Early and Late Results of the Modified Waterston Shunt with PTFE Grafts for Palliation of Complex Congenital Cyanotic Heart Disease in Neonates

Abstract

During a 12 year period from 1978 to 1989, 35 infants under 4 weeks of age underwent palliative surgery for complex congenital cyanotic heart disease with a short (1-1.5 cm) PTFE graft between the ascending aorta and the right pulmonary artery (modified Waterston shunt). Twenty-three infants had pulmonary atresia and 14 had severe pulmonary stenosis. Underlying cardiac lesions were tetralogy of Fallot (n = 11), single ventricle (n = 7), transposition complexes (n = 6), and intact ventricular septum and hypoplastic right heart syndrome (n = 13). There were 4 early deaths (10.7%) in the entire series, 2 of which were shunt related. Three of the 4 occurred during our initial experience with this shunt in 1978 and 1979. They led to the modified Waterston shunt being abandoned for 3 years in favor of other shunt procedures. Since 1983 one early death occurred in 28 infants (3.5% mortality) with no death in the latest 26 patients. All patients were followed up between 6 and 108 months. There were 4 late deaths, one of which was shunt related. We observed a significant difference in the shunt patency rate between 4 and 5 mm grafts: palliation was adequate after 2 years in 52% of the patients when a 4 mm graft was used and in 89% of the 5 mm graft group (p less than 0.005). Reshunting was necessary in 7 infants between 5 and 60 months after primary surgery. Recatheterization was performed in 17 infants for suspected shunt failure (n = 6) or diagnostic reasons (n = 11).(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiogram‐gated multislice spiral CT in functionally univentricular heart following long‐lasting Waterston–Cooley anastomosis

“…1,[16][17][18] With the modified PTFE shunt grafts, early shunt failure is in the range of 0-30%. 1 Woolf et al found that the incidences for early shunt failure, mortality at revision of early shunt failure and overall hospital mortality proved all to be lower for the PTFE shunt in comparison not only to the original Waterston shunt but also to the Blalock-Taussig shunt. 19 Fontan and Baudet showed that 'right heart bypass' is a clinically successful approach to the management of tricuspid atresia.…”

“…Waterston and Potts anastomoses have been widely replaced by other procedures. 1 So far, cardiac catherization has been defined as the gold standard in preoperative imaging of congenital heart defects.…”

“…Despite an increasing frequency of corrective procedures for cyanotic congenital heart defects at a young age, systemic‐pulmonary artery shunts continue to play an important role in the management of such defects, either as preliminary procedure for correctable lesions or as a means of permanent palliation 1 …”

“…Meanwhile, because of their high complication rates Waterston and Potts anastomoses have been widely replaced by other procedures 1 …”

“…Despite an increasing frequency of corrective procedures for cyanotic congenital heart defects at a young age, systemicpulmonary artery shunts continue to play an important role in the management of such defects, either as preliminary procedure for correctable lesions or as a means of permanent palliation. 1 Since the introduction of a subclavian-pulmonary artery shunt by Blalock and Taussig, 2 several other systemicpulmonary artery anastomoses have been described such as direct aorto-pulmonary shunts between the ascending aorta and the right pulmonary artery by Waterston 3…”