Banding of the Patent Ductus Arteriosus During Modified Blalock-Taussig Shunt Surgery in Neonates With Pulmonary Atresia

Abstract

We read with great interest the recent article by Zahorec and colleagues [1Zahorec M. Hrubsova Z. Skrak P. Poruban R. Nosal M. Kovacikova L. A comparison of Blalock-Taussig shunts with and without closure of the ductus arteriosus in neonates with pulmonary atresia.Ann Thorac Surg. 2011; 92: 653-658Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar] in the August 2011 issue of The Annals of Thoracic Surgery. They compare the results of closure versus nonclosure of the patent ductus arteriosus during modified Blalock-Taussig (MBT) shunt surgery in neonates with pulmonary atresia. The authors show that the ductal closure group has a significantly higher resuscitation, reintervention, and mortality rates compared with the nonclosure group during the early postoperative period. We also practice closure and nonclosure of the patent ductus arteriosus during MBT shunt surgery in a similar patient group [2Erek E. Yalçinbaş Y.K. Mamur Y. et al.Systemic-to-pulmonary shunt operation in neonates with ductus-dependent pulmonary blood flow.Turkish J Thorac Cardiovasc Surg. 2007; 15: 29-35Google Scholar]. Similar to other reports [3Alkhulaifi A.M. Lacour-Gayet F. Serraf A. Belli E. Planché C. Systemic pulmonary shunts in neonates: early clinical outcome and choice of surgical approach.Ann Thorac Surg. 2000; 69: 1499-1504Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar, 4Santoro G. Capozzi G. Caianiello G. et al.Pulmonary artery growth after palliation of congenital heart disease with duct-dependent pulmonary circulation: arterial duct stenting versus surgical shunt.J Am Coll Cardiol. 2009; 54: 2180-2186Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar], acute shunt thrombosis was the major cause of mortality and morbidity in our patients. High pulmonary vascular resistance and small vessels are responsible for this complication. Another important concern is the development of pulmonary edema and heart failure due to high pulmonary blood flow, which is the cause of shunt and ductal flow. In agreement with the experience described in the article [1Zahorec M. Hrubsova Z. Skrak P. Poruban R. Nosal M. Kovacikova L. A comparison of Blalock-Taussig shunts with and without closure of the ductus arteriosus in neonates with pulmonary atresia.Ann Thorac Surg. 2011; 92: 653-658Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar], we have experienced an alternative approach to gain the ductal patency and, at the same time, to avoid the volume overload and low cardiac output. We performed banding of the patent ductus arteriosus in our last 8 cases. The ductus arteriosus was banded by a Ligaclip over a nylon tape encircling the ductus. This way, the ductus might provide additional pulmonary flow and it could be easily debanded in case of shunt failure. In the postoperative period, we continued pGE2 infusion of minimal dose for 2 days to improve the patency of the ductus. Only 1 patient underwent an urgent debanding of the ductus in the intensive care unit due to shunt thrombosis and this patient underwent shunt revision under stable hemodynamic conditions. In conclusion, we believe that MBT shunts without closure of the patent ductus arteriosus is a beneficial procedure in neonates with pulmonary atresia. Banding of the ductus arteriosus may be an alternative option for an optimal postoperative recovery with decreased postoperative complications. ReplyThe Annals of Thoracic SurgeryVol. 94Issue 2PreviewWe appreciate the response to our recent publication regarding management of the patent ductus arteriosus (PDA) during the modified Blalock-Taussig (MBT) shunt procedure in neonates by Onan and colleagues [1]. Consistent with our results, the authors described their positive experience with ductal patency during the early postoperative course after the MBT shunt in neonates with pulmonary atresia. To avoid a potential volume overload from high pulmonary blood flow, they suggested performing banding of the arterial duct during the MBT shunt procedure and continuing with prostaglandins after surgery. Full-Text PDF