Blalock-Taussig Research Articles

Modified Blalock-Taussig Shunt: A Single-Center Experience and Follow-Up.

The modified Blalock-Taussig shunt (MBTS) is used to palliate patients with restrictive pulmonary blood flow in complex cardiac anomalies. We describe the immediate and follow-up results of patients with MBTS in our center. Patients who received MBTS (excluding those with hypoplastic left heart syndrome) from May 2008 to December 2018 were retrospectively identified. Hospital records were evaluated to determine patient demographics, diagnoses, and perioperative data. Patients were followed up by echocardiograph to evaluate the patency of the graft until stage II procedure or death. MBTS was performed in 25 patients by 2 surgeons; 16% were neonates, and 60% had pulmonary atresia and 24% tetralogy of Fallot. The patients' median age was 2.6 months (range 0.2 to 372), and median weight was 5.3 kg (range 1.9 to 45). Preoperative oxygen saturation (SaO2) was 68.7% ± 7.8%. Forty-eight percent of patients received a 3.5-mm graft, and 20% received a concomitant pulmonary arterioplasty with cardiopulmonary bypass. Postoperative SaO2 was 83.2% ± 3.6%, significantly different from preoperative SaO2 (P < .05). Follow-up duration was 1.2 years (range 0.3 to 7.8), with no graft blockage. Three patients died in hospital from cardiorespiratory decompensation after MBTS with concomitant pulmonary arterioplasty. The median age of patients receiving a stage II procedure was 1 year (range 0.4 to 17.4). Actuarial 1-year survival was 79.7% (95% confidence interval 53.1% to 92.2%). MBTS continues to be valuable for palliation of complicated cyanotic congenital heart disease, yet mortality was considerable with concomitant pulmonary arterioplasty. With effective coagulation, the patency rate of grafts was high.

A shunt decision-making protocol in the surgical palliation of hypoplastic left heart syndrome from 2004 to 2016.

The aim of this study was to study the impact of a decision-making protocol for shunt type in the Norwood procedure for hypoplastic left heart syndrome. Our cohort extends from 2004 to 2016. In era 1 (pre-2008), there was no policy for the choice of Norwood shunt. In era 2 (post-2008), a standard protocol was implemented. The right ventricle (RV)-to-pulmonary artery conduit was utilized for low-birth weight patients (<2.5 kg). The right modified Blalock-Taussig Shunt (RBTS) was constructed for normal birth weight patients. The records of 133 consecutive operative patients with hypoplastic left heart syndrome anatomy between 2004 and 2016 were retrospectively reviewed. Survival risk factors were analysed using the Cox proportional hazards risk model. The Norwood procedure was performed at a mean age of 2.9 ± 1.9 days. Bidirectional cavopulmonary shunt was performed at a median age of 99 days (interquartile range 91-107). In era 1, 38.6% (22/57) of patients received the RBTS and 61.4% (35/57) of patients received the RV-to-pulmonary artery conduit. In era 2, 86.8% (66/76) of patients received the RBTS and 13.2% (10/76) of patients received the RV-to-pulmonary artery conduit. The actuarial survival to Fontan was 72.2% (96/133). Era 1 patients were more likely to die within the 1st year (hazard ratio = 2.310, P = 0.025). The shunt protocol may improve outcomes in high-risk patients, and we have demonstrated the reliability of the RBTS in low-risk patients. The short- and mid-term outcomes of our Norwood population justify the continued efforts to improve surgical and perioperative management.

Advances in Pediatric Ductal Intervention: an Open or Shut Case?

