Bilateral Bidirectional Glenn Anastomosis in an Adult Patient with Aneurysmal Degeneration after an Original Blalock-Taussig Shunt / 日本心臓血管外科学会雑誌

A male patient with single ventricle pulmonary stenosis, and persistent left superior vena cava underwent original Blalock-Taussig shunt (BTS) at 2 years of age and suffered from infective endocarditis at 38 years of age. A systemic work-up detected dural arteriovenous fistula and aneurysmal dilatation of the original BTS. Cardiac catheterization and cardiac magnetic resonance imaging revealed an appropriate pulmonary vasculature for bidirectional Glenn anastomosis and sufficient antegrade pulmonary blood flow through the pulmonary valve. Bilateral bidirectional Glenn anastomosis and resection of the aneurysm of the BTS-associated aneurysm were successfully performed.

Effect of modified Blalock-Taussig shunt on the treatment of cyanotic congenital heart diseases in neonates / 中国胸心血管外科临床杂志

@#Objective    To analyze the effect of modified Blalock-Taussig shunt on the treatment of cyanotic congenital heart diseases in neonates. Methods    The clinical data of 33 neonates undergoing modified Blalock-Taussig shunt between January 1, 2013 and December 31, 2017 were reviewed, including 28 males and 5 females with the age of 3.0-28.0 (18.0±6.1) d and weight of 1.9-3.7 (2.9±0.5) kg. Results    There were 3 (9.1%) in-hospital deaths. Ten (30.3%) patients required early unplanned reoperations after surgery. Five (15.2%) patients were lost to follow-up. In the multivariate analysis, preoperative acidosis, emergency operation and postoperative bedside thoracotomy were independent risk factors of early death. During the follow-up of 18.0-93.0 (40.2±22.5) months, there was no death and 9 (36.0%) survival patients underwent corrective surgery and stage-two palliative surgery. In the multivariate analysis, preoperative hyperhemoglobinemia was an independent risk factor of nonadministration of the corrective surgery and stage-two palliative surgery. Receiver operating characteristic curve showed that preoperative hyperhemoglobinemia was significant in determining whether secondary surgery was possible. Conclusion    The modified Blalock-Taussig shunt is effective in promoting development of pulmonary arteries and preparing for the secondary surgery. The rate of mortality and postoperative complications after the neonatal modified Blalock-Taussig shunt remains high. The rate of secondary surgery is still low during follow-up.

Staged Repair of Unilateral Absence of the Right Proximal Pulmonary Artery Using Autologous Azygos Vein Graft Interposition / 日本心臓血管外科学会雑誌

The isolated unilateral absence of a proximal pulmonary artery is a rare congenital lesion that presents various symptoms. Although some reports have shown one-stage reconstruction of the pulmonary circulation in infants, the two-stage approach is required in the situation of pulmonary arterial hypoplasia. In these cases, the usual approach is systemic pulmonary shunting for the first operation, to obtain growth of the pulmonary vascular bed, and then connecting bilateral pulmonary arteries for the second operation. Moreover, in the majority of patients without a right proximal pulmonary artery, some material is required for reconstructive surgery that corresponds to the patient's growth. A girl aged 2 years and 10 months with absent right proximal pulmonary artery, underwent modified Blalock-Taussig shunting with a free autograft of the azygos vein. The shunt was banded to prevent excessive pulmonary blood flow. Reconstructive surgery was performed 10 months after the first operation. At the second operation, growth of the right distal pulmonary artery and azygos autograft was satisfactory. Therefore, we used this autograft as an interposed graft of the right and main pulmonary arteries. Her postoperative course was uneventful. We advocate the usefulness of the azygos vein for graft material possessing the possibility of growth. This autograft is useful for pulmonary arterial reconstruction, such as the present case, and also may be useful for a systemic-pulmonary shunt, while growth is anticipated for more complex heart diseases.

Potts Anastomosis: Transthoracic Echocardiographic Features - Tetralogy of Fallot, Doubly Committed Sub-arterial Ventricular Septal Defect, Anomalous Left Anterior Descending Coronary Artery Crossing Right Ventricular Outflow Tract / Anastomosis de Potts: características ecocardiográficas transtorácicas - tetralogía de Fallot, defecto septal con compromiso doble subarterial ventricular, y arteria coronaria descendente anterior izquierda anómala a través del tracto de salida ventricular derecho

ABSTRACT Potts anastomosis is a central systemic-pulmonary surgical shunt between the descending aorta and the left pulmonary artery, developed and subsequently disbanded in the 1950s to provide pulmonary blood flow in patients with tetralogy of Fallot. Blalock-Taussig shunt is a peripheral systemic pulmonary communication which was varied to make the modified Blalock-Taussig shunt, which is now the standard of surgical care for temporary or permanent blood flow to the right or left pulmonary artery from the subclavian artery. The central shunts were disbanded in the 1950s as early development of pulmonary hypertension and its sequelae were the major prohibitive complications. This is a case report of a patient with tetralogy of Fallot with a rare combination of doubly committed sub-arterial ventricular septal defect, anomalous left anterior descending coronary artery crossing the right ventricular outflow tract and patent ductus arteriosus, who developed pulmonary hypertension within four years of Potts anastomosis and then required cardiac and lung transplantation. The transthoracic echocardiographic images are the focussed feature in this paper, confirming clearly defined structural anatomy in complex structural congenital heart disease.

