Document Detail


Criterions for selection of patients for, and results of, a new technique for construction of the modified Blalock-Taussig shunt.
MedLine Citation:
PMID:  16984698     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We describe alternative surgical techniques for construction of systemic-to-pulmonary arterial shunts, and propose criterions for their application in selected patients. PATIENTS AND METHODS: We constructed a variety of modified systemic-to-pulmonary arterial shunts, using polytetrafluoroethylene grafts, in 92 selected patients with cyanotic congenital heart disease and anomalies of the aortic arch and systemic veins. Their age ranged from 7 days to 3.6 years, with a mean of 7.08 months. We performed 88 operations through a thoracotomy. Of this cohort, 60 patients underwent a second-stage operation, with 15 receiving a superior cavopulmonary connection, 16 a total cavopulmonary connection, and 29 proceeding to biventricular repair after a mean interval of 15.6 months. We have 21 patients awaiting their second or final stage of palliation. RESULTS: There were five early (5.4%) and six late deaths (6.8%), two of which were related to construction of the shunts. At a mean follow-up of 45.29 months, the increase in diameter of pulmonary trunk and its right and left branches was uniform and significant (p value less than 0.001). Pulmonary arterial distortion requiring correction at the time of second-stage operation was observed in 5 patients (6.1%). Adequate overall palliation was achieved in 98% of the cohort at 8 months, 91% at 12 months, and 58% at 18 months. CONCLUSIONS: Patients with a right- or left-sided aortic arch and right-sided descending thoracic aorta, those with anomalies of systemic venous drainage masking the origin of great arterial branches, and those with disproportionately small subclavian arteries, constitute the ideal candidates for our suggested modification of the construction of a modified Blalock-Taussig shunt. The palliation provided by these shunts was satisfactory, with predictable growth of pulmonary arteries, insignificant distortion in the great majority, and easy take-down.
Authors:
Ujjwal K Chowdhury; Panangipalli Venugopal; Shyam S Kothari; Anita Saxena; Sachin Talwar; Ganapathy Subramaniam; Rajvir Singh; Kizakke K Pradeep; Siddhartha Sathia; A Sampath Kumar
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiology in the young     Volume:  16     ISSN:  1047-9511     ISO Abbreviation:  Cardiol Young     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-09-20     Completed Date:  2007-01-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9200019     Medline TA:  Cardiol Young     Country:  England    
Other Details:
Languages:  eng     Pagination:  463-73     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India. ujjwalchow@rediffmail.com
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MeSH Terms
Descriptor/Qualifier:
Anastomosis, Surgical / methods
Angiography
Aorta, Thoracic / surgery*
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation / instrumentation*
Child, Preschool
Decision Making
Echocardiography
Follow-Up Studies
Heart Defects, Congenital / diagnosis,  surgery*
Humans
Infant
Infant, Newborn
Patient Selection*
Polytetrafluoroethylene
Prosthesis Design
Pulmonary Artery / surgery*
Treatment Outcome
Venae Cavae / surgery*
Chemical
Reg. No./Substance:
9002-84-0/Polytetrafluoroethylene

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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