Blalock-Taussig Research Articles

Duct Stenting vs. Modified Blalock-Taussig Shunt: New Insights Learned From High-Risk Patients With Duct-Dependent Pulmonary Circulation.

BackgroundAs no data were available on the comparison of outcomes between modified Blalock-Taussig shunts (MBTs) vs. duct-stenting (DS) in patients with pulmonary atresia (PA) and an increased ductal tortuosity and in patients with pulmonary atresia and intact septum (PA-IVS) with right ventricle-dependent coronary circulation (RVDCC), we aimed to perform a single-center retrospective evaluation.MethodsBetween 2010 and 2019, 127 patients with duct-dependent pulmonary circulation (DDPC) underwent either MBTs (without additional repairs) (n = 56) or DS (n = 71). The primary endpoint was defined as arriving at the next planned surgery (Glenn or biventricular repair) avoiding one of the following: (1) unplanned surgery or unplanned perforation of the pulmonary valve (PVP) with a stent, (2) procedure-related permanent complications, and (3) death. Two subgroups were considered: (1) patients who had a ductal curvature index (DCI) >0.45 (n = 32) and (2) patients with PA-IVS and RVDCC (n = 13). Ductal curvature index (DCI) was measured in all the patients to assess the tortuosity of the ducts. Patients with DCI >0.45 were considered as being in a high-risk group for the duct-stenting; a previous study showed that the patients with a DCI < 0.45 had a better outcome when compared with those with a DCI> 0.45.ResultsThe primary outcome was achieved equally in the two groups (77.5% in DS, 75% in MBTs). Hospital deaths, need for ECMO, and the occurrence of major complications was more frequent in the group with MBTs with an Odds Ratio (OR) of 5, 0.8, and 4, respectively, and a 95% Confidence Interval (CI) 1.1–22.6, 0.7–0.9, and 1.6–10.3, respectively, and a P-value < 0.05. For the two subgroups, the primary outcome was achieved in 64% of patients with a DCI >0.45 who received MBTs compared to 20% in those with DS (OR 3.5, 95% CI 1.2–10, P 0.005). While 74.1% of the patients with PA-IVS and RVDCC after DS had achieved the primary outcome, all patients with MBTs had an impaired outcome (OR 3.5, 95%CI 1–11.2, P 0.004).ConclusionMBTs showed a better outcome in patients with tortuous ducts compared to DS. DS seems to be superior in patients with DDPC with DCI <0.45 and patients with PA-IVS with RVDCC.

The Hemodynamic Effect of Modified Blalock–Taussig Shunt Morphologies: A Computational Analysis Based on Reduced Order Modeling

The Modified Blalock Taussig Shunt (MBTS) is one of the most common palliative operations in case of cyanotic heart diseases. Thus far, the decision on the position, size, and geometry of the implant relies on clinicians’ experience. In this paper, a Medical Digital Twin pipeline based on reduced order modeling is presented for fast and interactive evaluation of the hemodynamic parameters of MBTS. An infant case affected by complete pulmonary atresia was selected for this study. A three-dimensional digital model of the infant’s MBTS morphology was generated. A wide spectrum of MBTS geometries was explored by introducing twelve Radial Basis Function mesh modifiers. The combination of these modifiers allowed for analysis of various MBTS shapes. The final results proved the potential of the proposed approach for the investigation of significant hemodynamic features such as velocity, pressure, and wall shear stress as a function of the shunt’s morphology in real-time. In particular, it was demonstrated that the modifications of the MBTS morphology had a profound effect on the hemodynamic indices. The adoption of reduced models turned out to be a promising path to follow for MBTS numerical evaluation, with the potential to support patient-specific preoperative planning.

Patent ductus arteriosus stenting versus modified Blalock-Taussig shunt for palliation of duct-dependent pulmonary blood flow lesions.

