title: Systemic-pulmonary artery shunts in infants: modified Blalock-Taussig and central shunt procedures.
abstract: Access is gained through a midline sternotomy, the thymus partially excised and the superior part of the pericardium is opened. The innominate vein is retracted and the innominate artery is mobilized up to the bifurcation. The aorta is retracted to the left, the superior vena cavae to the right and the right atrial appendage inferiorly. The adventitia around the right pulmonary artery (PA) is dissected, taking care to incise the bulky pericardial reflection between the superior vena cavae and the trachea. Heparin is administrated. An occlusive clamp is applied to the right PA to test for haemodynamic tolerance prior to proceeding with the interposition of a suitable size artificial vascular prosthesis, based on the weight of the patient, between the innominate artery, or proximal subclavian artery and the right PA. Alternatively, if a sufficient main PA is present and adequate flow from a patent ductus arteriosus an end-to-side interposition shunt may be constructed between the ascending aorta and the main PA, provided the patient is stable with the test occlusion of the main PA. The management of the patent arterial ductus depends on whether or not there is forward flow through the PA.
authors.affiliation: Chris Barnard Division of Cardiothoracic Surgery at Red Cross Children's Hospital, Cape Heart Centre, University of Cape Town, Cape Town, South Africa.
authors.forename: Andre
authors.initials: A
authors.lastname: Brooks
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D016122:Brachiocephalic Trunk / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D003490:Cyanosis; D005260:Female; D006330:Heart Defects, Congenital / Q000145:classification / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011651:Pulmonary Artery / Q000601:surgery; D011652:Pulmonary Circulation; D013019:South Africa; D013348:Subclavian Artery / Q000601:surgery; D016019:Survival Analysis
keywords: Blalock–Taussig shunt; Central shunt; Cyanotic heart disease; Modified Blalock–Taussig shunt; Shunt