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Ann Thorac Surg 2001;71:1753
© 2001 The Society of Thoracic Surgeons

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Correspondence

Simple shunting of thoracoabdominal aneurysms with visceral perfusion: Reply

^a First Department of Surgery, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto 860-8556, Japan

e-mail: ryuji{at}kaiju.medic.kumamoto-u.ac.jp

To the Editor

We would like to thank Mr Privitera and Dr Cusimano for their comment on the blood supply of the abdominal viscera and lower extremities during aortic clamping in our case [1]. We agree that the Gott shunt [2] is effective for distal perfusion with a low dose of heparin and obviates the need for cardiopulmonary bypass as the authors described. However, we suggest that the shunt flow may become variable by opening or clamping the shunt, or by the use of cardiovascular agents. In addition, we can not control proximal blood pressure to maintain coronary and cerebral blood perfusion only by the Gott shunt if massive bleeding occurs. We believe that the use of cardiopulmonary bypass and selective distal perfusion was much safer than the Gott shunt in our case, because the patient also had a distal aortic aneurysm proximal to the clamping site. We also believe that the Gott shunt is not always applicable for all thoracic and thoracoabdominal aneurysms. The perfusion support system should be selected case by case.

References

1. Kunitomo R., Goto H., Utoh J., Kitamura N. Thoracoabdominal aortic aneurysm combined with aortic occlusion. Ann Thorac Surg 2000;69:623-625.[Abstract/Free Full Text]
2. Gott V.L. Heparinized shunts for thoracic vascular operations. Ann Thorac Surg 1972;14:219-220.[Medline]

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