Patent ductus arteriosus (PDA) stenting is an alternative to modified Blalock-Taussig shunt (MBTS) as first-stage palliation of duct-dependent lesions. The superiority of one approach over the other is still controversial. Our objective was to compare PDAstent versusMBTS for palliation in regard to safety, efficacy, and efficiency. From 2010 to 2021, 134 patients had first-stage palliation with either PDAstent (n = 83) or MBTS (n = 51). Twenty-seven patients failed the primary treatment and were converted to the other group. The study endpoints were hospital outcomes, interstage reintervention, and concomitant procedures at the second-stage palliation. Patients with PDAstent were significantly younger. The prevalence of antegrade pulmonary blood flow (PBF) was higher in patients who had MBTS and graft thrombosis was higher in the PDAstent. Hospital stay was significantly longer in patients who had MBTS. Predictors of prolonged mechanical ventilation were low-weight, MBTS, and conversion. Intensive careunit stay significantly increased with conversion, low-weight, and antegrade PBF. The interstage intervention was required more frequently in PDA-stent group. Predictors of reintervention were conversion and pulmonary atresia with the intact interventricular septum. Pulmonary artery plasty was required more frequently during the second-stage palliation in PDA-stent group. PDAstent is an alternative to MBTS for first-stage palliation. It is associated with shorter hospital stays and avoidance of surgery at the expense of a high rate of stent thrombosis and interstage reintervention. Conversion increased the risk of the procedure. More studies are needed to determine factors that affect PDA-stent outcomes and patient selection criteria.

Exploratory Use of Glycoprotein IIb/IIIa Inhibition in Prevention of Blalock-Taussig Shunt Thrombosis.

Morbidity and mortality related to modified Blalock-Taussig shunt (mBTTS) thrombosis remain a significant risk. Platelet inhibition following mBTTS may reduce this risk. However, oral antiplatelet agents have variable absorption following surgery. We determine risk factors for mBTTS thrombosis and hypothesize that IV glycoprotein IIb/IIIa inhibitor (tirofiban) as a bridge to oral aspirin reduces the rate of shunt thrombosis in the immediate postoperative period. End points within the 14-day follow-up period include mBTTS thrombosis, overall thrombosis, bleeding, length of stay, and mortality. Retrospective, Institutional Review Board-approved cohort study. Single-center cardiac ICU. Patients under the age of 18 who had an mBTTS placed within the study period of January 2008 to December 2018 were included. Patients were divided into two groups: standard of care (SOC) anticoagulation alone and SOC with tirofiban as a bridge to oral aspirin. Freedom from mBTTS thrombosis was estimated using the Kaplan-Meier method. A multivariable predictive model using the four most significant risk factors was developed using logistic regression. A total of 272 patients were included: 36 subjects in the SOC/tirofiban group and 236 in the SOC group. Shunt thrombosis occurred in 26 (11%) SOC group with zero in SOC/tirofiban group ( p = 0.03). The median time to thrombosis was 0 days (range, 0-12 d). The area under the curve for the predictive model (anticoagulation group, history of coagulopathy, intraoperative shunt clipping, and shunt size/weight ratio) is 0.790 ( p < 0.001). Prevalence of bleeding and mortality was not significantly different between the groups. Highest risk for shunt thrombosis following mBTTS occurs within the first few days after surgical procedure. Tirofiban is a safe addition to SOC and may be an effective strategy to prevent early mBTTS thrombosis.

Models are useful, but they are still only the models ….

