Systemic pulmonary shunt performed with Shelhigh internal mammary artery: early results.

OBJECTIVE: The purpose of this study was to evaluate early findings for aortopulmonary shunts using bovine internal mammary artery grafting. METHODS: Bovine internal mammary artery grafts biomodified with glutaraldehyde and the Shelhigh No-React process were used between May 2005 and April 2006 in our clinic for 20 cases of aorta-pulmonary artery shunts. We implanted 2 sizes of grafts, either a graft with 4-mm proximal and 5-mm distal diameters or a graft with 5-mm proximal and 6-mm distal diameters. Patients were between 20 days and 7 years of age, and the sex distribution was 55% female and 45% male. A Blalock-Taussig shunt with left thoracotomy was performed in patients 2 years of age and older, and a central shunt with sternotomy was performed for patients younger than 2 years. Eight patients underwent operation under emergency conditions. Nine patients had tetralogy of Fallot and/or pulmonary atresia (PA); 3 had transposition of the great arteries, ventricular septal defect, and pulmonary stenosis (PS); 3 had tricuspid atresia; 3 had PS and double-inlet left ventricle; and 2 had PA. RESULTS: After the operation, immediate recovery of oxygen saturation and partial oxygen pressure was observed in all patients. Pulse oximetry measurements showed patient oxygen saturation to be between 84% and 100%. One patient underwent reoperation at the third postoperative hour because of bleeding. Two patients died from causes unrelated to the graft. The hospitalization period was between 7 and 29 days. Echocardiography evaluations showed no shunt obstruction for the early (first postoperative week) or middle (postoperative week 24) period. CONCLUSION: With this study, we assessed the use of the Shelhigh internal mammary artery graft instead of synthetic (polytetrafluoroethylene) tubular grafts in shunt operations for congenital heart diseases with decreased pulmonary blood flow and no evidence of calcification. Further investigation involving a larger number of cases and longer-term results for patency are needed to confirm our findings.

A novel approach for off-pump atrial septostomy applications.

Atrial septostomy or septectomy are required to enable atrial mixture in various congenital cardiac lesions. The aim of this article was to introduce a technique where atrial septostomy application could be employed off pump with the aid of a new device. To our knowledge this is the first report for this technique in the literature. We report the results of 7 patients for whom we employed our technique successfully using a new combined device as an alternative to traditional methods. The major advantage of our approach was avoiding detrimental effects of cardiopulmonary bypass applications.