Criterions for selection of patients for, and results of, a new technique for construction of the modified Blalock-Taussig shunt

2006 ◽  
Vol 16 (5) ◽  
pp. 463-473 ◽  
Author(s):  
Ujjwal K. Chowdhury ◽  
Panangipalli Venugopal ◽  
Shyam S. Kothari ◽  
Anita Saxena ◽  
Sachin Talwar ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Pulmonary Arteries ◽  
Surgical Techniques ◽  
Great Majority ◽  
Venous Drainage ◽  
P Value ◽  
Second Stage ◽  
Pulmonary Arterial ◽  
Cavopulmonary Connection ◽  
Blalock Taussig Shunt

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 polytetrafluroethylene 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 withdisproportionately 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.

Non-confluent pulmonary arteries in a patient with pulmonary atresia and intact ventricular septum: ? a 5th aortic arch with a systemic-to-pulmonary arterial connection

2000 ◽  
Vol 10 (4) ◽  
pp. 419-422 ◽  
Author(s):  
Astolfo Serra ◽  
Francisco Chamie ◽  
R.M. Freedom
Keyword(s):  
Pulmonary Artery ◽  
Aortic Arch ◽  
Pulmonary Arteries ◽  
Pulmonary Atresia ◽  
Left Pulmonary Artery ◽  
Ventricular Septum ◽  
Intact Ventricular Septum ◽  
Right Pulmonary Artery ◽  
Pulmonary Arterial ◽  
The Right

AbstractMajor abnormalities of pulmonary circulation are uncommon in the patient with pulmonary atresia and intact ventricular septum. Non-confluent pulmonary arteries have only rarely been described in this setting. In this case report, we describe a patient in whom the pulmonary arteries are non-confluent, with the right pulmonary artery supplied through a right-sided arterial duct, and the left pulmonary artery most likely through a fifth aortic arch, thus providing a systemic-to-pulmonary arterial connection. We discuss the various forms of non-confluent pulmonary arteries in the setting of pulmonary atresia and intact ventricular septum.

Sternotomy versus Mini-Sternotomy in Pediatric Patients undergoing Modified Blalock-Taussig Shunt

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sherif Azab ◽  
Ashraf A El Midany ◽  
Ayman A Doghish ◽  
Abdelfatah E Salah El-din Abugabal
Keyword(s):  
Pediatric Patients ◽  
Randomized Study ◽  
Young Infant ◽  
Cardiac Anomaly ◽  
P Value ◽  
Safe Alternative ◽  
Icu Stay ◽  
Superficial Wound ◽  
Pulmonary Arterial ◽  
Blalock Taussig Shunt

Abstract Background In the present era, primary correction is the preferred approach to the neonate or young infant with a cardiac anomaly who has two ventricles. However, when only one functional ventricle is present or pulmonary blood flow is reduced, an initial palliative systemic-to-pulmonary arterial shunt is mandatory. In this study we compare post-operative short term outcomes of sternotomy versus mini-sternotomy approaches in pediatric patients undergoing Modified Blalock Taussig Shunt. Patients and Methods A prospective randomized study was conducted on 90 patients who were schedueled for MBT shunt due to a group of cyanotic heart disease. They comprised 2 groups G1: sternotomy group (n = 45) and G2: ministernotomy group (n = 45). Results Mean age was 11± 3.39 months and mean weight was 6.75±1.96 kg in the sternotomy group, while for ministernotomy group the mean age was 10.55± 4.65 and mean weight was 7.00±2.03 kg. The change (%) between preoperative and postoperative oxygen saturation was 35.6% for sternotomy group and 43.8% for ministernotomy group. There were seven cases of mortality (15.6%) in sternotomy grouped compared to three cases of mortality (6.7%) in ministernotomy with P value of 0.314. Superficial wound infection occurred in one case (2.2%) in each group. Mean duration of ventilation was 52.53 ± 15.76 h for sternotomy group and 46.93±19.23 h for ministernotomy group with P value of 0.025, mean ICU stay was 7.42 ± 2.94 days for sternotomy group and 5.13± 2.37 days for ministernotomy with P value of < 0.001. Conclusion Upper ministernotomy is a safe alternative approach for MBT shunt in pediatric patients. It provides the advantages of less ventilation time, less post operative bleeding, and ICU stay.

global mathematical modelling of the norwood circulation: a multiscale approach for the study of the pulmonary and coronary arterial perfusions

2004 ◽  
Vol 14 (S3) ◽  
pp. 71-76 ◽  
Author(s):  
francesco migliavacca ◽  
katia laganà ◽  
giancarlo pennati ◽  
marc r. de leval ◽  
edward l. bove ◽  
...  
Keyword(s):  
Pulmonary Arteries ◽  
Systemic Circulation ◽  
Multiscale Approach ◽  
Pulmonary Perfusion ◽  
Pulmonary Shunt ◽  
Caval Vein ◽  
Inferior Caval Vein ◽  
Pulmonary Arterial ◽  
The Right ◽  
Blalock Taussig Shunt

the norwood procedure involves three separate stages of operative corrections. the first stage involves re-fashioning the pulmonary trunk into a neo-aorta so that it is possible to establish an unrestricted systemic circulation. an interpositional, or systemic-to-pulmonary arterial, shunt is then created between the neo-aorta and the pulmonary arteries to allow pulmonary perfusion and gas exchange. two of the available options for the systemic-to-pulmonary shunt are the central shunt and the right modified blalock-taussig shunt. in the setting of a central shunt, pulmonary perfusion is derived from a conduit placed between the pulmonary arterial bed and the neo-aorta whereas, in the modified blalock-taussig shunt, the conduit is interposed between one of the pulmonary arteries and the brachiocephalic artery. in subsequent stages, pulmonary perfusion is provided directly by deoxygenated blood. this is achieved by connecting, first, the superior caval vein, and then the inferior caval vein, to the pulmonary arteries. it is usually during the second stage that the systemic-to-pulmonary shunt is removed.