Dr. Peer with colleagues [1] verifies the hypothesis that mechanical assistance of the pulmonary blood flow in a Norwood circulation can increase systemic blood flow and oxygen delivery. The verification of this hypothesis was not performed in vivo but using a circulatory lumped parameter model, which was developed to simulate a Norwood circulation with 3.5-mm Blalock–Taussig (BT) shunt in a neonate. Irrespective of the topic of the study, the idea to test the physiologic consequences of our surgical procedures using a computational model is not new but still a very attractive concept. The obvious advantage is the avoidance of the patients suffering in the case of a wrong idea, but the main disadvantage (and I think the main limitation of such studies) is underestimation of the biology complexity. Nevertheless, I admire the efforts of the authors to construct such a computational model as well as the new idea alone. One of the 2 key findings of the study is that the mechanical support of the pulmonary blood flow increases the systemic cardiac output. The increase of the systemic blood flow almost equals the decrease of the BT-shunt flow. This means that the effect of better systemic perfusion is caused only by the reduction of the BT-shunt flow due to competitive flow from the pump (effect of the redistribution of the blood flow). The model does not assess the effect of the reduction of the preload and filling of the ventricle on the systemic cardiac output (relative hypovolaemia in the systemic circulation). The authors analyze 4 different amount of assisted pulmonary blood flow: 200, 400, 600 and 800 ml/min and in each case the systemic blood flow increases linearly. If we take 800 ml/min from the right atrium of a newborn heart (even if we assume that there is an additional inflow bladder with a volume of 25 ml as designed in the presented model) and pump to the pulmonary circulation, the question is, if there is still enough blood to fill the single ventricle? The model should predict when the filling of the ventricle (preload) would be a limiting factor for the systemic blood flow and even a cause for a reversal flow through the BT shunt.

Extubation Failure in Infants with Modified Blalock-Taussig Shunt: The Incidence, Predictors, and Outcomes

Infants with congenital heart diseases often require mechanical ventilation and a prolonged intensive care unit (ICU) stay due to complex cardiopulmonary complications. The primary objective of the study was to determine the incidence and predictors of tracheal extubation failure in infants undergoing modified Blalock-Taussig shunt (MBTS). The secondary objective was to evaluate if extubation failure was associated with increased mortality and longer ICU and hospital stays. Single-center, retrospective, cohort study. Tertiary center pediatric cardiac ICU. Infants who underwent MBTS between January 2010 and December 2019. None. The demographic data and details related to the preoperative, intraoperative, and pretracheal extubation clinical conditions in the ICU were compared between the 2 study arms. Statistically significant predictors were analyzed using multivariate analysis. The p value was based on the Student's -t test for continuous variables and the chi-square test for categorical variables. A total of 146 infants were recruited for the study. Extubation failure occurred in 27 infants (18.5%), resulting in longer ICU and hospital stays. Extubation failure was deemed to be positively associated with preoperative mechanical ventilation duration, the need for escalation of the inotropic score, diaphragmatic paralysis, and systolic blood pressure ≤50th percentile at the time of extubation. The incidence rate of extubation failure after placement of MBTS was 18.5%. Preoperative mechanical ventilation, diaphragmatic paralysis, the need for escalation of the inotropic score, and systolic blood pressure ≤50th percentile could be considered predictors of extubation failure in these infants.

Mechanical support of pulmonary blood flow as a strategy to support the Norwood circulation-lumped parameter model study.

We hypothesize that mechanical assistance of the pulmonary blood flow in a Norwood circulation can increase systemic blood flow and oxygen delivery. The aim of the study was to compare haemodynamics of an unassisted Norwood Blalock-Taussig shunt circulation with a mechanically assisted pulmonary flow-based Norwood circulation, using a lumped parameter computational model. A neonatal circulatory lumped parameter model was developed to simulate a Norwood circulation with a 3.5-mm Blalock-Taussig shunt in a 3.5-kg neonate. A roller pump circulatory assist device with an inflow bladder was incorporated into the Norwood circulation to mechanically support the pulmonary circulation. Computer simulations were used to compare the haemodynamics of the assisted and unassisted circulations. Assisted and unassisted models with normal (56%) and reduced ejection fraction (30%) were compared. Compared to the unassisted Norwood circulation, the systemic flow in the assisted Norwood increased by 25% (ejection fraction = 56%) and 41% (ejection fraction = 30%). The central venous pressure decreased by up to 3 mmHg (both ejection fraction = 56% and ejection fraction = 30%) at a maximum pulmonary assist flow of 800 ml/min. Initiation of assisted pulmonary flow increased the arterial oxygen saturation by up to 15% and mixed venous saturation by up to 20%. This study demonstrates that an assisted pulmonary flow-based Norwood circulation has higher systemic flow and oxygen delivery compared to a standard Norwood Blalock-Taussig shunt circulation.