To review the most recent literature on pediatric transcatheter ductal intervention including ductus arteriosus occlusion and stenting. With the development and FDA approval of smaller ductal devices, including most recently the Amplatzer Piccolo Occluder (Abbott, Abbott Park, IL), transcatheter ductus arteriosus device closure is now being safely performed in premature infants and patients < 6kg using a transvenous approach. In patients with ductus-dependent pulmonary blood flow, ductal stenting with pre-mounted coronary artery stents has been shown to be an acceptable alternative to the surgically placed Blalock-Taussig shunt. Centers with experience in ductal stenting have demonstrated success, even with the tortuous ductus. Innovation in transcatheter device technology and procedural practices have allowed for significant advances. Transcatheter ductal device closure is a reasonable alternative to surgical ligation even in premature, low-birthweight infants. Ductal stenting is also an accepted alternative to the modified Blalock-Taussig shunt. We anticipate continued advancement and procedural refinement over the next several years.

The effect of a valved small conduit on systemic ventricle–pulmonary artery shunt in the Norwood-type palliation

The aim of this study was to clarify the impact of valved systemic ventricle-pulmonary artery (SV-PA) shunt on outcomes after stage-1 Norwood-type palliation (NP) compared with the modified Blalock-Taussig shunt. Consecutive patients who underwent NP between 2003 and 2019 were enrolled. SV-PA shunts using the expanded polytetrafluoroethylene valved conduit were implanted in 18 patients (valved SV-PA group), and another 18 patients underwent modified Blalock-Taussig shunt during NP (modified Blalock-Taussig shunt group). All valved conduits were made in our institution in advance. No differences in baseline characteristics were found between the groups, except for shunt size. During a median 2.9 (interquartile range 0.4-6.4, maximum 14.2) years of follow-up, 8 (22.2%) patients died across both groups. There were no statistically significant differences in early mortality (5.5% vs 11.1%, P = 0.55) and overall survival rates at 5 years (80.8% vs 71.4%, P = 0.48) in the valved SV-PA and modified Blalock-Taussig shunt groups. No statistically significant difference was observed in the frequency of interventions between the groups (31% vs 33%, P = 1.0). At the time of the bidirectional Glenn procedure, the systemic ventricular end-diastolic volume index was significantly lower (84 ± 24 vs 106 ± 31 ml/m2, P = 0.05) and the ejection fraction was significantly greater (62 ± 8% vs 55 ± 9%, P = 0.03) in the valved SV-PA group. There was no statistically significant difference in the pulmonary artery index (228 ± 85 vs 226 ± 60 mm2/m2, P = 0.92). A valved SV-PA shunt using an expanded polytetrafluoroethylene valved conduit was associated with preserved ventricular function after NP and did not impair pulmonary artery growth by controlling pulmonary regurgitation.

Compression of the left mainstem bronchus by patent ductus arteriosus in neonates under consideration for ductal stenting

Stent angioplasty of patent ductus arteriosus has been shown to be a viable alternative to operative shunt placement in cyanotic neonates. With broader implementation of this strategy, novel complications are bound to arise. We present a series of cases evaluated for ductal stent angioplasty in which a dilated and torturous ductus arteriosus compressed the left mainstem bronchus. After reviewing our recent experience with ductal stenting and isolated Blalock-Taussig shunts, our best estimate of the incidence of bronchial compression by the dilated ductus is 4.6% (3/64, 95% confidence interval 1.0-12.9%). Awareness of the airway and other nonvascular contents of the thorax is an important consideration prior to ductal stenting.

Characteristics of Pulmonary Vascular Remodeling in a Porcine Model of Shunt-Associated Pulmonary Arterial Hypertension.

