Pleural flap for treating perigraft leak after a modified Blalock-Taussig shunt

Plasa oozing through the graft after a modified Blalock-Taussig shunt is a troublesome complication. We encountered a massive leak following a modified Blalock-Taussig shunt in a 2 1/2 year-old-girl which required reexploration. The leak was treated by wrapping the polytetrafluoroethylene shunt with the parietal pleura flap harvested from the adjacent chest wall. The patient had an uneventful recovery. Covering of the polytetrafluoroethylene shunt with parietal pleura appears to stop plasma leak through the graft following a modified Blalock-Taussig shunt.     

Single-stage repair of tetralogy of Fallot with pseudoaneurysm: a unique approach

Pseudoaneurysm is a potentially lethal complication after modified Blalock-Taussig shunt. This report describes a frequently misdiagnosed clinical presentation along with noninvasive diagnosis of pseudoaneurysm after a modified Blalock-Taussig shunt. We report a novel single-stage surgical management of the pseudoaneurysm with concomitant complete repair of tetralogy of Fallot.     

Bidirectional Glenn procedure for an infected modified Blalock–Taussig shunt

A 1-month-old girl underwent right modified Blalock-Taussig shunt (mBTS) for pulmonary atresia with hypoplastic right ventricle. Five months after palliation, she suffered from sepsis and progressive desaturation following otitis media. Computed tomography and angiography revealed a pseudoaneurysm surrounding the mBTS graft. After stabilization of the infection, we performed pseudoaneurysm resection, shunt-graft removal, and the bidirectional Glenn (BDG) procedure under cardiopulmonary bypass. Her condition improved, and she was discharged on the 17th day after surgery. When parameters for the partial right heart bypass should permit, the BDG procedure can be a beneficial recovery procedure for the cases of infected pseudoaneurysm after mBTS in Fontan candidates.     

Pseudoaneurysm following modified Blalock-Taussig shunt mimicking suprasternal abscess: A rare presentation

The modified Blalock-Taussig shunt is a well-recognized palliative procedure for cyanotic congenital heart disease. Post procedure pseudoaneurysm mimicking a suprasternal abscess is of very rare occurrence. We present a child of L-Transposition of great arteries (L-TGA), pulmonary atresia and ventricular septal defect (VSD) with small pulmonary artery size that underwent modified Blalock Taussig shunt for severe cyanosis at 1 1/2 years. Six months after the procedure the child presented with a suprasternal swelling and fever. Angiography showed pseudoaneurysm from the proximal anastomotic site. The pseudoaneurysm was suitably tackled by interventional techniques and surgery for the underlying cardiac condition is being planned.     

Right lower lobe consolidation: an unusual complication of the modified Blalock-Taussig operation

Persistent right lower lobe consolidation in a 5-year-old girl is described. In infancy she had been diagnosed to have tricuspid atresia and pulmonary stenosis, and she had undergone a modified Blalock-Taussig shunt using a polytetrafluoroethylene tube graft at the age of 1 year. The shunt had parasitized and then occluded the right main bronchus. At bronchoscopy, the shunt was removed. The pneumonia resolved, and the child remains well 10 months later. This complication of the modified Blalock-Taussig shunt, which does not appear to have been reported previously, demonstrates the need for bronchoscopy in unresolving pneumonia in childhood.     

Reoperation of Blalock-Taussig shunt for double outlet right ventricle and pulmonary atresia in an adult

A 36-year-old man was admitted to our hospital due to dyspnea and pneumonia. He had undergone left classical Blalock-Taussig shunt at 5 years old and right modified Blalock-Taussig shunt at 16 years old, because he was judged as no indication for any radical operation. Since the last surgery, he had stopped visiting hospital. Computed tomography showed pneumonia and pulmonary embolism in the left lower lung and occlusion of the right modified Blalock-Taussig shunt. After pneumonia was improved by antibiotic treatment, he underwent reoperation of the right modified Blalock-Taussig shunt using 8 mm knitted Dacron graft. Postoperative course was uneventful and dyspnea and cyanosys were improved. We successfully treated a complicated case of an adult congenital heart disease by reoperation of the right modified Blalock-Taussig shunt.     

Right ventricular aneurysm following modified Norwood-Sano operation for hypoplastic left heart syndrome

Hypoplastic left heart syndrome is a rare congenital heart defect characterized by underdevelopment of left-sided heart structures, including the aortic arch. The contemporary surgical management of this anomaly includes the Norwood procedure and provision of pulmonary blood flow by either a modified Blalock-Taussig shunt (MBTS) or a right ventricle-to-pulmonary artery (RV-PA) conduit, commonly referred to as the Sano shunt. We report on an unusual complication of the Sano shunt, that of a giant right ventricular pseudoaneurysm occurring at the shunt insertion site.     

