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Ann Thorac Surg 1987;44:495-498
© 1987 The Society of Thoracic Surgeons

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Articles

Indication for Systemic-Pulmonary Artery Shunts Guided by Two-Dimensional and Doppler Echocardiography: Criteria for Patient Selection

From the Department of Pediatric Cardiology and Cardiac Surgery, Hospital Pediatrico "Bambino Gesú," Rome, Italy

Accepted for publication April 14, 1987.

^* Address reprint requests to Dr. Marino, Dipartimento Medico-Chirurgico di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesú, Piazza S. Onofrio, 4, 00165 Roma, Italy

From June, 1983, to February, 1987, 91 patients with pulmonary outflow tract obstruction underwent a systemic-to-pulmonary artery shunt without an invasive study. The surgical indication was based on two-dimensional (2-D) and Doppler echocardiography only. In 82 patients (90.1%), 2-D and Doppler echocardiography allowed correct assessment of the intracardiac anatomy and of the morphology of the pulmonary arteries, pulmonary veins, and aortic arch. The aortic arch anatomy was misdiagnosed in 6 patients (6.6%) who underwent a modified instead of a classic Blalock-Taussig shunt. In 3 patients (3.3%), the indication for the systemic-pulmonary artery shunt was inappropriate; in 1, operative death resulted from the incomplete diagnosis. After the preselection of patients based on knowledge of the anatomical patterns, a systemic-pulmonary artery shunt may be performed without cardiac catheterization if these rules for definitive patient selection are followed: (1) accurate clinical assessment to identify the patients with restricted pulmonary blood flow; (2) precise intracardiac diagnosis by 2-D and Doppler echocardiography; and (3) definitive 2-D echocardiographic visualization of the pulmonary venous connection and the confluence of the pulmonary arteries.

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