Optimal Graft Size of Modified Blalock-Taussig Shunt for Biventricular Circulation in Neonates and Small Infants

Abstract

The modified Blalock-Taussig shunt (mBTS) is one of the most important palliative procedures in congenital heart surgery. However, in neonates and small infants, operative mortality and morbidity due to excessive pulmonary blood flow or shunt failure remains high. In this study, a small shunt graft (3.0-mm diameter) was estimated to determine the optimal shunt graft size of BTS as an initial palliation for ultimate biventricular circulation. Eighteen patients weighing an average 3.5 kg who underwent mBTS from July 2004 to January 2013 at our institute were reviewed. We divided the study cohort into two groups: group S (n = 10) included patients with 3.0-mm diameter shunt grafts, and group L (n = 8) included patients with 3.5-mm diameter shunt grafts. There were no hospital deaths or shunt occlusion in either group. One group L patient (12.5%) had cardiogenic shock due to excessive pulmonary blood flow. There were no differences in postoperative arterial oxygen saturation (SaO2) between the groups. There were no differences in body weight at intracardiac repair (ICR) between the groups. During the interstage to ICR, body weight gain was significantly greater in group S than in group L (P = 0.008). The small shunt graft (3.0-mm diameter) in BTS was safe, provided adequate pulmonary blood flow, and led to significant weight gain between mBTS and ICR for ultimate biventricular circulation in neonates and small infants with low body weight.

The effect of modified Blalock-Taussig shunt anastomosis angle and pulmonary artery diameter on pulmonary flow

“…In the majority of neonates, most stages of cardiac repair are performed between 3 months and 2 years after the primary shunting stage, depending on the primary diagnosis and procedure performed. Although progress has been made in primary total correction and the perioperative management of neonates and children with congenital heart diseases, palliative procedures still play a vital role in high-risk patients with complex cardiac lesions such as hypoplastic left heart syndrome ( 14 ).…”

Application of mathematical modelling for the evaluation of the results of systemiс-pulmonary shunts formation

“…M. Shibata с соавт. предложили индекс трансплантата: соотношение площади поперечного сечения трансплантата и площади поверхности тела [18]. Тромбоз шунта в раннем послеоперационном периоде встречается в 9,4-13,7 % случаев [19].…”

Mathematical Analysis and Physical Profile of Blalock-Taussig Shunt and Sano Modification Procedure in Hypoplastic Left Heart Syndrome: Review of the Literature and Implications for the Anesthesiologist

“…Studies using CFD for modeling graft-vessel interactions in mBT have shown that the effect of diameter on flow patterns and shear stress/rate distribution is greater than that of other variables, such as the angle of incidence and the shape of the graft. 63 In that regard, the one factor that surgeons should take into consideration when performing mBT is the diameter that best suits the size of aorta and pulmonary artery in a particular child, 107 and mathematical modeling with computer-assisted dynamics might be considered in assisting this task. 108 Retrospective reports have shown evidence of better short-term survival with an RV-PA shunt compared with an mBT shunt.…”