Blalock-Taussing Shunt Research Articles

Mid-Term Results and Risk Factors For 10 Years of Functional Single Ventricle Associated With Total Anomalous Pulmonary Venous Connection

There are few surgical treatment results in elderly patients with functional single ventricle (FSV) and total anomalous pulmonary venous connection (TAPVC). We retrospectively analyzed 10 years of mid-term surgical treatment results and risk factors of these age-specific people. Between March 2008 and December 2018, 43 consecutive patients with FSV and TAPVC received initial surgical palliation in our center. There were 20 cases of supracardiac TAPVC, 21 of cardiac type, and two cases of mixed type. Initial surgical palliation procedures involved pulmonary artery banding (PAB) for patients, modified Blalock-Taussing shunt (mBTs) for five patients, and bidirectional Glenn (BDG) for 34 patients. TAPVC repair was performed in 12 patients during BDG. The 1-year and 5-year overall survival rates were 69.7% and 62.8%, respectively. In TAPVC repair group and non-TAPVC repair group, the 1-year overall survival rates after initial surgical palliation were 41.7 and 80.5%, respectively, and the 3-year ones were 25% and 77%, respectively. There were significant differences in the type of TAPVC (P < 0.001), preoperative pulmonary venous obstruction (P = 0.001), and overall mortality (P = 0.001) between these two groups. Cox univariate and multivariable analysis indicated concomitant TAPVC repair was the only risk factor for mortality. The mid-term results of surgical treatment of FSV and TAPVC, especially for patients who underwent concomitant TAPVC repair, remain poor. TAPVC repair may be a priority over single-ventricular palliative surgery for patients with FSV and TAPVC.

Right ventricle function longitudinal evaluation after norwood procedure: comparison between right ventricle-pulmonary artery shunt and blalock-taussing shunt

Abstract Background Norwood procedure represents the first of three surgical steps toward Hypoplastic left heart syndrome (HLHS) complete palliation. Two are the main surgical techniques allowing the reconstruction of Norwood circulation: the right ventricle-pulmonary artery shunt (RVPAS) and the modified Blalock-Taussing shunt (mBTS). However, still little is known about the impact on right ventricle (RV) function of the required ventriculotomy for the RVPAS. Purpose The aim of the study was to investigate the changes in RV function in HLHS patients after RVPAS vs mBTS. Methods The cohort included 27 consecutive HLHS patients (10 in the modified Blalock-Taussig shunt group and 17 in the RVPAS group) who successfully underwent Norwood procedure in a single tertiary paediatric cardiology centre. Longitudinal strain (LS) and strain rate (LSR), tricuspid annulus peak systolic excursion (TAPSE) and fractional area change (FAC) were evaluated in all patients before Norwood and in three different breakpoints in the steady state after Norwood procedure (30 days after Norwood, 90 days after Norwood, 140 days after Norwood). Results Ventricular loading conditions (diuretic treatment, blood pressure and tricuspid regurgitation) were similar in both groups. No significant differences were found at different time points between RVPAS and mBTS group in terms of LS, LSR, TAPSE and FAC. However, when we compared RV function before and after Norwood procedure, 90 days after the procedure, patients who did not undergo RV ventriculotomy (mBTS group) showed significant improvement in LS compared to pre-surgical assessment (mBTS: +27.35±43.47% vs RVPAS: −8,20±25.25%, p=0,03). This finding was consistent but no longer statistically significant at 140 days after Norwood (mBTS: +13.81±21.99% vs RVPAS: −4.90±27.97%, p=0,12). Conclusion After Norwood procedure mBTS patients showed a significant increase in LS when compared with patients who underwent RVPAS. This finding was consistent but no longer significant at 140 days after Norwood probably because the number of patients was too small to reach a significant level. These data support the use of LS in HLHS patient's evaluation and may be of value to find a patient-tailored timing for the second surgical stage. TAPSE, FAC, LS and LSR trends Funding Acknowledgement Type of funding source: None

The surgical result of the double outlet right ventricle with obstruction of right ventricular outlet

