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Alcíbar J, Peña N, Cabrera A, Jiménez A, Gómez S, de la Torre J, Oñate A. [Stent implantation in palliative central aortopulmonary shunt of congenital cardiopathies with pulmonary hypoperfusion. Experience of 2 cases]. Rev Esp Cardiol 1999; 52:863-8. [PMID: 10563161 DOI: 10.1016/s0300-8932(99)75014-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We describe the pioneer experience of balloon angioplasty and stent implantation in the central polytetrafluoroethylene aorto-pulmonary shunt. Two infants 1 and 13 month-old, with cyanotic complex congenital cardiopathy and pulmonary hypoperfusion, presented signs of prosthesis dysfunction with severe and critic hypoxemia. The angioplasty and stent implantation were performed through retrograde femoral arterial approach and "freely" (without a guide catheter) in the first case and venous via by using Judkins right coronary guiding catheter in the second one. Both cases experienced sustained O2 saturation improvement, although the neonate died on the fifth post-procedure day clue to acute renal failure. The postmortem anatomical findings are shown.
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Affiliation(s)
- J Alcíbar
- Sección de Hemodinámica, Hospital de Cruces, Vizcaya
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2
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Kessler RM, Wernly JA, Akl BF, Rode R. Ascending aorta to right pulmonary artery interposition shunt in critically ill infants. J Card Surg 1994; 9:37-42. [PMID: 7511948 DOI: 10.1111/j.1540-8191.1994.tb00821.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In spite of a trend toward earlier complete repair, some neonates and infants with complex cyanotic heart disease continue to require interim palliation with systemic-to-pulmonary artery shunts. A variety of shunt procedures have been proposed, each with inherent advantages and disadvantages. We have found a prosthetic interposition shunt between the ascending aorta and right pulmonary artery (AA-RPA) to be effective in very young infants with small vessels. Over a 15-year period, 51 patients, mean weight 3.33 kg and mean age 59 days, underwent this procedure with a 13% perioperative mortality and a 78% 2-year overall shunt patency rate. We conclude that the AA-RPA interposition shunt is a safe, effective procedure in these infants.
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Affiliation(s)
- R M Kessler
- University of New Mexico, Division of Thoracic and Cardiovascular Surgery, Albuquerque 87131-5341
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3
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Welch E, Zabaleta I, Fojaco R, Perryman R. Aneurysm of the right ventricular outflow tract: a complication of aorta-main pulmonary (central) shunt. Pediatr Cardiol 1991; 12:229-32. [PMID: 1946013 DOI: 10.1007/bf02310572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The ascending aorta-main pulmonary artery (central) polytetrafluoroethylene (PTFE) Gore-Tex shunt was introduced in 1975 by Gazzaniga and coworker. It is a widely used palliative procedure. We present a case study with an unusual late complication. An aneurysm was discovered at autopsy in a patient who was diagnosed at birth with hypoplastic right ventricle, pulmonary valve atresia, small main and branched pulmonary arteries. At 4 days of age, the patient underwent an aorta to main pulmonary artery (PTFE) Gore-Tex shunt. Subsequent echocardiogram showed dilatation of the right ventricular outflow tract. To our knowledge, this is the first reported case of right ventricular outflow tract (RVOT) aneurysm following central aortopulmonary shunt.