A Tetralogy of Fallot Patient Survived Only with a Classical Blalock-Taussig Shunt for more Than 50 Years.

A Tetralogy of Fallot Patient Survived Only with a Classical Blalock-Taussig Shunt for more Than 50 Years.

The Effects of the Mechanical Properties of Vascular Grafts and an Anisotropic Hyperelastic Aortic Model on Local Hemodynamics during Modified Blalock-Taussig Shunt Operation, Assessed Using FSI Simulation.

Cardiovascular surgery requires the use of state-of-the-art artificial materials. For example, microporous polytetrafluoroethylene grafts manufactured by Gore-Tex® are used for the treatment of cyanotic heart defects (i.e., modified Blalock–Taussig shunt). Significant mortality during this palliative operation has led surgeons to adopt mathematical models to eliminate complications by performing fluid–solid interaction (FSI) simulations. To proceed with FSI modeling, it is necessary to know either the mechanical properties of the aorta and graft or the rheological properties of blood. The properties of the aorta and blood can be found in the literature, but there are no data about the mechanical properties of Gore-Tex® grafts. Experimental studies were carried out on the mechanical properties vascular grafts adopted for modified pediatric Blalock–Taussig shunts. Parameters of two models (the five-parameter Mooney–Rivlin model and the three-parameter Yeoh model) were determined by uniaxial experimental curve fitting. The obtained data were used for patient-specific FSI modeling of local blood flow in the “aorta-modified Blalock–Taussig shunt–pulmonary artery” system in three different shunt locations: central, right, and left. The anisotropic model of the aortic material showed higher stress values at the peak moment of systole, which may be a key factor determining the strength characteristics of the aorta and pulmonary artery. Additionally, this mechanical parameter is important when installing a central shunt, since it is in the area of the central anastomosis that an increase in stress on the aortic wall is observed. According to computations, the anisotropic model shows smaller values for the displacements of both the aorta and the shunt, which in turn may affect the success of preoperative predictions. Thus, it can be concluded that the anisotropic properties of the aorta play an important role in preoperative modeling.

Outcomes After Stage I Norwood Palliation in a Recently Established Program Can Achieve Results Similar to Longer Established Services

Infants with hypoplastic left heart syndrome (HLHS) or similar single ventricle cardiac lesions require a three-stage surgical approach, the first step being the Stage I Norwood procedure. The Queensland Children's Hospital (QCH) in Australia is a tertiary hospital providing the only cardiac surgical service to children in Queensland and northern New South Wales. To review the centre's outcomes of Norwood procedures performed in the last 6 years. We retrospectively evaluated all infants undergoing the stage I Norwood procedure between January 2015 and August 2021. Mortality, intensive care length of stay, events of cardiac arrest following surgery and duration of mechanical ventilation were calculated and analysed for subgroups depending on type of pulmonary shunt type (right-ventricle-to-pulmonary-artery shunt [RVPAS] vs the modified Blalock-Taussig shunt [MBTS]). Forty-nine (49) patients were included. Overall survival to stage two operation (Glenn) was 90%. Both shunts were used evenly with the RVPA conduit preferred for HLHS and the MBTS largely chosen for hypoplastic left heart variants. In univariable analysis there was no difference in cardiac arrest or mortality rate for the patient with a RVPAS compared to the patient with a MBTS. We show that a recently established Norwood program can achieve results that are comparable to those reported by longer established centres, and the international literature.