Objective To summarize the early surgical result of the double outlet right ventricle (DORV) with obstruction of right ventricular outlet (RVOTO). Methods From January 2009 to July 2015, 66 cases of DORV with RVOTO received the surgical treatment, including 55 cases of biventricular repair, 5 cases of Blalock-Taussing (BT) shunt, 2 cases of Glenn shunts, and 4 cases of Fontan procedure. Results The Total mortality rate was 10.6% and 9.1%, and patients were died after the biventricular repair. The average duration of ventilation was (54.94±70.07)h, and the average residence time of intensive care unit (ICU) was (5.23±5.65)d. According to the RVOT pressure, 49 survival patients receiving biventricle repair were divided into three groups. The ventilation and ICU stay time was much longer in the >40 mmHg group (P<0.01). The main causes of death were low heart row syndrome, valvular regurgitation, third degree conduction block, and coronary anomalous origin. Conclusions Biventricular repair of the DORV with RVOTO can achieve good results. The complete atrioventricular septal defects (CAVSD) may increase the mortality of the patients with this kind of operation for a severe left ventricular outflow tract obstruction. Key words: Tetralogy of fallot/SU; Double outlet right ventricle/SU; Follow-up studies

Pulmonary deadspace and postoperative outcomes in neonates undergoing stage 1 palliation operation for single ventricle heart disease.

Increased pulmonary dead space fraction (VD/VT) has been associated with prolonged mechanical ventilation after surgery for congenital heart disease. The association of VD/VT with clinical outcomes in neonates undergoing stage 1 palliation for single ventricle congenital heart disease has not been reported. We describe changes in VD/VT, differences in VD/VT based on shunt type (right ventricle to pulmonary artery conduit vs modified Blalock-Taussing shunt) and association of VD/VT with postoperative outcomes in patients undergoing stage 1 palliation. Retrospective chart review for demographic, hemodynamics, outcome information, and VD/VT values were collected at 6-hour intervals during the first 48 postoperative hours in neonates undergoing stage 1 palliation. VD/VT was calculated using mixed expired CO2 (PeCO2) obtained from capnography and paired arterial blood gas CO2 values. Cardiac ICU in a tertiary care pediatric hospital. Newborns with single ventricle congenital heart disease undergoing stage 1 palliation during 2003-2004. Of the 51 patients, 31 had right ventricle to pulmonary artery and 20 had Blalock-Taussing shunt. Although VD/VT was lower in the Blalock-Taussing shunt group over all time points (p = 0.02), maximal VD/VT on day 1 (0.49 ± 0.07) and on day 2 (0.46 ± 0.08) were not different between the shunt groups. VD/VT decreased significantly over time in both shunt groups (p = 0.001 for right ventricle to pulmonary artery; p < 0.001 for Blalock-Taussing shunt). Higher maximal VD/VT during first 48 postoperative hours was independently associated with fewer ventilator (β = -26.6; p = 0.035) and hospital-free days in the first month after stage 1 palliation (β = -40.4; p = 0.002) after adjusting for potential confounders in a multivariable linear regression model. Increased pulmonary dead space exists early after stage 1 palliation operation for single ventricle congenital heart disease. Higher VD/VT during the first 48 postoperative hours was associated with longer duration of ventilation and hospital LOS and may be a useful marker of postoperative outcomes in this population.

In Vitro Study of the Norwood Palliation

The aim of this study was to build a mock circulatory system replicating in vitro the hemodynamics following the Norwood procedure and testing patient-specific anatomies focusing on the effect of aortic coarctation. Three anatomies were reconstructed from magnetic resonance images and rapid prototyped with transparent rigid resin. The models presented varying degrees of coarctation (none, moderate, and severe). A Blalock-Taussing (BT) shunt was modeled in all phantoms, which were inserted into a mock circulation. The single ventricle was simulated using a Berlin Heart driven with a PC-controlled piston. Resistive and compliant elements were implemented, creating a lumped parameter network. Pressure was measured at three locations: the transverse aortic arch, just after the aortic isthmus, and further downstream in the thoracic aorta. Volume distribution was derived from the instantaneous flow measurements at three outlets: upper body, lower body, and BT shunt. The combination of three-dimensional (3D) detailed anatomy and lumped parameter network effectively renders the circuit a multiscale in vitro model that successfully reproduces physiologic pressure signals. The pressure results highlight the larger pressure drop caused by coarctation and show the effect of pressure recovery. Results also suggest a reduction of flow to the lower body with increasing severity of coarctation, to the advantage of upper body and pulmonary circulation.