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Affiliation(s)
- E Welch
- Department of Pediatrics, University of Miami School of Medicine, Florida 33101
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4
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Marks LA, Mehta AV, Marangi D. Percutaneous transluminal balloon angioplasty of stenotic standard Blalock-Taussig shunts: effect on choice of initial palliation in cyanotic congenital heart disease. J Am Coll Cardiol 1991; 18:546-51. [PMID: 1713240 DOI: 10.1016/0735-1097(91)90613-e] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To date, attempted balloon dilation of stenotic standard Blalock-Taussig shunts has been largely disappointing. It has been suggested that this may be due to the use of balloons of insufficient diameter. Balloon dilation of stenotic Blalock-Taussig shunts was attempted with use of relatively large balloons in five patients (11 to 67 months old) with cyanotic heart disease who were becoming progressively cyanotic and polycythemic (hemoglobin 17.9 +/- 1.1 g/dl) because of discrete shunt stenosis at the site of pulmonary anastomosis. Balloon diameters selected were equal to or within 1 mm of the unobstructed proximal shunt diameter. Before balloon dilation the diameter at the site of the stenosis was 2.8 +/- 0.8 mm (range 1.7 to 4); after balloon dilation it was 5.7 +/- 1.1 mm (range 4.5 to 7.5). The diameter increased in all patients (range 2.0 to 3.5 mm); the mean increase was 2.8 +/- 0.2 mm (p less than 0.005). Expressed as a percent, the increase in diameter at the stenosis ranged from 80% to 182.4% (mean 108.2 +/- 16.8%). Before balloon dilation the systemic oxygen saturation was 72.8 +/- 9.2% (range 55% to 80%) and after balloon dilation it was 83.6 +/- 2.9% (range 80% to 87%). A satisfactory increase (range 6% to 25%) in blood oxygen saturation was seen in all patients; the mean increase was 10.8 +/- 3.2% (p less than 0.01). At follow-up, the oxygen saturation by pulse oximetry was 85.8 +/- 2.9% (mean 5.8 +/- 1.7 months after balloon dilation) and the hemoglobin was 15.6 +/- 1.9 g/dl (mean 6.6 +/- 1.5 months after balloon dilation).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L A Marks
- Department of Pediatrics, Temple University School of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania 19134
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Okita Y, Miki S, Kusuhara K, Ueda Y, Tahata T, Yamanaka K, Tamura T. Palliative reconstruction of right ventricular outflow tract in tetralogy with hypoplastic pulmonary arteries. Ann Thorac Surg 1990; 49:775-9. [PMID: 1692680 DOI: 10.1016/0003-4975(90)90021-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Twenty-five symptomatic patients with tetralogy of Fallot underwent palliative reconstruction of the right ventricular outflow tract without closure of the ventricular septal defect. Their ages ranged from 5 months to 20 years (mean age, 3.5 years). Eight patients had had 13 prior systemic-pulmonary arterial shunts. There were six hospital deaths (24%). Three patients needed a repeat right ventricular outflow reconstruction. There was one late death. The other patients manifested clinical improvement; hematocrit decreased from 0.54 to 0.43 (p less than 0.01) and arterial oxygen saturation increased from 63.0% to 83.2% (p less than 0.01). The size of the pulmonary artery, defined as the ratio of the sum of the diameter of the right and left pulmonary arteries to the diameter of the descending aorta, increased from 0.72 to 2.06 (p less than 0.01). Sixteen patients underwent a corrective operation 2.4 years after palliation. The results of palliative right ventricular outflow tract reconstruction suggest that it may be an optional strategy for the treatment of symptomatic patients who have tetralogy of Fallot with severely hypoplastic pulmonary arteries.
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Affiliation(s)
- Y Okita
- Department of Cardiovascular Surgery and Pediatric Cardiology, Tenri Hospital, Nara, Japan
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Alboliras ET, Chin AJ, Barber G, Helton JG, Pigott JD, Norwood WI. Pulmonary artery configuration after palliative operations for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 1989. [DOI: 10.1016/s0022-5223(19)34490-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Kusuhara K, Miki S, Ueda Y, Ohkita Y, Tahata T, Komeda M. Optimal flow of aorta-pulmonary artery shunt in patients with cyanotic heart disease. Ann Thorac Surg 1987; 44:128-34. [PMID: 2441665 DOI: 10.1016/s0003-4975(10)62021-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
An aorta-pulmonary artery shunt with an expanded polytetrafluoroethylene (Gore-Tex) tube graft (3 to 6 mm in diameter) was done in 33 cyanotic patients with complex congenital heart disease. The patients ranged from 14 days to 22 years old. In 28, the shunt flow (QB) was measured, and the optimal QB and graft size were determined. Nine patients had severe heart failure because of an excessively large shunt. Seven of these patients died, 5 early and 2 late after operation. The QBS in these 9 patients were extremely high; the QB index and the ratio of shunt flow to systemic flow (QB/QS) were 3.86 +/- 0.91 L/min/m2 (mean +/- standard deviation) and 52.4 +/- 9.7%, respectively. The QB index and the QB/QS of patients without severe cardiac failure were 1.49 +/- 0.92 L/min/m2 and 27.2 +/- 11.4%, respectively. In conclusion, the QB index, the QB/QS, or both should be maintained in the range of 1.6 to 2.4 L/min/m2 and 30 to 40%, respectively. In infants, however, it is advisable to control the flow at less than the range just given. Analysis of graft size in relation to body weight (BW, in kilograms) and body surface area (BSA, in square meters) showed that the optimal diameter (D, in millimeters) could be calculated by the following formulas: D = 1.88 In(BW) + 1.8 (r = .86) D = 0.87 In(BSA) + 5.3 (r = .73).
