reverse Blalock-Taussig shunt.
  
  
  RESULTS
  At the initial palliation, no differences were found in the demographics, systolic or diastolic pressures, or ventricular or atrioventricular valve function between the 2 groups. Group I had more infants with aortic atresia (P < .01) and smaller ascending aortas (P < .01). Before stage II, the retrograde aortic Doppler flow velocity increased in group I (P < .01) and was unchanged in group II. The reintervention rates before stage II were similar between the 2 groups. Before stage II, the ventricular end-diastolic pressure, left and right pulmonary artery pressures and diameters, and mixed venous and arterial saturations were similar between the 2 groups. The complication rates between the 2 groups were not significantly different, although a nonsignificant trend toward more neurologic complications was noted in group I. The Kaplan-Meier survival estimate at 1 year was similar between the 2 groups (63% for group I vs 71% for group II).
  
  
  CONCLUSIONS
  The presence of a reverse Blalock-Taussig shunt was not associated with more adverse events than those without. Gradual retrograde arch obstruction occurs commonly in palliated infants with aortic atresia. A reverse Blalock-Taussig shunt might play an important role to address the potential of retrograde obstruction, augmenting arch blood flow.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada.
authors.forename: Kenji
authors.initials: K
authors.lastname: Baba
authors.forename: Osami
authors.initials: O
authors.lastname: Honjo
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chaturvedi
authors.forename: Kyong-Jin
authors.initials: KJ
authors.lastname: Lee
authors.forename: Glen
authors.initials: G
authors.lastname: Van Arsdell
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Caldarone
authors.forename: Lee N
authors.initials: LN
authors.lastname: Benson
mesh_terms: D001013:Aorta, Thoracic / Q000503:physiopathology; D058366:Blalock-Taussig Procedure / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D001783:Blood Flow Velocity; D016122:Brachiocephalic Trunk / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D010166:Palliative Care / Q000379:methods*; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome