Accordion-Like Prosthesis for Modified Blalock-Taussig Shunt

Abstract

From March 1996 to July 2002, 26 consecutive patients, with a mean age of 17.9 months and a mean body weight of 6.6 kg, underwent the modified Blalock-Taussig shunt with a tubular accordion-like prosthesis. In a mean follow-up period (defined as the interval between the shunt procedure and repair or last evaluation) of 10.9 months (range, 1 to 32 months), there were 1 death due to excessive pulmonary blood flow in a neonate with hypoplastic left heart syndrome and 3 reoperations to correct shunt-related problems, 2 of them early and 1 late (to regulate pulmonary blood flow after left ventricular retraining for transposition of the great arteries). There was no occurrence of shunt obstruction or kinking. Other shunt-related early complications, such as bleeding, infection, or serous fluid leakage, did not occur, and no patient needed pulmonary artery reconstruction during surgical repair. Shunt patency was confirmed by Doppler echocardiography in all patients and also by angiography in 73% of the patients. This prospective study confirmed our preliminary results with this prosthesis. The use of this prosthesis is justified for reducing early and late complications potentially associated with the modified Blalock-Taussig shunt, particularly distortion of the pulmonary arteries.

Physiological Fontan Procedure

“…A preparation is generally required in the neonatal period to either increase (9–11) or decrease (12–17) the pulmonary blood flow, or to use the right ventricle and the proximal pulmonary artery to provide blood flow to the systemic circulation (18–20), with the pulmonary blood flow obtained with either a modified Blalock-Taussig shunt (21, 22) or with a right ventricle to pulmonary artery conduit (23).…”

Editorial: Univentricular Heart

“…Since the first stage in both groups is a palliative approach, over the years, the progress with the available materials and technology facilitated the surgical palliations to increase the pulmonary blood flow with systemic-to-pulmonary shunt (modified Blalock–Taussig shunt) ( 2 , 3 ) as well as the control of distal pulmonary artery pressure and flow with adjustable pulmonary artery banding ( 4 , 5 ).…”

Surgical Approaches to the Blalock Shunt

“…The classic BT shunt entailed a direct anastomosis between subclavian artery and pulmonary artery and was replaced in 1975 by a modified BT shunt where an interposition graft, such as a polytetrafluroethylene (PTFE) conduit was placed connecting the subclavian and the pulmonary artery (PA) [2]. This led to better results and much of the morbidity of the classic BT shunt was avoided [3][4][5]. The modified BT shunt was thought to be an excellent operation for palliation and good results were achieved as early as 1979 [6].…”