Lung biopsy is the gold standard for evaluating pathological changes in the pulmonary vascular bed. Knowing the distribution characteristics of pulmonary vascular lesions can improve the accuracy of lung biopsy. To investigate the distribution characteristics of pulmonary vascular remodeling, a reliable porcine model of shunt-associated pulmonary arterial hypertension (PAH) was established. Twenty piglets were randomly divided into the experimental group (n = 10) and the control group (n = 10). A modified Blalock-Taussig shunt (MBTS, left innominate artery to main pulmonary artery) was created surgically in the experimental group. Three months later, an invasive catheter was used to obtain hemodynamic parameters, and lung biopsy was performed to assess the remodeling of pulmonary vascular bed. MBTS was successfully implemented in six piglets. There's no significant difference in hemodynamic parameters of the two groups before the shunt. However, these parameters and right ventricular hypertrophy index of the experimental group were significantly increased after three months shunting. Pathological changes in the experimental group, including thickening of pulmonary artery media, intimal fibrosis, and right ventricular hypertrophy, were observed. Furthermore, the percentage of media thickness and medial area of the experimental group were significantly higher than control group. Histopathology showed that vascular remodeling of the lung was inhomogeneous and that the lateral lesion was more severe than other segments. These results indicated that MBTS could be used to establish a reliable porcine model of shunt-associated PAH and that multisite detection with different segments should be applied to assess the severity of pulmonary vascular remodeling.

Anterograde blood flow associated with Blalock-Taussig shunts does not modify pulmonary artery growth compared with Blalock-Taussig shunt alone

The difference between extreme Tetralogy of Fallot (T4F) and pulmonary atresia with ventricle septal defect (PA/VSD) is the anterograde pulmonary blood flow. It is speculated that the association of modified Blalock-Taussig shunt (mBTs) and additional pulmonary blood flow favours shunt thrombosis but promotes better pulmonary arterial (PA) growth. This study sought to compare (PA) growth after mBTs shunt between T4F and AP/VSD. From 1995 to 2018, 79 mBTs were performed in infants (< 1 years), 45 for T4F and 34 for AP/VSD. Using a 1:1 propensity score match analysis, 38 patients were included ( n = 19 in each group). The primary outcome was operative mortality, mBTs thrombosis, and PA growth. After matching, the preoperative Nakata was similar (101 ± 8 mm 2 /m 2 in T4F; 106 ± 8 in AP/VSD P = 0.75 ). The age and weight were similar (24,3 ± 5 days, 3.3 ± 0.5 kg in T4F; 24,15 ± 4, 3.3 ± 0.9 in AP/VSD P = 0.84 and P = 0.77 respectively ). The mBTs size was similar (4.15 ± 0.5 mm in T4F; 4.3 ± 0.5 in PA/VSD P = 0.35). There was no difference in in-hospital mortality ( n = 0, in T4F; n = 2, 11% in AP/VSD, P = 0.14) and mBTs thrombosis (3,16% in T4F; 2,11% in AP/VSD, P = 0.18). The time to extubation tended to be longer in T4F (5 ± 1days vs. 2 ± 1 P = 0.06). The left and right PA diameter at time of biventricular repair were similar (7.5 ± 0.5 mm, 7 ± 0.2 in T4F; 8.1 ± 0.7 mm, 7 ± 1 in AP/VSD P = 0.43 and P = 0.78, Fig. 1 ) and the Nakata delta (112 ± 23 mm 2 /m 2 in T4F; 110 ± 17 in AP/VSD P = 0.78). Median time to complete repair was the same in the PA/VSD (12.26 [3.9-25] months) compared with T4F (9.7 [6.2–41.1] months) P = 0.87). The interstage reintervention were similar (3.16% in T4F; 4.22% in AP/VSD , P = 0.9 ). Anterograde blood flow with mBTs did not increase the risk of mBTs thrombosis. We could not show benefit of anterograde blood flow with mBTS versus mBTS for pulmonary arteries growth. Anterograde blood flow did increase the time to extubation, probably by increasing total pulmonary blood flow.