Classic Blalock-Taussig shunt in neonates

BACKGROUND: The choice of palliative procedure for neonates with congenital cyanotic heart defects remains controversial. Several reports have questioned whether the classic Blalock-Taussig shunt is adequate in neonates, because it shows a high rate of mortality and early shunt failure. The purpose of this study is to evaluate the early and late results of classic Blalock-Taussig shunt in neonates. METHODS: From December 1981 to December 1996, 31 neonates underwent a classic Blalock-Taussig shunt. Mean age at operation was 15.9 days (range, 2 to 28 days), and mean body weight was 3214 g (range, 2229 to 4468 g). The major diagnoses were pulmonary atresia with intact ventricular septum (6 patients) and with ventricular septal defect (4), univentricular heart (6), tricuspid atresia (5), tetralogy of Fallot (4), transposition of the great arteries (3), and double outlet right ventricle (3). RESULTS: There were no early deaths. There was one early shunt failure. The patient underwent a replacement of Blalock-Taussig shunt by vascular graft on the 1st postoperative day. Two patients with non-confluent central pulmonary artery underwent a contralateral modified Blalock-Taussig shunt on the 22nd and 42nd postoperative day, respectively. There were two late deaths before the definitive repair was performed. Twelve patients required an additional shunt operation. The mean interval between the initial and the second shunt procedure was 27.7 months (range, 6 to 67 months). Ten patients underwent definitive operation and the mean interval to that procedure was 55.5 months (range, 14 to 121 months). Shunt patency was 94.7+/-5.1% at 3 years. The freedom from cardiac event (cardiac deaths or repeat shunting procedure) was 80.5+/-7.1% at 1 year and 54.9+/-9.4% at 3 years. CONCLUSIONS: The classic Blalock-Taussig shunt has a low operative mortality and has provided excellent long-term palliation in the neonate. We conclude that a classic Blalock-Taussig shunt should be considered a reasonable choice in neonates requiring a palliative procedure for congenital cyanotic heart defects.     

Does the modified Blalock-Taussig shunt cause growth of the contralateral pulmonary artery?

BACKGROUND: Although some pediatric cardiology departments have a policy of adopting primary correction of tetralogy of Fallot in all symptomatic infants, we and others still palliate neonates and infants. Effective palliation should ameliorate symptoms and allow growth of the pulmonary arteries. Although studies on the growth of the ipsilateral and contralateral pulmonary arteries after a classic Blalock-Taussig shunt have been reported, pulmonary artery growth after a modified Blalock-Taussig shunt has not been studied as thoroughly. Therefore, we examined whether there is equal growth of the contralateral pulmonary artery after a modified Blalock-Taussig shunt. METHODS: We retrospectively analyzed the records of 140 patients with symptomatic tetralogy of Fallot who had a modified Blalock-Taussig shunt between October 1985 and October 1995. The median age at the time of the Blalock-Taussig shunt was 1.6 months. All patients had corrective procedures at a median age of 1.7 years. Cineangiography was done before the corrective procedure. From the angiograms the diameter of the right and left pulmonary arteries before their first lobar branches and the diameter of the descending thoracic aorta at the level of the diaphragm were measured. For each patient the ratios of right pulmonary artery to descending thoracic aorta and left pulmonary artery to descending thoracic aorta were determined and compared using Student's t test. RESULTS: Of the 140 patients, 114 had a left-sided Blalock-Taussig shunt, 20 had a right-sided shunt, and 6 patients had bilateral shunts. The mean right pulmonary artery to descending thoracic aorta ratio was 1.10 and the mean left pulmonary artery to descending thoracic aorta ratio was 0.98. This difference was not significant. CONCLUSION: We showed equal growth of the right and left pulmonary arteries with no distortion after a modified Blalock-Taussig shunt. If palliation is considered, the modified Blalock-Taussig shunt remains our choice.     

Fontan operation through a right lateral thoracotomy to treat Cantrell syndrome with severe ectopia cordis

A median sternotomy would be very difficult for Cantrell syndrome with severe ectopia cordis. For Cantrell syndrome and tricuspid atresia after left modified Blalock-Taussig shunt with severe ectopia cordis, defect in the middle and inferior portion of the sternum, and the closing of ventriculo-peritoneal shunt, we performed extracardiac total cavopulmonary connection through a right lateral thoracotomy after establishing right modified Blalock-Taussig shunt and performing coil embolization of left modified Blalock-Taussig shunt by cardiologists.     

