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Ann Thorac Surg 1987;44:128-134
© 1987 The Society of Thoracic Surgeons

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Articles

Optimal Flow of Aorta–Pulmonary Artery Shunt in Patients with Cyanotic Heart Disease

Division of Cardiovascular Surgery, Tenri Hospital, Tenri City, Nara, Japan

Accepted for publication December 12, 1986.

^* Address reprint requests to Dr. Kusuhara, Division of Cardiovascular Surgery, Tenri Hospital, 200 Mishimacho, Tenri City, Nara, Japan 632

An aorta–pulmonary artery shunt with an expanded polytetrafluoroethylene (Gore-Tex) tube graft (3 to 6 mm in diameter) was done in 33 cyanotic patients with complex congenital heart disease. The patients ranged from 14 days to 22 years old. In 28, the shunt flow (Q_B) was measured, and the optimal Q_B and graft size were determined.

Nine patients had severe heart failure because of an excessively large shunt. Seven of these patients died, 5 early and 2 late after operation. The Q_Bs in these 9 patients were extremely high; the Q_B index and the ratio of shunt flow to systemic flow (Q_B/Q_s) were 3.86 ± 0.91 L/min/m² (mean ± standard deviation) and 52.4 ± 9.7%, respectively. The Q_B index and the Q_B/Q_s of patients without severe cardiac failure were 1.49 ± 0.92 L/min/m² and 27.2 ± 11.4%, respectively.

In conclusion, the Q_B index, the Q_B/Q_s, or both should be maintained in the range of 1.6 to 2.4 L/min/m² and 30 to 40%, respectively. In infants, however, it is advisable to control the flow at less than the range just given. Analysis of graft size in relation to body weight (BW, in kilograms) and body surface area (BSA, in square meters) showed that the optimal diameter (D, in millimeters) could be calculated by the following formulas:

D = 1.88 ln(BW) + 1.8 (r = .86)

D = 0.87 ln(BSA) + 5.3 (r = .73)

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