Towards virtual surgery planning: the modified Blalock-Taussig Shunt

A modified Blalock-Taussig shunt (MBTS) is an aortopulmonary shunt to establish or augment pulmonary perfusion in congenital cardiac defects with limited pulmonary blood flow. Proper function of this shunt is of utmost importance. In clinical practice, prediction of flow in an MBTS relies on previous experience. In the research field, computational modeling techniques have been developed to simulate flow in an MBTS and predict its performance. These techniques are promising but also time consuming and prone to uncertainties; therefore not yet suitable for clinical practice. Here we present a simplified, patient-based computational model to predict mean circulatory flow characteristics after MBTS insertion. Simulations performed over a range of pulmonary vascular resistances, were compared to data from: i) previous modeling studies; ii) data from the specific patient modeled, and iii) a cohort of patients with MBTS. Model predictions were within one standard deviation from cohort data; and within 1% from results of previous (more complex) computational models. In comparison to previous studies, our model is computationally stable with significantly shorter computational time to perform simulations. We envision that our approach could be used in the future to perform virtual surgeries, quickly testing different surgical scenarios using the patient own geometrical and physiological characteristics, to aid surgeons in decision making.

Primary Central Pulmonary Artery Plasty for Ductal-Associated Pulmonary Artery Coarctation

Infants with functionally single ventricle who require a modified Blalock-Taussig shunt can have stenosis at the ductal insertion site on the pulmonary artery (PA), the so-called ductal-associated PA coarctation. We hypothesized that central PA plasty with resection of the ductal tissue on the PA during the first palliation would prevent PA coarctation and obtain well-balanced PA for Fontan operation. We performed this strategy on 40 consecutive patients (from 1998 to 2012, Age 38.4 ± 24.7 day [17 neonates], body weight 3.5 ± 0.8 kg, heterotaxy n = 27). The mean Nakata index (mm2/m2) before bidirectional cavopulmonary shunt was 230.7 ± 101.7 without pulmonary stenosis. The PA diameter ratio and lung perfusion ratio (nonshunt side and/or shunt side) were 0.93 ± 0.25 and 0.9 ± 0.2, respectively. This strategy may improve clinical outcomes on functional single ventricle patients with increased risk of stenosis from pulmonary coarctation, with avoidance of an unbalanced pulmonary vascular bed.

Very unusual giant pseudoaneurysm from insertion site of modified blalock-taussig shunt diagnosed by cardiac computed tomography: A case report

Very unusual giant pseudoaneurysm from insertion site of modified blalock-taussig shunt diagnosed by cardiac computed tomography: A case report

Right ventricular free wall strain predicts functional capacity in patients with repaired Tetralogy of Fallot.

To investigate the role of right ventricular free wall strain (RVFWSL) to predict low functional capacity in repaired tetralogy of Fallot (rTOF). We prospectively enrolled 33 patients with rTOF with moderate to severe PR who underwent rest and peak exercise echocardiography on a semisupine cycloergometer. Conventional function and strain imaging parameters of both ventricles were measured. Patients performing < 7 METS were defined to have low functional capacity. Logistic regression was used to identify parameters associated with low functional capacity. Eleven patients (33.3%) had low functional capacity. These patients were shorter (height 155 ± 7 vs 163 ± 9cm, p = 0.023), more frequently female (27.3 vs 72.7%, p = 0.024) and had history of Blalock-Taussig shunt (45.5 vs 9.1%, p = 0.027). On multivariate analysis RVFWSL was the only predictor of low functional capacity OR 1.39 (CI 95%, 1.06-1.83., p = 0.018) per % change. A RVFWSL < 17% (absolute value) had an AUC of 0.785, sensitivity of 81.8% and specificity of 77.3% to predict low functional capacity. Right ventricular free wall strain is an independent predictor of low functional capacity in repaired tetralogy of Fallot with moderate to severe PR. A value < 17% might be useful in deciding when to perform pulmonary valve replacement, when functional capacity cannot be objectively measured.

Expanding the donor pool for congenital heart disease transplant candidates by implementing 3D imaging-derived total cardiac volumes.