RESUMEN La anastomosis de Potts - desarrollada y disuelta posteriormente en los años 50 - es una derivación quirúrgica sistémico-pulmonar central entre la aorta descendente y la arteria pulmonar izquierda, cuyo fin es proporcionar flujo de sangre pulmonar en pacientes con la tetralogía de Fallot. La derivación de Blalock-Taussig es una comunicación pulmonar sistémica periférica. Este procedimiento sufrió cambios que condujeron a la derivación modificada de Blalock-Taussig, que es ahora el procedimiento quirúrgico estándar para tratar el flujo de sangre temporal o permanente hacia la arteria pulmonar derecha o izquierda desde la arteria subclavia. Las derivaciones centrales fueron disueltas en los años 50, cuando el desarrollo temprano de la hipertensión pulmonar y sus secuelas eran las complicaciones prohibitivas principales. Éste es un reporte de caso de un paciente con la tetralogía de Fallot con una rara combinación de defecto septal con compromiso doble subarterial ventricular, arteria coronaria descendente anterior izquierda anómala a través del tracto de salida ventricular derecho, y conducto arterioso persistente. El paciente desarrollo hipertensión pulmonar a los cuatro años de una anastomosis de Potts, y requirió entonces trasplante cardíaco y pulmonar. Las imágenes ecocardiografias transtorácicas constituyen el aspecto central de este trabajo, que confirma la anatomía estructural claramente definida de la enfermedad cardíaca congénita, estructuralmente compleja.

Laparoscopic colectomy in an adult with single ventricle physiology: Anesthetic implications and management.

Increasing numbers of adult patients with complex congenital heart conditions are presenting for noncardiac surgery later in life. These disorders can present challenges for surgical and anesthesia providers. Specifically, single ventricle lesions offer anatomic and physiologic concerns during the perioperative period. Single ventricle physiology represents a delicate balance between systemic and pulmonary blood flow. Any alterations in blood flow through these systems can produce undesirable hemodynamic changes, especially during the perioperative period. We present a case of an adult patient with a single left ventricle who presented for laparoscopic total colectomy due to inflammatory bowel disease. His abnormal anatomy coupled with the hemodynamic disruptions caused by laparoscopy presented significant anesthetic challenges. We highlight the anesthetic concerns of single ventricle physiology, specifically pertaining to laparoscopic surgery. We provide recommendations for safely managing these patients perioperatively. With detailed preoperative evaluation and close hemodynamic monitoring during the perioperative period, these patients can experience successful surgical and anesthetic outcomes.

Modified Blalock Taussig shunt: Comparison between neonates, infants and older children.

Objective: The aim was to compare various pre-and post-operative parameters and to identify the predictors of mortality in neonates, infants, and older children undergoing Modifi ed Blalock Taussig shunt (MBTS). Materials and Methods: Medical records of 134 children who underwent MBTS over a period of 2 years through thoracotomy were reviewed. Children were divided into three groups-neonates, infants, and older children. For analysis, various pre-and post-operative variables were recorded, including complications and mortality. Results: The increase in PaO2 and SaO2 levels after surgery was similar and statistically signifi cant in all the three groups. The requirement of adrenaline, duration of ventilation and mortality was signifi cantly higher in neonates. The overall mortality and infant mortality was 4.5% and 8%, respectively. Conclusion: Neonates are at increased risk of complications and mortality compared with older children. Age (<30 days), weight (<3 kg), packed red blood cells transfusion >6 ml/kg, mechanical ventilation >24 h and post shunt increase in PaO2 (PDiff) <25% of baseline PaO2 are independent predictors of mortality in children undergoing MBTS.

Modified Blalock-Taussig Shunt for the Patients with Complex Congenital Heart Defects in Early Infancy / 대한흉부외과학회지