The Role of 3D-Printing in a Case of Complex Congenital Heart Disease Undergoing Heart Transplantation

<h3>Introduction</h3> Patients with complex congenital heart disease (CHD) who undergo orthotopic heart transplantation (OHT) present technical difficulties due to collateral vessels, unusual anatomy and adhesions. Becoming familiar with the specific anatomy of each individual case prior to surgery is therefore crucial for the surgeon, and all available diagnostic methods should be used before embarking on the procedure. 3D-printing technology may play a pivotal role, as in this case report. <h3>Case Report</h3> A 36-year-old male was listed for OHT in the context of a complex cyanotic CHD consisting of a functional univentricular heart with hypoplasia of the right chambers with tricuspid and pulmonary atresia and an intact ventricular septum, palliated by a right Blalock-Taussig (BT) shunt at the age of 2, a left BT shunt at the age of 6 which was stented in the follow-up, and a bidirectional Glenn shunt when he was 21 years old. To depict this complex anatomy and its spatial relationships, a 3D model was printed and used by the surgical team to enhance their understanding of the patient anatomy and reenact the planned surgery beforehand, enabling the team to predict and avoid possible complications during the act (Figure). In March 2021, the patient underwent elective OHT. During the surgery, multiple MAPCAs were ligated due to diffuse bleeding. The left pulmonary artery (PA) ostial stenosis was resected and then distally anastomosed. In addition, an end-to-end anastomosis of the right PA to the right AP of the recipient was performed, proximal to the Glenn anastomosis, which was repaired with a pericardial patch. Ischemia and CBP time were 245 and 253 minutes. The postoperative course was uneventful with no evidence of bleeding complications. <h3>Summary</h3> 3D-printing should be taken into consideration as a tool for planning surgical interventions in patients with complex CHD listed for OHT. The information provided may be useful to avoid improvisation during the procedure and thus, lead to a decrease in the expected ischemic times.

A Tetralogy of Fallot Patient Survived Only with a Classical Blalock-Taussig Shunt for more Than 50 Years.

A Tetralogy of Fallot Patient Survived Only with a Classical Blalock-Taussig Shunt for more Than 50 Years.

Ventricular Assist Device (VAD) Implantation in a Patient with Complex Congenital Heart Disease (CHD)

<h3>Introduction</h3> VAD implantation in complex CHD patients presents physiologic and anatomic challenges. Few such cases have been described. <h3>Case Report</h3> We report a 41-year-old man with a history of dextrocardia, unbalanced atrioventricular (A-V) septal defect, single ventricle, heterotaxy with right atrial isomerism and asplenia, bilateral superior vena cava, pulmonic stenosis, and systemic hypertension. He had undergone surgical palliation including bilateral BT shunts (age 3 months and 7 years) and central aortopulmonary shunt at age 13 years. At age 14 years, he underwent bilateral bidirectional Glenn and extracardiac Fontan repair, followed by mechanical A-V valve replacement at age 21 years and epicardial pacemaker placement for paroxysmal atrial tachycardia (AT). He had recurrent heart failure hospitalizations requiring inotropes. Echocardiography now demonstrated moderate aortic regurgitation. Cardiac catheterization on milrinone and dobutamine found elevated Fontan pressures to 21 mmHg (panel A), reduced cardiac index to 1.4 L/min/m², normal pulmonary vascular resistance and no transhepatic gradient. An intra-aortic balloon pump was placed with improvement of his Fontan pressures to 17 mmHg. However, he subsequently developed refractory AT and cardiogenic shock. Due to cardiac deterioration, he underwent urgent HeartMate3 implantation and aortic valve repair with Park stitch (B: pre-op; C: post-op image) as a bridge to transplant. Surgical approach was an upper hemisternotomy and an anterior right thoracotomy at the 6th intercostal space. His course was complicated by postoperative bleeding requiring re-exploration of the chest, as well as acute kidney injury requiring temporary hemodialysis with subsequent renal recovery. He was transferred to acute rehab 3 weeks after surgery and was discharged home on guideline-directed medical therapy. <h3>Summary</h3> We report an adult patient with dextrocardia, Fontan repair, and single ventricle who underwent successful VAD implantation.

Bilateral chylothorax: A late complication of Kawashima procedure despite normal pulmonary pressures.