Heart transplant waitlist mortality remains high in infants <1year of age and among those with CHD. Currently, the median accepted donor-to-recipient weight percentage is approximately 130% of the recipient's weight. We hypothesized that patients with CHD may accept a larger organ using novel 3D-derived imaging data to estimate donor and recipient TCV. A single-center, retrospective study was performed using CT data for 13 patients with CHD and 94 control patients. 3D visualization software was used to create digital 3D heart models that provide an estimate of TCV. In addition, echocardiograms obtained prior to cross-sectional imaging were reviewed for presence of ventricular chamber dilation. Sixty-two percent (8/13) of patients with CHD had 3D-derived TCV resulting in a weight that was >130% larger than their actual weight. This was seen in single-ventricle patients following Blalock-Taussig shunt and Fontan palliation, and patients with biventricular repair. Of those, 75% (6/8) had reported moderate-to-severe ventricular chamber dilation by echocardiogram or cardiac magnetic resonance imaging. In a large portion of patients with CHD, 3D-derived TCV place the recipient at a higher listing weight than their actual weight. We propose obtaining cross-sectional imaging to better assess TCV in a recipient, which may increase the donor range for CHD recipients and improve organ utilization in pediatrics.

Outcomes of Multistage Palliation of Infants With Single Ventricle and Atrioventricular Septal Defect.

Published palliation outcomes of infants with functional single ventricle (SV) and common atrioventricular septal defect (AVSD) are poor due to associated cardiac and extracardiac anomalies and development of atrioventricular valve (AVV) regurgitation. We report current palliation results. From 2002 to 2012, 80 infants with functional SV with AVSD underwent multistage palliation. Competing-risks analyses modeled events after first-stage surgery and Glenn (death/transplantation vs next palliation surgery) and examined factors associated with survival and AVV intervention. Sixty-eight (80%) patients received neonatal palliation: modified Blalock-Taussig shunt (n = 33, 41%), Norwood (n = 20, 25%), and pulmonary artery band (n = 15, 19%), whereas 12 (15%) received primary Glenn. On competing-risks analysis, one-year following first-stage surgery, 29% of patients had died or received transplantation and 62% had undergone Glenn. Five years following Glenn, 9% of patients had died or received transplantation and 68% had undergone Fontan. Overall eight-year survival was 64% and was lower in patients with genetic syndromes (53% vs 82%), patients requiring concomitant total anomalous pulmonary venous connection repair (53% vs 69%), and those requiring neonatal palliation (48% vs 100%). Factors associated with mortality were unplanned reoperation (hazard ratio [HR]: 3.7 [1.7-8.0], P = .001) and extracorporeal membrane oxygenation use (HR: 7.1 [3.0-16.6], P < .001). Initial AVV regurgitation ≥ moderate was associated with AVV intervention (HR: 6.2 [2.4-16.1], P = .002) with eight-year freedom from death or AVV intervention of 25% in those patients. Patients with SV with AVSD are a distinct group and commonly have associated cardiac and extracardiac malformations that complicate care and affect survival. The development of AVV regurgitation requiring intervention is common but does not affect survival.

Choice of shunt type for the Norwood I procedure: does it make a difference?

This study aimed to compare pulmonary artery (PA) growth between patients who received a right ventricle-to-PA (RV-PA) shunt and those who received a modified Blalock-Taussig shunt (mBTS). All consecutive patients with hypoplastic left heart syndrome who underwent the Norwood I procedure between 2001 and 2017 were included in the study. Pre-stage 2 angiograms were analysed to measure the size of the PA. The Nakata index was calculated to estimate PA growth. The ratio of the right PA to left PA cross-sectional area (RPA/LPA) was used to calculate the difference in growth between the 2 branches. Study end points were shunt failure, shunt-related mortality and growth of the PAs. A total of 223 patients with hypoplastic left heart syndrome (RV-PA group = 137, mBTS group = 86) underwent the Norwood I procedure, and 186 patients (RV-PA n = 116, mBTS n = 70) achieved the stage 2 procedure. PA growth was better in patients with mBTS (Nakata index: RV-PA = 282, mBTS = 315 mm2/m2, P = 0.021). LPA growth was worse compared to RPA growth in both groups (RPA/LPA: RV-PA = 1.21, mBTS = 1.29, P = 1.0). Patients with RV-PA shunts experienced more frequent shunt stenosis compared to patients with mBTS (26 vs 2, P < 0.010). Freedom from shunt failure was 83.3 ± 3.2% and 94 ± 2% at 6 months in the RV-PA and mBTS groups, respectively (P = 0.003). PA growth is significantly better in patients who received an mBTS. Moreover, patients with an RV-PA shunt more frequently experienced shunt failure due to shunt stenosis. However, survival after the NW procedure is not shunt dependent and growth of the LPA is less pronounced than RPA, regardless of the shunt type.