Optimal Dual-Chamber Pacing Therapy Improves Cardiac Function in a Patient with Complex Congenital Heart Disease and Bradyarrhythmias

A 38-year-old female with complex congenital heart disease was repeatedly hospitalized because of congestive heart failure with symptoms of New York Heart Association (NYHA) class IV. Her complex disease was composed of dextrocardia, single ventricle, transposition of the great arteries, atrial septal defect, pulmonary stenosis. She underwent Blalock-Taussing shunt and Waterston operations in her childhood. During follow-up in our outpatient clinic, 12-lead electrocardiograms showed advanced atrioventricular block and sinus bradycardia. These bradyarrhythmias affected progressively congestive heart failure. Accordingly, we performed the implantation of a dual-chamber pacemaker. At that time, we implanted two screw-in-leads intravenously on optimal sites of the atrium and ventricle without complications. The pacing therapy improved her heart failure with the reduction of NYHA class from III to IV and the decrement of serum brain natriuretic peptide level from 1,079 to 194 pg/mL. After the procedure, she had no hospitalization in the follow-up period of one year. Thus, pacing sites is extremely important when we perform pacemaker implantation in a patient with congestive heart failure and conduction disturbance, particularly in the setting of complex congenital heart disease.

A case of fetal heterotaxy syndrome

Heterotaxy syndrome is a disorder that results in abnormal placement of organs. We report the prenatal diagnosis of complex cardiac abnormalities associated with left isomerism. A 32-year-old multigravida was referred to our hospital for evaluation of abnormal sonographic findings. On prenatal sonography, we suspected a double outlet of the right ventricle, right ventricular hypertrophy, a ventricular septal defect, a large azygos vein instead of an inferior vena cava, a right-sided stomach, and asplenia. Postnatal imaging studies confirmed these findings, except a left-sided single spleen. After birth, the infant underwent a left modified Blalock-Taussing shunt and underwent a 2nd surgical procedure (Kawashima operation, right pulmonary artery angioplasty, and atrial septal defect widening). This report suggests intrauterine fetal sonography can accurately delineate abnormal fi ndings in heterotaxy, allowing perinatal counseling and postpartum planning for corrective surgery.

Octreotide therapy in two children with intractable postoperative chylothorax

Postoperative chylothorax is sometimes difficult to be managed either by conventional therapies or by surgery. Herein, we report the experience of octreotide therapy for intractable postoperative chylothorax in two children (one was severe tetralogy of Fallot received Blalock-Taussing shunt, and the other was a single ventricle received bi-directional Glenn shunt) and review the literature on octreotide efficacy.

Risk Factor of Interim Failure and Early Detection of the High-Risk Patients with Functional Single Ventricle after Blalock-Taussing Shunt

The purpose of this study was to identify the risk factor of interim failure and to consider the method for detecting high-risk patients after Blalock-Taussing shunt. Between 1990 and 2004, 64 patients with functional single ventricle and low pulmonary flow underwent Blalock-Taussing shunt. We evaluated risk factors of interim failure by Logistic regression. Furthermore, assessments by catheterization and echocardiography were compared between Group Completion (Group C; 36 patients who had completed the Fontan operation or were Fontan candidates) and Group Failure (Group F; 20 patients who died before the Fontan operation or dropped out from Fontan candidate). In Group C, the survival at 10 years was 93%. The risk factor of interim failure was a systemic ventricular end-diastolic volume (SVEDV) of more than 250% of normal after shunt. The ventricular volume by echocardiography in Group C had been maintained between 190% and 200% of normal. By contrast, the ventricle in Group F had been significantly dilated after postshunt short term. The risk factor of interim failure was postshunt ventricular dilation, and the dilation was identified after postshunt short term. We recommend volume study within two to three months after shunt, and bidirectional cavopulmonary anastomosis should be immediately indicated to patients with ventricular dilation.

