Pediatric Cardiac Surgery: A Challenge of Skill and Creativity in Constant Search Results

Abstract

2. New technique in surgical procedure 2.1 Blalock-Taussig shunt in neonates using the brachiocephalic trunk (innominate artery) to ensure long patency Placement of a Blalock-Taussig (BT) shunt is a "closed-heart" procedure performed as a first stage to correct Tetralogy of Fallot or others cyanotic congenital heart diseases. Placement of www.intechopen.com Contemporary Pediatrics 202 a shunt is usually a temporary measure designed to alleviate symptoms until such time that the patient is in better condition to undergo complete repair.The usual approach is performed by systemic-pulmonary shunts using right or left thoracotomy and today we used median sternotomy approach, for interposition of polytetrafluoroethylene (PTFE) vascular graft between the subclavian and pulmonary arteries. In preterm or low birth weight children it is often found a subclavian artery of small diameter (2.5 to 3.0 mm), which could jeopardize the flow of the shunt due to difference in calibers between this vessel and the PTFE graft, compromising the patient's life. In order to overcome this anatomical difficulty, since 1986, we have been performing technical modifications of the B-T shunt, with PTFE prosthesis anastomosed to the brachiocephalic (innominate artery) trunk, always larger in diameter than the subclavian artery. To this end, the approach by thoracotomy was always done by other side of the descending aorta or the same side of the origin of the brachiocephalic trunk (BCT). This technique is an original contribution of our group. This approach causes essentially a trauma to the lungs and some difficulty for dissection and definitive surgical ligation during later correction. Since 1990 we have held the B-T shunt between the innominate artery and the right pulmonary artery, through a median thoracotomy, allowing a more comfortable procedure with hemodynamic and oximetric patient's control. This technique is viable with advantages over lateral approach due to cutting easier access, vascular structure dissection, avoiding lung trauma; on the other hand, a rapid cardiopulmonary bypass is installed, if hypoxic crisis occurs during the surgical procedure. (Fig. 1) www.intechopen.com Pediatric Cardiac Surgery: A Challenge of Skill and Creativity in Constant Search Results 203 2.2 Patient information Sixty four patients; mean age of the patients was 29.3 ± 1.0 days (1 day to 17 years-old). Five neonates with mean weigh 2,600 gr (1,800 to 3,000 gr), were operated between 1987 and 1988, with interposition of PTFE graft between the BCT and right pulmonary artery (RPA), due to the reduced diameter of the subclavian artery. Four patients had hospital discharge with pervious BT shunt. The diagnosis of cardiac malformation was: T. of Fallot, pulmonary Atresia with intact ventricular septum, Tricuspid atresia and Univentricular heart. www.intechopen.com Contemporary Pediatrics 204 3. Total cavopulmonary connection for treatment of the univentricular heart-Staged strategy 3.1 First stage: Bidirectional Glenn The Fontan repair and its modifications...