Progress of patients with pulmonary atresia after systemic to pulmonary arterial shunts

• Published in: The Annals of thoracic surgery Vol. 51; no. 3; pp. 401 - 407
• Main Authors: Calder, A.Louise, Chan, Nien-Shen, Clarkson, Patricia M., Kerr, Alan R., Neutze, John M.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-1991; Elsevier Science
• Subjects: Abnormalities, Multiple - mortality; Abnormalities, Multiple - surgery; Anastomosis, Surgical - adverse effects; Angiocardiography; Arterial Occlusive Diseases - etiology; Arterial Occlusive Diseases - mortality; Biological and medical sciences; Blood Vessel Prosthesis; Cardiology. Vascular system; Cineangiography; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Heart; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Humans; Infant; Infant, Newborn; Medical sciences; Palliative Care; Polytetrafluoroethylene; Prognosis; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - surgery; Pulmonary Valve - abnormalities; Pulmonary Valve - surgery; Reoperation; Subclavian Artery - surgery; Survival Rate; Vascular Patency; Human; Prognosis; Congenital; Cardiovascular disease; Pulmonary valve; Pulmonary artery; Blalock Taussig operation; Treatment; Follow up study; Surgery; Atresia; Complication; Child; Left to right shunt
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/0003-4975(91)90853-I

Between February 1980 and June 1987, 42 shunts were placed in 39 infants with pulmonary atresia: 33 were modified Blalock-Taussig shunts with polytetrafluoroethylene (PTFE) and 9 were classic Blalock-Taussig shunts. There were four hospital deaths not related to the shunts. The remaining 35 patients were followed up for 1.6 months to 6.3 years (mean, 24.7 ± 18 months). Repeat cineangiocardiographic studies revealed stenosis or distortion of the pulmonary arteries related to the site of the shunt in
11
/
22
patients (50%) with PTFE shunts and in
1
/
6
(17%) with classic Blalock-Taussig shunts; the stenosis was severe in only 1 patient. Mean increase in the pulmonary arterial index in the group with classic Blalock-Taussig shunts was 117 ± 52 mm
2/m
2 (not significant) and in the group with PTFE shunts, 158 ± 21 mm
2/m
2 (
p < 0.001). Late shunt occlusion occurred in 1 patient 23 months postoperatively. Thereafter, shunt patency rate remained at 94% ± 6%. At the end of 1 year 81% ± 7% of patients were judged to have adequate palliation, but between 2 and 3 years, only 60% ± 10%. Univariate analysis showed that after 2 years the ranking order for successful palliation was classic Blalock-Taussig, 5-mm PTFE, and 4-mm PTFE shunts, but differences did not achieve statistical significance.