Hypercyanotic spell after general anesthesia in Tetralogy of Fallot

A 21-year-old woman with tetralogy of Fallot referred because of a right temporo-occipital abscess, 2-months history of progressive visual loss, and headache. She had history of multiple drainages of brain abscesses and a Blalock-Taussing shunt, which was failed. With general anesthesia (GA) she underwent a temporo-occipital craniotomy and en-block removal of abscess. After termination of GA, she experienced two generalized seizures and became unconscious, tachycardia, and respiratory distress. The ABG showed low PaO2 and low pH. The respiratory distress was controlled by propranolol. When hypercyanotic spell occurs during anesthesia or early postoperative period, could cause serious problems for diagnosis and treatment.

Transhepatic closure of atrial septal defect and assisted closure of modified Blalock/Taussig shunt

The details of transhepatic closure of moderate - large size atrial septal defect as well as assisted closure of a modified Blalock Taussig shunt in a 2 1/2 year old patient with occluded femoral vessels are discussed. The technical variations as well as the potential advantages of this route are outlined.

唇顎裂を伴った無脾症候群の１例

Asplenia syndrome is characterized by complex congenital heart defects, asplenia, and abdominal heterotaxy. We report a case of asplenia syndrome associated with cleft lip and alveolus. The patient underwent cheiloplasty while in good condition after cardiac surgery, i. e., Blalock-Taussing shunt operation. Prophylaxis against infective endocarditis is important, and the operation was performed successfully without any infection. There were no circulatory problems, and the patient had an uneventful hospital stay.

The effect of adenosine triphosphate on the functional status of the ductus arteriosus

We investigated whether a low-dose infusion of ATP-MgCl2 could affect the functional status of the ductus arteriosus during hypoxia-induced pulmonary vasoconstriction. Three-day-old piglets were made hypoxic by ventilation with a mixture containing 10% oxygen, 4% CO2, and balance nitrogen. Serial infusions of ATP-MgCl2 at 0.1, 0.5, and 1.0 mg/kg/min were compared with preinfusion hypoxia baselines. The functional status of the ductus arteriosus was determined by change in transit time of a bolus of iced saline between thermistor probes in the pulmonary artery and aorta. The method was validated using a Blalock-Taussing shunt (subclavian to pulmonary artery) in 3-week-old piglets instrumented in a similar manner. In these three-day-old piglets, hypoxia alone produced a significant elevation in pulmonary artery pressure and reduction in PO2. All dose rates of ATP-MgCl2 produced a significant decrease in mean pulmonary artery pressure. Systemic pressure was significantly decreased only during the 1.0-mg/kg/min infusion. Transit times of a bolus of iced saline during the validation were definitive for characterizing a situation of "shunt open" or "shunt closed." Infusion of ATP-MgCl2 produced no change in the status of the ductus arteriosus in 45 (94%) of the determinations. In only three cases was the effect of ATP-MgCl2 sufficient to result in a functional change in the status of the ductus arteriosus. Pre- and postductal pulmonary artery PO2 were not altered during ATP-MgCl2 infusion, thus corroborating the transit time determinations. From these results, we conclude that an infusion of ATP-MgCl2 does not alter the functional status of the ductus arteriosus.

Ｂｌａｌｏｃｋ‐Ｔａｕｓｓｉｇ手術における肺動脈および左心系の発育に関して

Ｂｌａｌｏｃｋ‐Ｔａｕｓｓｉｇ手術における肺動脈および左心系の発育に関して

Double outlet right ventricle with 1-malposition of the aorta.

Four patients are described with a recently recognized variant of double outlet right ventricle. Clinical examination favoured tetralogy of Fallot, but the chest X-ray suggested corrected transposition. Catheterization and angiocardiography showed that the aorta was to the left of the main pulmonary artery, and both arose from a normally positioned morphological right ventricle. Egress of blood from the left ventricle was through a subaortic ventricular septal defect. In all patients severe pulmonary stenosis was present and the right coronary artery ran an anomalous course anterior to the pulmonary valve ring. Two children had successful total correction, and one a palliative Blalock-Taussing shunt. Necropsy material from the fourth patient allowed confirmation of the ventricular morphology and the conducting tissued was examined. In corrective surgery, blood from the left ventricle was rerouted into the aorta by an intraventricular baffle. Pulmonary stenosis was relived by infundibulectomy and outflow tract patch.