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Ann Thorac Surg 1991;51:401-407
© 1991 The Society of Thoracic Surgeons

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Articles

Progress of patients with pulmonary atresia after systemic to pulmonary arterial shunts

Departments of Cardiology and Cardiothoracic Surgery, Green Lane Hospital, Auckland, New Zealand

Accepted for publication October 30, 1990.

^_* Address reprint requests to Dr Calder, Department of Cardiology, Green Lane Hospital, Green Lane West, Auckland 3, New Zealand.

Between February 1980 and June 1987, 42 shunts were placed in 39 infants with pulmonary atresia: 33 were modified Blalock-Taussig shunts with polytetrafluoroethylene (PTFE) and 9 were classic Blalock-Taussig shunts. There were four hospital deaths not related to the shunts. The remaining 35 patients were followed up for 1.6 months to 6.3 years (mean, 24.7 ± 18 months). Repeat cineangiocardiographic studies revealed stenosis or distortion of the pulmonary arteries related to the site of the shunt in [equation] patients (50%) with PTFE shunts and in [equation] (17%) with classic Blalock-Taussig shunts; the stenosis was severe in only 1 patient. Mean increase in the pulmonary arterial index in the group with classic Blalock-Taussig shunts was 117 ± 52 mm²/m² (not significant) and in the group with PTFE shunts, 158 ± 21 mm²/m² (p < 0.001). Late shunt occlusion occurred in 1 patient 23 months postoperatively. Thereafter, shunt patency rate remained at 94% ± 6%. At the end of 1 year 81% ± 7% of patients were judged to have adequate palliation, but between 2 and 3 years, only 60% ± 10%. Univariate analysis showed that after 2 years the ranking order for successful palliation was classic Blalock-Taussig, 5-mm PTFE, and 4-mm PTFE shunts, but differences did not achieve statistical significance.

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