Does a ventriculotomy have deleterious effects following palliation in the Norwood procedure using a shunt placed from the right ventricle to the pulmonary arteries?

2007 ◽  
Vol 17 (2) ◽  
pp. 145-150 ◽  
Author(s):  
Eric M. Graham ◽  
Andrew M. Atz ◽  
Scott M. Bradley ◽  
Mark A. Scheurer ◽  
Varsha M. Bandisode ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Systolic Function ◽  
Pulmonary Arteries ◽  
Norwood Procedure ◽  
Ventricular Systolic Function ◽  
Second Stage ◽  
The Right ◽  
Blalock Taussig Shunt

Introduction: A recent modification to the Norwood procedure involving a shunt placed directly from the right ventricle to the pulmonary arteries may improve postoperative haemodynamics. Concerns remain, however, about the potential problems produced by the required ventriculotomy. Methods: We compared 76 patients with hypoplastic left heart syndrome who underwent the Norwood procedure, 35 receiving a modified Blalock-Taussig shunt and the remaining 41 a shunt placed directly from the right ventricle to the pulmonary arteries. We reviewed their subsequent progress through the second stage of palliation. A single observer graded right ventricular function, and the severity of tricuspid regurgitation, based on blinded review of the most recent echocardiograms prior to the second stage of palliation. Results: At the time of catheterization prior to the second stage, patients with a shunt placed from the right ventricle to the pulmonary arteries, rather than a modified Blalock-Taussig shunt, had higher arterial diastolic blood pressure, at 44 versus 40 millimetres of mercury, p equal to 0.02, lower ventricular end diastolic pressures, at 8 versus 11 millimetres of mercury, p equal to 0.0002, and larger pulmonary arteries as judged using the Nakata index, at 270 versus 188 millimetres squared per metres squared, p equal to 0.009. There was no difference in qualitative ventricular systolic function or tricuspid regurgitation between groups. No differences were found between groups during the hospitalization following the second stage of palliation. A trend towards improved survival to the second stage was seen following the construction of a shunt from the right ventricle to the pulmonary arteries. Conclusions: Construction of a shunt from the right ventricle to the pulmonary arteries is associated with lower right ventricular end diastolic pressures, larger pulmonary arterial size, and higher systemic arterial diastolic pressures. No apparent deleterious effects of the right ventriculotomy were observed in terms of qualitative ventricular systolic function or tricuspid regurgitation.

State-of-the-art pulmonary arterial imaging – Part 2

VASA ◽  
2018 ◽  
Vol 47 (5) ◽  
pp. 361-375 ◽  
Author(s):  
Harold Goerne ◽  
Abhishek Chaturvedi ◽  
Sasan Partovi ◽  
Prabhakar Rajiah
Keyword(s):  
Pulmonary Artery ◽  
State Of The Art ◽  
Therapy Monitoring ◽  
Pulmonary Arteries ◽  
Imaging Modalities ◽  
Cross Sectional ◽  
Multiple Imaging ◽  
Cross Sectional Imaging ◽  
Pulmonary Arterial ◽  
Arterial Imaging

Abstract. Although pulmonary embolism is the most common abnormality of the pulmonary artery, there is a broad spectrum of other congenital and acquired pulmonary arterial abnormalities. Multiple imaging modalities are now available to evaluate these abnormalities of the pulmonary arteries. CT and MRI are the most commonly used cross-sectional imaging modalities that provide comprehensive information on several aspects of these abnormalities, including morphology, function, risk-stratification and therapy-monitoring. In this article, we review the role of state-of-the-art pulmonary arterial imaging in the evaluation of non-thromboembolic disorders of pulmonary artery.

State-of-the-art pulmonary arterial imaging – Part 1

VASA ◽  
2018 ◽  
Vol 47 (5) ◽  
pp. 345-359 ◽  
Author(s):  
Yuki Tanabe ◽  
Luis Landeras ◽  
Abed Ghandour ◽  
Sasan Partovi ◽  
Prabhakar Rajiah
Keyword(s):  
State Of The Art ◽  
Pulmonary Arteries ◽  
Pulmonary Angiography ◽  
Imaging Modalities ◽  
Nuclear Medicine Imaging ◽  
Multiple State ◽  
Pulmonary Arterial ◽  
Magnetic Resonance Imaging Mri ◽  
Acquired Abnormalities ◽  
Arterial Imaging

Abstract. The pulmonary arteries are affected by a variety of congenital and acquired abnormalities. Multiple state-of-the art imaging modalities are available to evaluate these pulmonary arterial abnormalities, including computed tomography (CT), magnetic resonance imaging (MRI), echocardiography, nuclear medicine imaging and catheter pulmonary angiography. In part one of this two-part series on state-of-the art pulmonary arterial imaging, we review these imaging modalities, focusing particularly on CT and MRI. We also review the utility of these imaging modalities in the evaluation of pulmonary thromboembolism.

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