Modified Blalock-Taussig shunt in infants and young children. Clinical and catheterization assessment

The effectiveness of 19 modified Blalock-Taussig shunts performed with expanded polytetrafluoroethylene was evaluated clinically and by cardiac catheterization with angiography 4 to 24 months after operation. Fifteen patients underwent operation in infancy. Conduit diameters included 4 mm (nine cases), 5 mm (eight cases), and 6 mm (two cases) sizes. Two of the 4 mm conduits failed after 1 year following implantation. The remaining 17 shunts (89%) remained widely patent. In patients with patent shunts, the oxygen saturation values were significantly improved from the preoperative values. Two children demonstrated associated subclavian artery occlusion distal to the graft anastomosis. There were no deaths. Thirteen children underwent more complete elective cardiac repair 5 to 24 months later. Although the modified Blalock-Taussig procedure is an effective short-term alternative to the classic Blalock-Taussig shunt, the effectiveness of the 4 mm diameter conduit may be limited without postoperative anticoagulant therapy.     

A Five-Year Clinical Experience with 112 Blalock-Taussig Shunts

In spite of recent advances in neonatal open repair for complex cyanotic heart disease, some patients require palliation with a systemic-to-pulmonary artery shunt. We report a 5-year experience (1985–1990) with 112 Blalock-Taussig shunts. Forty-six of the 92 patients had some variant of tetralogy of Fallot, with a wide spectrum of diagnoses in the remainder. The median age at surgery was 3 months. A classic Blalock-Taussig shunt was done in 26% (group I), and a 4- or 5-mm PTFE graft was utilized in the remainder (group II). The technical aspects of each of the procedures are reviewed. There were three early deaths in the entire group, none of them related to Blalock-Taussig shunt function. There was no incidence of early shunt insufficiency, bleeding, infection, limb ischemia, or pulmonary artery distortion. There was a 21% incidence of clinical congestive heart failure, seen somewhat more commonly in group I. The overall need for reshunting/open repair was similar in both groups, but there was a statistically longer interval between the initial Blalock-Taussig shunt and the second procedure in group I (21.6 vs 12.4 months). The Blalock-Taussig shunt remains a safe, reliable, and effective means of increasing pulmonary flow. (J Card Surg 1993; 8:9–17)     

False aneurysm formation: a complication following the modified Blalock-Taussig shunt

False aneurysm formation is a rare complication of the modified Blalock-Taussig shunt. A patient is described in whom this complication arose 11 months after operation. Death resulted from rupture of the aneurysm into the right lung with associated massive hemoptysis. The onset of hemoptysis in patients with a functioning modified Blalock-Taussig shunt may be the first evidence of a developing false aneurysm.     

Surgical strategy for pulmonary coarctation in the univentricular heart.

OBJECTIVE: The placement of a modified Blalock-Taussig shunt in patients suffering from pulmonary coarctation can result in the aggravation of uneven pulmonary blood flow. This may subsequently obviate the possibility of future performance of the Fontan procedure. The objective of this study was to evaluate mid-term results in patients with pulmonary coarctation who had undergone the placement of a modified Blalock-Taussig shunt, coupled with a pulmonary artery angioplasty. METHODS: We retrospectively reviewed the records of 13 patients who had undergone the placement of a modified Blalock-Taussig shunt, coupled with concomitant pulmonary angioplasty, between September 1998 and August 2002. All patients received follow-up angiographic evaluations. RESULTS: On the ipsilateral side of the modified Blalock-Taussig shunt, we observed a significant increase in the pulmonary artery index during a mean follow-up period of 11+/-5 months (preoperative 82+/-37 mm2/m2, follow-up 129+/-57, p=0.03). On the contralateral side, we also observed a significant increase in the pulmonary artery index (preoperative 90+/-56 mm2/m2, follow-up 137+/-56, p=0.047). There was one late death. During the follow-up period (mean 23+/-18 months), 10 patients received either a bidirectional or total cavopulmonary shunt and five of these patients underwent extracardiac Fontan operations. CONCLUSIONS: Our study demonstrated that the placement of a modified Blalock-Taussig shunt, with concomitant pulmonary artery angioplasty, constitutes a good initial surgical strategy in cases of univentricular heart with pulmonary coarctation.     

Reverse Blalock-Taussig shunt facilitates the growth of the ascending aorta after hybrid palliation

A 13-day-old baby girl with tricuspid atresia (IIc), who was prematurely born at 32 weeks and 5 days of gestation and weighed 2.2 kg, underwent bilateral pulmonary artery banding, ductal stenting, and reverse Blalock-Taussig shunt. Cardiac computerized tomography at 4 months postoperatively showed that the ascending aorta outgrew the somatic growth, presumably thanks to the forward flow through the reverse Blalock-Taussig shunt. At 6 months postoperatively, the patient underwent a successful second-stage operation.     