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Barragry TP, Steves Ring W, Blatchford JW, Foker JE. Central aorta-pulmonary artery shunts in neonates with complex cyanotic congenital heart disease. J Thorac Cardiovasc Surg 1987. [DOI: 10.1016/s0022-5223(19)36359-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Evans VL, Hallman GL, Vargo TA, Gutgesell HP. False aneurysm of the ascending aorta from an expanded polytetrafluoroethylene (Gore-Tex) aortopulmonary shunt. Ann Thorac Surg 1985; 39:573-5. [PMID: 4004400 DOI: 10.1016/s0003-4975(10)62004-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A false aneurysm of the ascending aorta developed in a 25-month-old male infant with tetralogy of Fallot because of an expanded polytetrafluoroethylene (PTFE) shunt that had been inserted between the ascending aorta and right pulmonary artery when the patient was 3 months of age. Surgical repair of tetralogy of Fallot with ligation of the PTFE graft was performed at 19 months of age. The false aneurysm at the site of the systemic anastomosis to the shunt was discovered 6 months later and was successfully repaired. Because of the potential for graft dehiscence secondary to growth, we recommend that PTFE shunts be removed completely or, at least, ligated and divided at the time of corrective surgical intervention.
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Stark J. The use of Gore-Tex graft reinforced with external rings in pediatric cardiac surgery. Ann Thorac Surg 1985; 39:188-9. [PMID: 3970614 DOI: 10.1016/s0003-4975(10)62565-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Lamberti JJ, Carlisle J, Waldman JD, Lodge FA, Kirkpatrick SE, George L, Mathewson JW, Turner SW, Pappelbaum SJ. Systemic-pulmonary shunts in infants and children. J Thorac Cardiovasc Surg 1984. [DOI: 10.1016/s0022-5223(19)38389-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Bove EL, Sondheimer HM, Kavey RE, Byrum CJ, Blackman MS, Parker FB. Subclavian-pulmonary artery shunts with polytetrafluorethylene interposition grafts. Ann Thorac Surg 1984; 37:88-91. [PMID: 6691743 DOI: 10.1016/s0003-4975(10)60718-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Systemic-pulmonary artery shunts remain an important treatment in cyanotic patients. Central shunts continue to pose early and late problems when standard Blalock-Taussig shunts are not possible. Twenty patients underwent subclavian-pulmonary artery shunt procedures with polytetrafluoroethylene (PTFE) prostheses between October, 1980, and August, 1982. Their ages ranged from 1 day to 15 years; 11 patients were less than 14 days old. The arterial oxygen tension rose from 30.7 +/- 11.9 mm Hg to 51.3 +/- 9.1 mm Hg (standard deviation; p less than 0.001) and from 26.4 +/- 7.5 mm Hg to 50.5 +/- 9.3 mm Hg (p less than 0.001) among the 11 neonates. There were no hospital deaths and only 2 late deaths (not shunt related). All patients have patent shunts and excellent relief of cyanosis. The 18 survivors have been followed for an average of 19 months (range, 7 to 29 months). No patient has required reoperation for shunt inadequacy or thrombosis. Recatheterization in 11 patients has demonstrated normal pulmonary pressures and good pulmonary artery growth without vessel distortion. Subclavian-pulmonary shunts using PTFE provide long-term palliation in cyanotic patients. This type of shunt appears to offer important advantages over other shunt procedures, including the classic Blalock-Taussig operation, in newborns.