IntroductionChylothorax, a relatively rare congenital heart disease early postoperative complication, is occurring more frequently due to complexity of cardiac surgeries.Presentation of caseWe present a 9-month-old boy who had hypoplastic left heart (HLH) syndrome with interrupted inferior vena cava (IVC) and bilateral superior vena cava (SVC) palliated with left sided modified Blalock-Taussig (MBT) shunt during neonatal period and second stage palliation with left sided bidirectional glen (BDG) procedure and right sided Kawashima procedure develop bilateral chylothorax two weeks after discharge.DiscussionThis is the first reported case in the literature of a patient who developed chylothorax with relatively low Fontan systemic venous pressures after a Kawashima procedure. Clinically important chylothorax may be a marker of poor long-term outcomes, demonstrating an inability to handle overwhelming lymphatic congestion.ConclusionEarly diagnosis of chylothorax in complex cardiac surgeries may permit successful conservative management.

Catheter-Directed Thrombolysis for Acute Blalock-Taussig Shunt Obstruction

Acute obstruction of a modified Blalock-Taussig shunt may result in life-threatening hypoxia in patients with shunt-dependent pulmonary circulation. We here report successful relief of shunt blockage due to thrombosis in immediate postoperative period with transcatheter thrombolysis by Urokinase in an infant. Our case highlights the need of early diagnosis as well as the important role of emergent catheter-directed thrombolysis as an effective rescue strategy to restore the patency of acutely thrombosed Blalock-Taussig shunt.

Right Ventricular Outflow Tract Stenting as the First Option for Palliation of Neonates with Severe Tetralogy of Fallot

Background: Neonates with Tetralogy of Fallot (TOF) might be prostaglandin dependent and cannot be discharged from the hospital except after complete correction or palliation. Palliation could be achieved by modified Blalock-Taussig Shunt (BTS), ductal stenting, or right ventricular outflow tract (RVOT) stenting. Objective: The objective of this study was to present our experience of palliating neonates with severe TOF who require augmentation of the pulmonary blood flow by RVOT stenting. Methods: This study was conducted on a series of patients who had RVOT stenting in PSCC-Qassim, Saudi Arabia, from August 2016 till December 2019. Cases that had RVOT stenting are included. The patient's clinical data, echocardiography, cardiac catheterization, and follow-up data were recorded. Data were analyzed using The Microsoft Excel data analysis tool. Results: During the study period, four consecutive patients with a diagnosis of TOF with significant cyanosis underwent RVOT stenting. The mean age and weight were 2.8±1.7 days and 2.9±0.1 kg respectively. All were on prostaglandin infusion before the intervention. The mean saturation before and after RVOT stenting was 63% (±11%) and 82% (±4%) respectively (p = 0.018). One patient required RVOT stent dilatation after 4 months. All patients are alive and had complete TOF repair at a median age of 6.5 months (range 6 to 12 months). The median follow-up period is 13 months. The median branch PAs diameter and Z-score before RVOT stenting and immediately before complete TOF repair were 2.8 mm (Z score: -2.5) and 5.5 mm (Z score: -0.5 to -1.16) respectively (p = 0.001). Conclusion: RVOT stenting is a reasonable alternative palliation for patients with severe TOF. The technique of stent deployment in the RVOT is challenging and requires pre-intervention planning and discussion. Using soft catheters, coronary wires, and the premounted coronary stents facilitate crossing of the RVOT and pulmonary valve and then stent deploymen

Type I and II pulmonary atresia with intact ventricular septum in infants: a 10-year experience in initial surgery at one center

