The Waterston anastomosis with no deaths in the neonate

Current results with construction and interruption of the Waterston anastomosis

The Waterston anastomosis was constructed in 21 infants and neonates between 1973 and 1977. Sixteen neonates were 1 week old or less and 8 were less than 24 hours old. There were 2 operative deaths, giving a hospital survival of 90%. There were 3 late deaths. All surviving infants received satisfactory palliation except 1 who required a Potts anastomosis one year later. During the same time interval, 9 other patients who had had a Waterston anastomosis underwent complete intracardiac repair. Seven of them had significant angulation of the right pulmonary artery necessitating patch reconstruction. All patients survived operation, and follow-up pulmonary angiograms demonstrated only a slight persistent narrowing of the right pulmonary artery in 2 patients. We conclude that the Waterston anastomosis can be constructed with a low operative mortality even in the severely cyanotic neonate and that it can be taken down at the time of complete repair with minimal morbidity and no mortality even if it has significantly angulated the right pulmonary artery.

The Blalock-Taussig shunt in the neonate

With improvements in the techniques of microvascular surgery, the Blalock-Taussig shunt has been applied to smaller infants. We report our experience in 17 neonates (mean age 9 days, mean weight 3.2 kg) who underwent emergency shung operations. The early mortality was 17.6% (3 of 17), with only 1 death (7%) from renal failure and sepsis, in the last 14 patients. Three shunts were patent but inadequate and required a secondary procedure, which was successful in all 3. There were 3 patients with late shunt failures at a mean of 15 months postoperatively, while 2 are still doing well at 15 and 18 months. No patients developed congestive cardiac failure. The late mortality was high (5 of 14), but was due to late shunt failure and was preventable in only 1 patient. These results are encouraging, and we continue to perform the Blalock-Taussig shung in neonates. It is hoped that improvements in technique will reduce the incidence of inadequate shunts.