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Ann Thorac Surg 1998;66:2161
© 1998 The Society of Thoracic Surgeons

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Correspondence

Growth of the subclavian artery to pulmonary artery anastomosis: a caveat

^a King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia

e-mail: alhalees{at}kfshrc.edu.sa

To the Editor

We read the article by Yoshimura et al [1] with great interest. From our own experience we agree with their conclusion. Direct subclavian to pulmonary artery shunts (classical Blalock-Taussig shunts) constructed with an absorbable suture do grow. However, this growth can be unlimited. If patients are lost to follow-up such continued growth may lead to pulmonary hypertension and render the patient unsuitable for corrective procedures or significantly increase the risk of them.

In our own experience of more than 600 systemic to pulmonary artery shunts constructed for various types of complex congenital heart disease, about 20% were classic. Most of our classic shunts were constructed with polydioxanone sutures. We always felt that this would allow for growth despite never having studied the hypothesis. This is our reason for performing such shunts on very small neonates and infants who are expected to need a long period of palliation.

We recently encountered two patients who were lost to follow-up and presented 11 years and 8 years later. Both had classic Blalock-Taussig shunts constructed in infancy; and both had significant growth in the subclavian artery and anastomosis (Fig 1). Although they had significant elevation of pulmonary artery pressure, their pulmonary vascular beds were still reactive, which luckily allowed us to successfully perform the corrective procedures. It is therefore our advice not to use classic shunts routinely. If this is needed for a specific indication, it is better not to use an absorbable suture for the anastomosis. Patients should be followed up carefully to avoid problems such as we encountered.

View larger version (147K): [in this window] [in a new window]   Fig 1. Right classic Blalock-Taussig shunt in a patient with functional single-ventricle and pulmonary stenosis 11 years after construction.

1. Yoshimura N., Yamaguchi M., Ohashi H., et al. Growth of the subclavian artery and the anastomosis in Blalock-Taussig shunt: absorbable versus nonabsorbable suture. Ann Thorac Surg 1998;65:1746-1750.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Zohair Al-Halees Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Al-Halees, Z. Articles by Al-Fadley, F. Search for Related Content PubMed Articles by Al-Halees, Z. Articles by Al-Fadley, F. Related Collections Related Article