Holodiastolic Flow Reversal in Descending Aorta with Right Coronary Artery to Coronary Sinus Fistula.

Apulsed-wave Doppler spectral profile can be used as a modality to objectively assess flows in the descending thoracic aorta.1 The normal profile reveals systolic antegrade flow; however, a small amount of retrograde diastolic flow is physiologic and increases with age and decreasing aortic compliance. The image on the left reveals holodiastolic flow reversal and increased end-diastolic velocity, as seen with the yellow arrow and asterisk, revealing continuous retrograde flow in the descending thoracic aorta. Both increased velocities and holodiastolic reversal correlate with increasing severity of aortic insufficiency, large arteriovenous fistula, patent ductus arteriosus, and systemic to pulmonary artery communications such as Blalock–Taussig shunt.1 A computed tomographic angiography scan, right image, reveals a markedly dilated right coronary artery (RCA) extending in a serpiginous fashion laterally and along the undersurface of the heart. In this plane, the right coronary artery is cut along its short axis revealing a severely dilated coronary sinus (CS) communicating with the right coronary artery via fistula, marked by the red arrow. The continuous pressure gradient from the arterial (high pressure) to venous (low pressure) system explains the flow reversal pattern in the descending aorta while hemodynamically responsible for the decreased diastolic forward flow and left-to-right shunting. The consequences of a significantly increased shunt-flow include volume overload, pulmonary hypertension, and heart failure.2 The fistulous communication with the venous system is responsible for diverting oxygenated blood, leading to myocardial ischemia. Anesthetic management includes avoiding hemodynamic fluctuations as anesthesia-induced hypotension decreases coronary perfusion and potentiates myocardial ischemia while hypertension increases the risk of rupturing a dilated coronary artery.3The authors declare no competing interests.

Primary versus staged repair of Fallot with borderline pulmonary artery anatomy

BackgroundSurgical management of tetralogy of Fallot (TOF) can be either with a total primary repair or staged repair. The superiority of one technique over the other is still debatable, especially in developing countries with late presentation and limited resources. The objective of this study was to compare the outcome of patients with tetralogy of Fallot and borderline pulmonary anatomy defined as McGoon ratio between 1.2 and 1.6 who underwent primary versus staged repair.ResultsThe patients were divided into two groups: group A included patients who underwent primary repair (n = 120) and group B included patients who underwent repair after previous modified Blalock-Taussig (MBT) shunt operation (n = 100). Patients in group B were significantly older (11 ± 2.6 vs. 7 ± 3.1 months; p < 0.001) and had higher McGoon ratio (1.61 ± 0.07 vs. 1.5 ± 0.08; p < 0.001). In group B, the total operative time (277 ± 21.3 vs. 232 ± 24.6 min; p < 0.001), cardiopulmonary bypass time (81 ± 13.7 vs. 60 ± 11.2 min; p < 0.001), and ischemic time (64 ± 12 vs. 53 ± 7.1 min; p < 0.001) were significantly higher. There was no difference in postoperative complications between both groups. In-hospital mortality was nine patients (7.5%) in group A and 6 (6%) in group B (p = 0.791).ConclusionPrimary repair of tetralogy of Fallot in patients with borderline McGoon ratio is safe with low morbidity and mortality. It has the potential of decreasing hospital stay, cost, and resource utilization of the two-stage repair.

