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

Calder, A. Louise; Chan, Nien-Shen; Clarkson, P. M.; Kerr, A.; Neutze, John M.

doi:10.1016/0003-4975(91)90853-i

Cited by 15 publications

(6 citation statements)

References 12 publications

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“…Results reported after palliation with either a modified or a classic shunt are conflicting. 4,5,9,[12][13][14][15][16] We observed adequate growth of the pulmonary arteries, which symmetrical, and compared favourably with other reported series on central aortopulmonary shunts. [6][7][8]10 We presume that the shunts constructed using our modification have a likelihood of greater inflow and outflow capacity, and hence predispose to better pulmonary arterial growth.…”

Section: Discussionsupporting

confidence: 85%

Criterions for selection of patients for, and results of, a new technique for construction of the modified Blalock-Taussig shunt

et al. 2006

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Patients with a right- or left-sided aortic arch and right-sided descending thoracic aorta, those with anomalies of systemic venous drainage masking the origin of great arterial branches, and those with disproportionately small subclavian arteries, constitute the ideal candidates for our suggested modification of the construction of a modified Blalock-Taussig shunt. The palliation provided by these shunts was satisfactory, with predictable growth of pulmonary arteries, insignificant distortion in the great majority, and easy take-down.

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Section: Discussionsupporting

confidence: 85%

Criterions for selection of patients for, and results of, a new technique for construction of the modified Blalock-Taussig shunt

et al. 2006

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“…More centrally placed shunts result in better distribution of blood flow to the lungs, thereby enhancing symmetrical pulmonary vascular growth and minimizing any iatrogenic deformation of the pulmonary branches. To achieve this goal, several technical modifica- tions of surgical palliation (20,(25)(26)(27) or various percutaneous approaches have been proposed (1)(2)(3)(4)(5)(6)(7)28). Over the last few years, AD stenting has gained wide acceptance as a reliable alternative to systemic-to-pulmonary shunt in patients with CHD-DPC.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Artery Growth After Palliation of Congenital Heart Disease With Duct-Dependent Pulmonary Circulation

Santoro

Capozzi

Caianiello

et al. 2009

Journal of the American College of Cardiology

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“…Pulmonary arterial distortion was noted in 33% of patients in the series by Gladman et al [7]. Special points After shunting, the pulmonary blood flow improves, which results in an increased growth of the pulmonary arteries or annulus [11][12][13]. This may reduce the need for a transannular patch at corrective surgery.…”

Section: Surgerymentioning

confidence: 94%

“…The reported incidence of pulmonary artery distortion varies considerably. In the series by Calder et al [11], arterial distortion occurred in four of 21 patients with a 5-mm PTFE shunt and in seven of 21 patients with a 4-mm PTFE shunt. Pulmonary arterial distortion was noted in 33% of patients in the series by Gladman et al [7].…”

Section: Surgerymentioning

confidence: 96%

“…This may reduce the need for a transannular patch at corrective surgery. Calder et al [11] reported a significant increase in the growth of the pulmonary arteries after modified Blalock-Taussig shunts. The Nakata index increased from 149 ± 73 mm 2 /m 2 to 325 ± 152 mm 2 /m 2 in the patients with 5-mm PTFE shunts and increased from 141 ± 35 mm 2 /m 2 to 280 ± 88 mm 2 /m 2 in patients with 4-mm shunts (P < 0.002).…”

Section: Surgerymentioning

confidence: 97%

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Tetralogy of fallot

Gouw

Sreeram

2001

Curr Treat Options Cardio Med

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The optimal surgical approach and timing for patients with tetralogy of Fallot remain controversial. There are two options in current practice: a two-stage repair (an initial palliative aortopulmonary shunt at an early age followed by complete repair at an older age) or primary complete repair. There has been a trend towards primary repair at a young age, which can be attributed to advances in anesthetic and cardiac surgical techniques. Primary repair has several advantages. The correction can be done in one operation and shunt complications are avoided. Progressive right ventricular fibrosis, ventricular hypertrophy, and chronic hypoxia are avoided, which may reduce the incidence of late ventricular arrhythmias. However, surgical correction at a young age is associated with an increased incidence of transannular patching and consequent pulmonary regurgitation. Progressive pulmonary regurgitation is associated with late ventricular arrhythmias and sudden death. These consequences may be prevented by timely pulmonary valve replacement. Palliative procedures include an aortopulmonary shunt, balloon dilation of the right ventricular tract, and stent placement. Of these measures, the aortopulmonary shunt is preferred, as it results in a more predictable outcome. Complications associated with shunt placement include shunt occlusion, pulmonary artery distortion, and occasionally, volume overloading of the left ventricle and pulmonary circulation. Institutional and surgeon preferences exist for either surgical strategy, and ultimately are justifiable when they produce the best outcomes for the individual patient. The optimal surgical strategy has to be determined by large prospective randomized studies that compare the functional status of the pulmonary valve and the need for reoperation at long-term follow-up.

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

Cited by 15 publications

References 12 publications

Criterions for selection of patients for, and results of, a new technique for construction of the modified Blalock-Taussig shunt

Criterions for selection of patients for, and results of, a new technique for construction of the modified Blalock-Taussig shunt

Pulmonary Artery Growth After Palliation of Congenital Heart Disease With Duct-Dependent Pulmonary Circulation

Tetralogy of fallot

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