Neonatal Blalock-Taussig Shunt: Technical Aspects and Postoperative Management

Abstract

A systemic-pulmonary artery shunt in neonates with decreased pulmonary blood flow is technically demanding. We describe our surgical technique, postoperative management, and results in 19 neonates who underwent a modified Blalock-Taussig shunt between April 2003 and March 2006. Prostaglandin infusion was required in 8 patients who were critically cyanosed, and 5 were on inotropic support preoperatively. A 3.5 or 4.0-mm polytetrafluoroethylene graft was anastomosed with 8/0 polypropylene suture. Postoperatively, systemic pressure was kept slightly higher than normal, and heparin was started early. One patient required revision of the shunt, and one was reexplored for bleeding. There were 2 hospital deaths (mortality, 11%) in patients with preoperative hemodynamic instability. The mean follow-up period was 12 months, with no late postoperative shunt blockage or death. Meticulous surgical technique and judicious use of heparin and inotropic agents improved the outcome and reduced the incidence of shunt blockage and reexploration for bleeding.

Modified Blalock Taussig shunt: Comparison between neonates, infants and older children

“…The preoperative SaO 2 and PaO 2 in our patients were 69.21% ±7.67% and 39.54 ± 6.29 mmHg, respectively. The preoperative SaO 2 in our study was higher in comparison to other study groups [14,18,19] because of two reasons-one, we measured the SaO 2 after intubation in the operation room and second only 28% (37 of 134) children underwent emergency shunt for acute systemic desaturation. The post MBTS SaO 2 was 84.29% ±7.68%, which is similar to other investigators who reported a post shunt SaO 2 between 77% and 89%.…”

“…These values are higher as compared to other studies [13][14][15]18,19] We selected all the children undergoing MBTS surgery in a 2 year period, whereas other investigators defined age limits for their research and have concentrated on neonates. [10,13,14,19,20] Although, palliation with definite procedures is becoming common in young age, many older children still undergo MBTS because of complex anatomy, underdeveloped branch PAs and/or systemic desaturation (emergency MBTS). The preoperative SaO 2 and PaO 2 in our patients were 69.21% ±7.67% and 39.54 ± 6.29 mmHg, respectively.…”

“…[5] Other anomalies Shauq et al [8] in their study have reported significantly longer ventilation time, inotropic support requirement, and Intensive Care Unit (ICU) and hospital stay in children undergoing MBTS through a sternotomy. In spite of wide clinical experience, the overall mortality with MBTS varies between 2.3% and 16% [9][10][11][12] and around 9-11% [13][14][15] for neonatal Blalock Taussig (BT) shunts. This retrospective analysis was designed with the following objectives: 1.…”

Outcome of Staged Repair of Tetralogy of Fallot with Pulmonary Atresia and a Ductus-dependent Pulmonary Circulation: Should Primary Repair Be Considered?

“…After the shunt operation, for whatever reason, management of decreased pulmonary blood flow is technically demanding [10]. The major cause of decreased pulmonary blood flow is known to be shunt obstruction.…”

Neonatal Shunt Operations

“…The authors have successfully managed these critical cases of the pediatric cardiac surgery. 1 However, we believe their manuscript contains certain points to be stressed on.…”