Status of Systemic Artery to Pulmonary Artery Shunts in Complex Congenital Heart Disease

Abstract

Introduction:

Primary repair of cyanotic congenital heart disease has become increasingly popular over the past decade. This is mainly due to technological advances which have allowed cardiopulmonary bypass and postoperative care of the sick neonate to reach an advanced level of sophistication. Blalock-Taussig Shunts which since 1945 (1) had been the mainstay of palliative surgical management in babies with cyanotic heart disease are now done much less frequently.  The diameter of both the proximal and distal anastomosis is wider than that of the subclavian artery and also of the pulmonary artery and helps maintain long term patency of the shunt. It should also be noted that the continuity of the subclavian artery is not interrupted so perfusion of the arm is not jeopardized.

Results:

In this series 35 shunts were done in 32 patients. There were 17 classical Blalock Taussig shunts and 16 modified (PTFE) BlalockT aussig shunts. Two central aortopulmonary shunts were required after failure of classical BTS. There were no intraoperative deaths.  In Conclusion, a classical Blalock-Taussig shunt Can be performed with acceptable mortality in the neonate and provides effective and long term palliation. The modified BTS using the PTFE graft offers several advantages Over the classical procedure but because of a relatively short follow—up, its use is restricted at present to patients where unfavorable anatomy precludes a classical BTS or a classical BTS has failed.