title: The short- and long-term effect of Blalock-Taussig shunt size on the outcome after first palliative surgery for cyanotic heart diseases.
abstract: OBJECTIVE
  The Blalock-Taussig (BT) shunt is regarded a safe and effective means increasing pulmonary blood flow for cyanotic heart conditions. The evaluation of shunt size for postoperative hemodynamics and until second-stage palliation remains difficult. Our objective is to compare the effect of different shunt sizes on short- and long-term outcomes after a BT shunt surgery.
  
  
  METHODS
  This is a retrospective review in a tertiary care hospital.
  
  
  METHODS
  The records of all patients with a modified BT shunt between January 2007 and January 2010 were reviewed.
  
  
  METHODS
  Patients were divided into 2 groups: Group A with a BT shunt of 3.5 mm and Group B with a BT shunt of 4 mm, and their body weight was less than 4 kg. Groups were compared for the short-term outcome, which includes: intensive care unit course, intensive care unit (ICU) and hospital stay, mortality during the same admission, and the size of branch pulmonary arteries (PAs) before second surgery.
  
  
  RESULTS
  A total of 29 (42%) patients were in Group A and 40 (58%) in Group B. There was no significant difference in the mean weight between both groups; P value .06. There was no significant difference between the 2 groups in regard to diastolic blood pressure and lactate levels by the end of the first 48 hours after surgery. Group A required longer duration of inotropes and more days of ventilation with P value .03 and .001, respectively. The mean (standard deviation) ICU and hospital stay were 10.0 (8.9) days and 17.0 (11.4) days, respectively, for Group A and 12 (8.9) days and 15 (12.9) days, respectively, for Group B with P value .7 and P value .6, respectively. Yet Group B had a better branch PA size and required lesser intervention for branch PAs in comparison to Group A.
  
  
  CONCLUSIONS
  These data suggest that a smaller shunt size may have a trend toward higher morbidity. A bigger shunt size does not necessarily lead to stealing phenomena and its consequences, and can be performed with a low risk leading to a better growth of branch PAs.
authors.affiliation: Raja Abou Elella, MD, Heart Centre, King Faisal Specialist Hospital and Research Centre,, PO Box 3354, Riyadh 11211, Saudi Arabia, rabouelella@yahoo.com.
authors.forename: Raja Abou
authors.initials: RA
authors.lastname: Elella
authors.forename: Neil
authors.initials: N
authors.lastname: Umereta
authors.forename: Ismail
authors.initials: I
authors.lastname: Alabari
authors.forename: Mamdouh
authors.initials: M
authors.lastname: Al Ahmadi
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al Wadai
mesh_terms: D062186:Arterial Pressure; D058366:Blalock-Taussig Procedure / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D010166:Palliative Care; D011651:Pulmonary Artery / Q000601:surgery*; D018633:Pulmonary Atresia / Q000601:surgery; D011666:Pulmonary Valve Stenosis / Q000601:surgery; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000601:surgery; D014188:Transposition of Great Vessels / Q000601:surgery; D016896:Treatment Outcome