BACKGROUND: This retrospective review examines the preoperative condition, postoperative course, mortality and cause of death for the patients who underwent modified Blalock-Taussig shunt for complex congenital heart defects in early infancy. MATERIALS AND METHOD: Fifty eight patients underwent modified Blalock-Taussig shunts from January 2000 to November 2003. The mean age at operation was 23.1+/-16.2 days (5~81 days), and the mean body weight was 3.4+/-0.7 kg (2.1~4.3 kg). Indications for surgery were pulmonary atresia with ventricular septal defect in 12 cases, pulmonary atresia with intact ventricular septum in 17, single ventricle (SV) in 18, and hypoplastic left heart syndrome (HLHS) in 11. Total anomalous pulmonary venous return (TAPVR) was associated with SV in 4 cases. RESULT: There were 11 (19.0%) early, and 5 (10.6%) late deaths. Causes of early death included low cardiac output in 9, arrhythmia in 1, and multiorgan failure in 1. Late deaths resulted from pneumonia in 2, hypoxia in 1, and sepsis in 1. Risk factors influencing mortality were preoperative pulmonary hypertension, metabolic acidosis, use of cardiopulmonary bypass, HLHS and TAPVR. Twenty four patients (41.4%) had hemodynamic instability during the 48 postoperative-hours. Six patients underwent shunt revision for occlusion, and 1 shunt division for pulmonary overflow. CONCLUSION: Modified Blalock-Taussig shunt for complex congenital heart defects in early infancy had satisfactory results except in high risk groups. Many patients had early postoperative hemodynamic instability, which means that continuous close observation and management are mandatory in this period. Aggressive management may appear warranted based on understanding of hemodynamic changes for high risk groups.

Surgical Result of the Modified Blalock-Taussig Shunt in Early Infancy / 대한흉부외과학회지

BACKGROUND: In this study, the role and the surgical outcome of the modified Blalock-Taussig shunt in the treatment of the infants with cyanotic complex congenital heart diseases were investigated. MATERIAL AND METHOD: Over the last 12 years, 105 modified BT shunts were performed in 100 infants. Postoperative course, shunt patency rate, complications, mortality and its risk factors were reviewed restrospectively. RESULT: The mean age at operation was 43.0 36.6 days. Sex ratio was 60:40(M:F). The postoperative oxygen saturations were lowest after mean duration of 11 hours after the shunt procedure. The operative mortality was 8%(8) with 3 late deaths. Causes of operative death included failure of maintenance of minimum oxygenation during the procedure(2), immediate postoperative shunt occlusion(2), respiratory failure(2), low cardiac output due to heart failure and pericardial effusion(2) and sepsis(2). Late deaths resulted from acute cardiac arrest during the follow up cardiac catheterization, hypoxic myocardial failure, and arrhythmia. Year of surgery, shunt size, age at operation, and complexity of the anomalies were not the risk factors for mortality. Six month shunt patency rate was 97% and overall patency rate was 96%. Postoperative complications comprised of shunt occlusion(6), phrenic nerve palsy(3), and wound infection(2). CONCLUSION: We demonstrated that modified Blalock-Taussig shunt was a useful tool to palliate the infants with complex cyanotic heart disease in whom early complete repair was not feasible with acceptable mortality and patency rate. An adequate postoperative management and a meticulous surgical technique may be key factors for the better results.

A Case of Successfully Treated by Local Low-dose Urokinase Infusion in Neonate with Blalock-Taussing Shunt Partially Occluded by Thrombus

For some cyanotic children with deficient pulmonary blood flow, the Blalock-Taussig shunt is a life-saving or temporizing form of palhation. Extensive experience has been gathered, and mortality and morbidity as well as the incidence of shunt stenosis and thrombosis have significantly decreased. However, even nowadays, the most frequently encountered complication excluding mortality in early postoperative course is occlusion of the shunt. We experienced a case of Blalock-Taussig shunt occlusion with thrombus. We diagnosed him as ventricular septal defect with pulmonary atresia by echocardiography and performed a right classic Blalock-Taussig shunt at 7th day of age, Oxygen saturation was gradually decreased since the 6th day postoperative. He was diagnosed as thrombosis of shunt at 12th day postoperative by cardiac angiography, and then was treated with a local low-dose urokinase infusion(1,000U/kg/hr) through Cobra catheter(Cook. In. Co.). After 21 hours, thrombolysis of shunts was comfirmed. We stopped the urokinase and medicated low-dose aspirin(5mg/kg/day). After the eighth day, shunt flow by echocardiography was patent.

A Case of Successfully Treated by Local Low-dose Urokinase Infusion in Neonate with Blalock-Taussing Shunt Partially Occluded by Thrombus

For some cyanotic children with deficient pulmonary blood flow, the Blalock-Taussig shunt is a life-saving or temporizing form of palhation. Extensive experience has been gathered, and mortality and morbidity as well as the incidence of shunt stenosis and thrombosis have significantly decreased. However, even nowadays, the most frequently encountered complication excluding mortality in early postoperative course is occlusion of the shunt. We experienced a case of Blalock-Taussig shunt occlusion with thrombus. We diagnosed him as ventricular septal defect with pulmonary atresia by echocardiography and performed a right classic Blalock-Taussig shunt at 7th day of age, Oxygen saturation was gradually decreased since the 6th day postoperative. He was diagnosed as thrombosis of shunt at 12th day postoperative by cardiac angiography, and then was treated with a local low-dose urokinase infusion(1,000U/kg/hr) through Cobra catheter(Cook. In. Co.). After 21 hours, thrombolysis of shunts was comfirmed. We stopped the urokinase and medicated low-dose aspirin(5mg/kg/day). After the eighth day, shunt flow by echocardiography was patent.