Evolution of the Norwood operation outcomes in patients with late presentation

ObjectivesWe present the evolution of Norwood operation outcomes and practice pattern changes over 15 years from a single institution in Saudi Arabia. We intended to identify time trends in patient selection, procedural details, and outcome predictors over time. MethodsPatients who underwent a Norwood operation (n = 145) between 2003 and 2018 with the use of a Blalock–Taussig shunt (BT group; n = 72), right ventricle to pulmonary artery shunt (Sano group; n = 66), or a primary cavopulmonary shunt (CPS group; n = 7) were included. The study outcomes were operative mortality, long-term survival, and multistate transition to CPS, Fontan, and death. ResultsMedian age was 29 days. Predictors of operative mortality were lower weight (P = .026), and longer bypass time (P = .014), whereas age, and type of shunt were not. Predictors of improved long-term survival were greater weight at operation (P = .0016), later era (P = .006), and shorter bypass time (P = .001). The multistate model revealed that patients with lower weight were more likely to undergo Sano versus BT (P < .001), and if BT was chosen in such patients, they were more likely to die (P = .027). The likelihood of receiving Sano shunt was 3-fold greater in the recent era (P = .003). ConclusionsImproved outcomes of the Norwood operation are evident in the recent era and with Sano shunt, especially in patients of smaller weight. Late presentation or older age is not a contraindication to Norwood operation. The incorporation of a primary CPS at stage one operation is feasible in selected patients.

Hemodynamic of the patent ductus arteriosus in neonates with modified Blalock-Taussig shunts

Background and objectiveStudying the hemodynamic effects of nonclosure of patent ductus arteriosus (PDA) on the modified Blalock-Taussig shunt (MBTS) is beneficial for surgical PDA management. In the present study, the effect of PDA on MBTS was investigated numerically. A series of parameters including energy loss, wall shear stress (WSS), and left/right Pulmonary artery (LPA/RPA) flow ratio were computed from simulations to analyze the hemodynamic effects of PDA on MBTS. MethodsTo ensure the universality of the research conclusions, three typical models, including models with a well-developed RPA, a symmetrically-developed pulmonary artery(PA) and a well-developed LPA, were constructed based on patient-specific pre-surgery clinical data sets. A commercial CFD solver ANSYS-Fluent software was adopted for this study. A pressure-based solver for incompressible Newtonian flows, the K-omega based shear-stress-transport model and a second-order accurate numerical discretization scheme were employed for simulation. ResultsOur results show that MBTS with nonclosure of PDA is accompanied by lower blood velocity, energy loss and WSS values at the MBT shunt; smaller vortex regions; higher oxygen content(Sao2) and PA flow; and more uniform velocity distribution in the LPA and RPA than MBTS with closure of PDA. If the PDA was not closed when performing primary MBTS, a series of hemodynamic changes occurs during PDA closure in postoperative recovery: the energy loss, PA flow and Sao2 decrease, while the oxygen delivery(Do2) and WSS values at the MBT shunt increase. ConclusionNonclosure of PDA could provide a better hemodynamic environment and play an active role in preventing early acute shunt failure. It could be preferred for cases with very low PA overflow risk and may benefit patients with an underdeveloped myocardium due to its lower energy dissipation than PDA closure. However, excessive PA flow induced by nonclosure of PDA may result in a series of complications. Surgeon's decision-making process with respect to PDA management should consider the individual patient to achieve optimal postoperative recovery.

Results of surgery on adults with functional single ventricle without prior cardiac surgery in childhood.

