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Ann Thorac Surg 1998;66:2161-2162
© 1998 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Department of Cardiothoracic Surgery, Kobe Children’s Hospital, 1-1-1, Takakura-dai, Suma-ku, Kobe 654-0081 Japan

To the Editor

We thank Dr Al-Halees and associates for their interest in our recent article. We reported that the diameters of both the subclavian artery and the subclavian artery-pulmonary artery anastomosis in patients who underwent a classic Blalock-Taussig shunt procedure with the use of absorbable polydioxanone suture were significantly greater than those in patients who underwent the same procedure with nonabsorbable polypropylene suture. Therefore, we concluded that the use of absorbable polydioxanone suture may improve the long-term results after Blalock-Taussig shunt operation [1].

We are pleased that another center has come to a similar conclusion about the use of polydioxanone sutures. We agree with Al-Halees and associates that a classic Blalock-Taussig shunt procedure should not be used routinely. In fact, we have performed modified Blalock-Taussig shunts with the use of 5-mm artificial vascular grafts in many patients. However, it is sometimes technically impossible to use a 5-mm graft, especially in tiny neonates with very small systemic and pulmonary vessels. Particularly in the tiny neonate, controversy still exists about the optimal shunt. We have performed the classic Blalock-Taussig shunt as a procedure of choice for neonates and early infants [2] because of the relatively disappointing palliation afforded by the 4-mm shunts [3].

Al-Halees and associates pointed out that unlimited growth of a classic Blalock-Taussig shunt may lead to pulmonary hypertension, especially in patients who are lost to follow-up. Although we agree with them that we should follow patients carefully to avoid such serious complications, none of the patients in our series were lost to follow-up and we have not encountered any patient who presented pulmonary hypertension after classic Blalock-Taussig shunt.

References

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]
2. Yoshimura N, Yamaguchi M, Ohashi H, Oshima Y, Toyoda Y, Ogawa K. Classic Blalock-Taussig shunt in neonate. J Cardiovasc Surg (in press).
3. Tamisier D., Vouhe P.R., Vernant F., Leca F., Massot C., Neveux J.Y. Modified Blalock-Taussig shunts: results in infants less than 3 months of age. Ann Thorac Surg 1990;49:797-801.[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): Yoshihiro Oshima Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Yoshimura, N. Articles by Ogawa, K. Search for Related Content PubMed Articles by Yoshimura, N. Articles by Ogawa, K. Related Collections Related Article