Ann Thorac Surg 1999;67:269-270
© 1999 The Society of Thoracic Surgeons
How To Do It
Modified Blalock-Taussig shunt with compensatory properties
Antonio F. Corno, MDa,
Michel Hurni, MDa,
Maurice Payot, MDb,
Ludwig K. von Segesser, MDa
a Service de Chirurgie Cardio-vasculaire, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
b Unité de Cardiologie Pédiatrique, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Accepted for publication July 13, 1998.
Address reprint requests to Dr Corno, Chirurgie Cardio-vasculaire, CHUV, rue du Bugnon 46, Lausemmé, CH-1011, Switzerland
 |
Abstract
|
|---|
Determination of the proper length of the tubular prosthesis is a major issue when performing a systemic–pulmonary artery shunt. The procedure is simplified by using a prosthesis with accordionlike properties. This was demonstrated in 7 consecutive infants with complex congenital heart defects, in whom systemic–pulmonary artery shunts were placed without early or late complications.
|
Introduction
|
|---|
Construction of a modified Blalock-Taussig shunt by interposing a tubular prosthesis between the subclavian artery and the superior aspect of the ipsilateral pulmonary artery is one of the most used palliative surgical procedures for cyanotic children with reduced pulmonary blood flow [1–4]. The tubular prosthesis used to construct the systemic–pulmonary artery shunt is made of expanded polytetrafluoroethylene (for example, Gore and Impra) [1–4].
A well-known issue in the construction of a modified Blalock-Taussig shunt is the determination of the proper length of the tubular prosthesis to avoid tension and redundancy and thus potential kinking [5]. A tubular prosthesis of polytetrafluoroethylene (Atrium) used in vascular operations has recently been considered suitable for pediatric cardiac procedures because of its concentric radial node design, easy handling and conformability, accordionlike property (Fig 1), high flexibility with extraordinary resistance to compression and kinking, and reduced needle-hole bleeding. This tubular prosthesis (Atrium) has been used to construct a systemic–pulmonary artery shunt as a palliative procedure (modified Blalock-Taussig shunt) in patients with complex cyanotic congenital heart defects.
View larger version (119K):
[in this window]
[in a new window]
|
Fig 1. Three identical (equal-length) segments of the Atrium prosthesis show its accordionlike property.
|
|
|
Material and methods
|
|---|
From March 1996 to May 1998, 7 consecutive patients with a mean age of 11 months (range, 1 to 23 months) and a mean body weight of 7.2 kg (range, 3.8 to 10.0 kg) underwent palliative surgical procedures to increase pulmonary blood flow. The diagnoses included tetralogy of Fallot with anomalous coronary artery in 3 patients (1 of whom also had left isomerism, anomalous systemic and pulmonary venous connection, hypoplastic right pulmonary artery, and right aortic arch), transposition of the great arteries with ventricular septal defect and pulmonary stenosis in 2 patients, pulmonary atresia with ventricular septal defect in 1 patient, and pulmonary atresia with intact ventricular septum in 1. A 4-mm Atrium tubular prosthesis was implanted in 3 patients, a 5-mm prosthesis in 3, and a 6-mm prosthesis in 1 patient. In 2 infants, the palliative procedure was performed on cardiopulmonary bypass to add an atrioseptectomy in 1 infant with transposition of the great arteries and a pulmonary valvotomy in the patient with pulmonary atresia with intact ventricular septum.
|
Results
|
|---|
There were no early or late deaths during a mean follow-up of 16 months (range, 1 to 25 months). The systemic arterial saturation on room air increased from a preoperative mean value of 67% (range, 63% to 78%) to a postoperative mean value of 89% (range, 85% to 93%). Patency of the shunt was confirmed clinically (continuous murmur) and by color Doppler echocardiography in all patients and by a postoperative angiogram made 13 and 14 months after operation in 2 patients. None of these patients had evidence of any of the complications reported with the expanded polytetrafluoroethylene prosthesis—bleeding, infection, and serous fluid leakage [6].
|
Comment
|
|---|
The high degree of flexibility, the extraordinary resistance to compression and kinking, and the conformability of this tubular prosthesis allow easy handling and adaptation to the variety of intrathoracic anatomies in patients with complex congenital heart defects. In particular, the accordionlike property makes the determination of the length of the prosthesis during the construction of the systemic–pulmonary artery shunt much easier. On the basis of these preliminary results with this tubular prosthesis in pediatric cardiac surgical patients, we believe more prospective studies are justified to evaluate its effectiveness in reducing the complications potentiallyassociated with the modified Blalock-Taussig shunt, including distortion of the pulmonary arteries.
|
References
|
|---|
-
Gazzaniga A.B., Lamberti J.J., Siewers R.D., et al. Arterial prosthesis of microporous expanded polytetrafluoroethylene for construction of aorta-pulmonary shunts. J Thorac Cardiovasc Surg 1976;72:357-363.[Abstract]
-
De Leval M.R., McKay R., Jones M., Stark J., Macartney F.J. Modified Blalock-Taussig shunt. J Thorac Cardiovasc Surg 1981;81:112-119.[Abstract]
-
Kay P.H., Capuani A., Franks R., Lincoln C. Experience with the modified Blalock-Taussig operation using polytetrafluoroethylene (Impra) grafts. Br Heart J 1983;49:359-363.[Abstract/Free Full Text]
-
Ilbawi M.N., Grieco J., DeLeon S.Y., et al. Modified Blalock-Taussig shunt in newborn infants. J Thorac Cardiovasc Surg 1984;88:770-775.[Abstract]
-
Kirklin J.W., Barratt-Boyes B.G. Cardiac surgery. New York: Churchill Livingstone, 1993.
-
LeBlanc J., Albus R., Williams W.G., et al. Serous fluid leakage: a complication following the modified Blalock-Taussig shunt. J Thorac Cardiovasc Surg 1984;88:259-262.[Abstract]
This article has been cited by other articles:
|
|
|
|
 
A. F Corno, M. Hurni, P. Tozzi, and L. K von Segesser
Accordion-Like Prosthesis for Modified Blalock-Taussig Shunt
Asian Cardiovasc Thorac Ann,
September 1, 2003;
11(3):
229 - 232.
[Abstract]
[Full Text]
|
|
|
Top
Abstract
Introduction