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Golam K, Patil RB, Patwardhan AM, Chaukar AP. An unusual post-operative complication following modified left Blalock-Taussig shunt. Indian J Thorac Cardiovasc Surg 1984. [DOI: 10.1007/bf02664924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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14
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Lodge FA, Lamberti JJ, Goodman AH, Kirkpatrick SE, George L, Mathewson JW, Waldman JD. Vascular consequences of subclavian artery transection for the treatment of congenital heart disease. J Thorac Cardiovasc Surg 1983. [DOI: 10.1016/s0022-5223(19)39204-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Brown JW, King H. Cardiac surgery in the critically ill infant during the first three months of life. Surg Clin North Am 1981; 61:1063-78. [PMID: 6171897 DOI: 10.1016/s0039-6109(16)42531-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Major advances have been made in the treatment of congenital heart disease in the past 10 years. Management of the 20 per cent of children who become critically ill during the first 3 months of life remains a major challenge because they represent the most extreme anatomic and physiologic derangements. A review of the recent data accumulated in the NERICP showed an overall mortality of 54 per cent in infants presenting for surgery in the first 2 months of life. We have reviewed our experience with over 400 procedures during the past 5 years in infants less than three months of age, and our overall mortality is 19 per cent. Primary repair remains our goal, but a disappointingly high mortality with primary repair in this group, by us and others, has caused us to perform palliative procedures when palliation in our experience offers an overall lower mortality.
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Arora R, Gupta MP. Management of cyanotic patients with congenital heart disease and decreased pulmonary blood flow. Indian J Pediatr 1981; 48:467-75. [PMID: 7327639 DOI: 10.1007/bf02822291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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18
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Edmunds LH, Stephenson LW, Gadzik JP. The Blalock-Taussig anastomosis in infants younger than 1 week of age. Circulation 1980; 62:597-603. [PMID: 7398021 DOI: 10.1161/01.cir.62.3.597] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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McKay R, de Leval MR, Rees P, Taylor JF, Macartney FJ, Stark J. Postoperative angiographic assessment of modified Blalock-Taussig shunts using expanded polytetrafluoroethylene (Gore-Tex). Ann Thorac Surg 1980; 30:137-45. [PMID: 7416836 DOI: 10.1016/s0003-4975(10)61230-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Thirty-six of 87 modified Blalock-Taussig shunts done with expanded polytetrafluoroethylene (Gore-Tex) were restudied angiocardiographically. In 7 patients the study was carried out within 1 month of the shunt operation because the patients failed to make satisfactory clinical progress. Two shunts were occluded and 1 ws stenosed; all 3 were in neonates. The remaining 29 patients were reinvestigated electively between 5 and 29 months postoperatively and had a 97% shunt patency rate. Because of the rather high incidence of irregular or stenosed shunts among neonates with 4 mm conduits, we now prefer to use a larger conduit even in this age group.
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Ciaravella JM, Midgley FM. Construction of interposition polytetrafluoroethylene ascending aorta-pulmonary artery shunt. Ann Thorac Surg 1980; 29:570-2. [PMID: 6992721 DOI: 10.1016/s0003-4975(10)61709-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The technique for constructing an ascending aorta-right pulmonary artery interposition shunt using a short segment of polytetrafluoroethylene is described. This technique has been used in 8 neonates ranging from 1 day to 11 months old. There has been 1 shunt-related death. There have been no clotted grafts or graft kinking noted. A continuous running suture placed before the graft is lowered into position facilitates exposure and suture placement. A median sternotomy or sternal transection has not been necessary.
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