BackgroundTo explore the effect of initial surgery for type I and II pulmonary atresia with intact ventricular septum (PA/IVS).Methods50 children with type I PA/IVS and 50 with type II PA/IVS who had undergone initial surgery were enrolled. Children with Type I were divided into groups A (n = 25) and B (n = 25). Group A had received BT shunt combined with PDA ligation and balloon dilatation of pulmonary valve, whereas group B had undergone BT shunt combined with PDA ligation and pulmonary valve incision. Children with type II were divided into groups C (n = 25) and D (n = 25). Group C had received BT shunt combined with PDA ligation, right ventricular outflow tract (RVOT) incision and transannular patch. Group D had undergone BT shunt combined with PDA ligation, RVOT incision, transannular patch and artificial pulmonary valve implantation. The differences in mechanical ventilation time, length of ICU stay, mortality rate, tricuspid Z value, tricuspid regurgitation, oxygen saturation, pulmonary regurgitation, McGoon ratio, pulmonary artery transvalvular pressure, survival rate were compared between groups A and B, between groups C and D respectively.ResultsThe ventilator assistance time and length of ICU stay were greater in group C than in group D (80.96 ± 8.42 h vs. 65.16 ± 4.85 h, P = 0.045; 222.00 ± 11.72 h vs. 162.48 ± 7.91 h, P = 0.048). The pulmonary artery transvalvular pressure was significantly higher in group A than in group B at 3, 6, 12, 24 and 36 months after surgery (64.86 ± 4.13 mmHg vs. 53.04 ± 5.64 mmHg, P = 0.045; 69.47 ± 1.93 mmHg vs. 55.95 ± 4.04 mmHg, P = 0.005; 80.16 ± 3.76 mmHg vs. 73.24 ± 2.34 mmHg, P = 0.035; 62.95 ± 5.64 mmHg vs. 48.47 ± 7.44 mmHg, P = 0.04; 53.69 ± 4.89 vs. 45.77 ± 3.26, P = 0.02). Furthermore, the tricuspid Z value was significantly greater in group B than in group A at 3 and 24 months after surgery (− (1.37 ± 0.04) vs. − (1.43 ± 0.06), P = 0.03; − (0.41 ± 0.06) vs. − (0.51 ± 0.11), P = 0.02).ConclusionsThe effect of BT shunt combined with PDA ligation and pulmonary valve incision is superior to BT shunt combined with PDA ligation and balloon dilatation of pulmonary valve, and the effect of BT shunt combined with PDA ligation, RVOT incision, transannular patch and artificial pulmonary valve implantation is superior to BT shunt combined with PDA ligation, RVOT incision and transannular patch.

Is More Popular Better?

Increasing Use of the Right Ventricle-to-Pulmonary Artery Shunt for Stage 1 PalliationThe Annals of Thoracic SurgeryPreviewStage 1 palliation of hypoplastic left heart syndrome entails use of the Norwood operation with a modified Blalock-Taussig shunt or a right ventricle-to-pulmonary artery shunt, or the hybrid procedure. Use trends and factors influencing palliation selection remain unclear. We aimed to evaluate these questions and to compare outcomes between types of stage 1 palliation. Full-Text PDF

Anesthetic management of a single-ventricle pediatric patient with scoliosis: A case report

Single ventricle is a complex cardiac disease which carry high morbidity and mortality and the average 3 years survival rate without Fontan procedure was approximated to be 75%. The most common etiologies are: hypoplastic left heart syndrome and tricuspid atresia. When those patient plan to go for surgery, it’s very essential for anesthetist to understand how the physiology is affected rather than etiology. BT shunt patency, right ventricular function and pulmonary artery pressure should be evaluated before any procedure under anesthesia. Scoliosis corrective surgery is a procedure that has its special considerations related to restrictive pulmonary disease, prone positioning, and major bleeding that may occur, which altogether will add to the risk when being conducted in a single-ventricle patient and will necessitate vigilance and special care during monitoring intraoperatively. Here, we report a simple way to monitor the transpulmonary pressure gradient through two central lines in the femoral and jugular veins as part of the patient’s anesthesia management.

Very preterm and very low birthweight infant with pulmonary atresia intact ventricular septum, right ventricle-dependent coronary circulation, and discontinuous pulmonary arteries.

Prematurity and low birthweight are associated with increased mortality in infants undergoing cardiac surgery. Pulmonary atresia with intact ventricular septum and right ventricle-dependent coronary circulation carries one of the highest risks of mortality. We present a patient who was born at 28 weeks of gestation at 1.2 kg, with pulmonary atresia intact ventricular septum, right ventricle-dependent coronary circulation, coronary artery atresia, and discontinuous pulmonary arteries, who successfully underwent palliation with a modified Blalock-Taussig shunt, pulmonary arterioplasty, and subsequently a bidirectional Glenn.