Patients with unoperated functional single ventricle (FSV) rarely survive into adulthood with good functional status and there are few reports about surgical results of adult patients with FSV. This study retrospectively reviews our experience with surgery in adult patients with FSV. From January 2008 to September 2017, 65 adult patients with FSV underwent surgery in our hospital. Twenty underwent Blalock-Taussig shunt or bidirectional Glenn procedures in other hospitals prior, and four were lost to follow-up. Finally, 41 patients were included in this study. The early postoperative mortality was 7.3% (3/41). Postoperative systemic arterial oxygen saturation (SpO2 , 83.7% ± 4.8%) was significantly higher than preoperative SpO2 (77.9% ± 10.1%, P < .01). The mean follow-up time was 3.9 ± 3.1 years (range 1-11 years). There was only one case of late mortality and massive hemoptysis was the cause of death. Right ventricular morphology and severe atrioventricular valve regurgitation (AVVR) were the risk factors of postoperative death for patients with pulmonary stenosis(PS). There was no death case in patients who received Fontan procedure. In a follow-up, we found the grade of AVVR was reduced and the grade of heart function (New York Heart Association) was improved. Adult patients with FSV can also undergo surgery. The mortality was acceptable and late results were satisfactory. After surgery, oxygen saturations increased, grades of AVVR decreased and the heart functions improved. Right ventricular morphology and severe AVVR were risk factors for patients with PS.

Correction to: Comparison of Outcomes at Time of Superior Cavopulmonary Connection Between Single Ventricle Patients With Ductal-Dependent Pulmonary Blood Flow Initially Palliated With Either Blalock-Taussig Shunt or Ductus Arteriosus Stent: Results From the Congenital Catheterization Research Collaborative

HomeCirculation: Cardiovascular InterventionsVol. 12, No. 11Correction to: Comparison of Outcomes at Time of Superior Cavopulmonary Connection Between Single Ventricle Patients With Ductal-Dependent Pulmonary Blood Flow Initially Palliated With Either Blalock-Taussig Shunt or Ductus Arteriosus Stent: Results From the Congenital Catheterization Research Collaborative Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection to: Comparison of Outcomes at Time of Superior Cavopulmonary Connection Between Single Ventricle Patients With Ductal-Dependent Pulmonary Blood Flow Initially Palliated With Either Blalock-Taussig Shunt or Ductus Arteriosus Stent: Results From the Congenital Catheterization Research Collaborative Originally published19 Nov 2019https://doi.org/10.1161/HCV.0000000000000045Circulation: Cardiovascular Interventions. 2019;12:e000045In the article by Meadows et al, “Comparison of Outcomes at Time of Superior Cavopulmonary Connection Between Single Ventricle Patients With Ductal-Dependent Pulmonary Blood Flow Initially Palliated With Either Blalock-Taussig Shunt or Ductus Arteriosus Stent: Results From the Congenital Catheterization Research Collaborative,” which appeared in the October 2019 issue of the journal (Circ Cardiovasc Interv. 2019;12:e008110. doi: 10.1161/CIRCINTERVENTIONS.119.008110), corrections were needed.In the Results section of the Abstract the sentence “Preoperative hemodynamics and overall pulmonary atresia growth were similar, although right pulmonary artery growth was better with DAS (change in z-score: 1.57 versus 0.65, P=0.026)” should be “Preoperative hemodynamics and overall pulmonary artery growth were similar, although right pulmonary artery growth was better with DAS (change in z-score: 1.57 versus 0.65, P=0.026).”In the Conclusions section of the Abstract, the sentence “Both groups demonstrated good pulmonary atresia growth” should be “Both groups demonstrated good pulmonary artery growth.”Additionally, Figures 1 and 2 were incorrect. Figure 1 should have been Figure 2, and Figure 2 should have been Figure 1, and both were missing units of “(Months)” on the x axis.This correction has been made to the article, which is available at: https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.119.008110. Previous Back to top Next FiguresReferencesRelatedDetails November 2019Vol 12, Issue 11 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/HCV.0000000000000045 Originally publishedNovember 19, 2019 PDF download Advertisement