Fontan operation for tricuspid atresia with dysplasia of the right ventricular myocardium and absence of pulmonary valve

We report a case of successful staged repair of tricuspid atresia with dysplasia of the right ventricular myocardium and absence of the pulmonary valve. The patient underwent the modified Blalock-Taussig shunt operation at 1 month the bidirectional Glenn procedure at 11 months, and the total cavopulmonary connection procedure using extracardiac graft at 2 years. It is important to prevent the left ventricular outflow tract obstruction (LVOTO) caused by the non-functioning right ventricle when the Fontan completion. We were safely able to disconnect the pulmonary trunk from the right ventricle using the transesophageal echocardiography to evaluate the LVOTO during operation.     

Technique and experience with azygos patch modified Blalock-Taussig anastomosis for congenital cyanotic heart disease

Seventeen patients 1 day to 28 months old with congenital cyanotic heart disease underwent a modification of the Blalock-Taussig shunt. Eight were newborn infants weighing 2.6 to 4.8 kg. All infants had complex congenital heart defects that were not considered amenable to early correction. There were no early deaths and no shunt failures. Postoperative complications were restricted to prolonged intubation in 2 patients and a subcutaneous wound infection in a 14-day-old infant. Follow-up from 1 to 31 months revealed minimal cyanosis, stable hemoglobin levels, and good shunt murmurs, and there have been no upper extremity complications. There were 2 late deaths; 1 (the oldest patient) was related to medication, and the second resulted from small bowel necrosis. The concept of the azygos vein patch modified Blalock-Taussig shunt involves two factors: (1) mobilizing as much length as possible of the subclavian artery in spite of its distal small size to allow for a tension-free shunt to prevent tension on the anastomosis as growth occurs, and (2) enlarging the subclavian artery distal to the vertebral artery origin with an autologous azygos patch. During performance of a standard Blalock-Taussig shunt, a longitudinal incision is made through the pulmonary artery across the anastomosis into the upper subclavian artery. The appropriate length of harvested azygos vein is used as a patch angioplasty across the shunt. A tension-free shunt with a patulous distal portion is achieved. Pulmonary overcirculation is avoided by the limiting size of the proximal subclavian artery. Temporary occlusion of the shunt at operation resulted in an increased mean blood pressure from 6 to 18% in all infants.(ABSTRACT TRUNCATED AT 250 WORDS)     

Blalock-Taussig shunts and modified Blalock-Taussig shunts

Between January 1981 and December 1983, 53 systemic-to-pulmonary artery shunts, Blalock-Taussig shunts (BTSs) and modified Blalock-Taussig shunts (MBTSs) were carried out either as a preliminary procedure before complete correction of heart defects or as a means of permanent palliation. Central shunts continue to pose early and late problems and we seldom use them. Fifteen patients underwent a BTS and 38 an MBTS with a 5 mm polytetrafluoro-ethylene (PTFE) graft. Their ages ranged from 3 days to 11 years; 21 patients were less than 3 months old and of these 15 had an MBTS; 36 patients were less than 1 year of age and 27 of them had an MBTS. Three patients were receiving prostaglandin at the time of surgery. The overall early hospital mortality was 5,6% (3 cases); these were babies less than 2 months old. The late mortality was 3,7% (2 cases); these deaths were not shunt-related and were in babies less than 4 months old. There were 4 cases of shunt failure (7,5%) at 6, 22, 26 and 27 months after operation; a second shunt was performed in all these patients. The 48 survivors have been followed up for an average of 23 months (range 5-41 months); 6 have already undergone a complete repair. Long-term results are difficult to assess accurately because of problems with follow-up. Eight of the 53 patients had mild congestive heart failure which responded to digitalis. Because of the reliability and excellent late patency of the PTFE prosthesis, we consider it to be superior to the Waterston shunt for relief of cyanosis in the neonate and infant and as reliable as the BTS.     

A method of treating serous fluid leak from a polytetrafluoroethylene Blalock-Taussig shunt

A 3 1/2-year-old girl with complex cyanotic congenital heart disease underwent palliation with a modified Blalock-Taussig shunt, for which a 6 mm polytetrafluoroethylene graft was used. Seroma formation with serous leakage occurred. Two periods of conservative management failed. At reoperation, treatment of the graft with intraluminal "fibrin glue" resulted in immediate resolution of the leak.     

Acute pulmonary edema after Blalock-Taussig anastomosis.

Acute pulmonary edema developed in 2 patients after a Blalock-Taussig shunt procedure. Both patients had a univentricular heart complex with pulmonary stenosis. One patient underwent a modified Blalock-Taussig shunt using a polytetrafluoroethylene tube and the other underwent a classic Blalock-Taussig anastomosis. Acute pulmonary edema after the Blalock-Taussig shunt is rare, but once it has occurred, immediate treatment is obligatory.