Systemic pulmonary shunts in neonates: early clinical outcome and choice of surgical approach

Alkhulaifi, Abdul M.; Lacour-Gayet, François; Sérraf, Alain; Belli, Emrè; Planché, C

doi:10.1016/s0003-4975(00)01078-x

Cited by 81 publications

(77 citation statements)

References 16 publications

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“…Pulmonary atresia with intact ventricular septum, when specifically analysed, did not come out as a significant risk factor for mortality in our cohort, probably because of small numbers. While Alkhulaifi et al [16] identified weight <2 kg and preoperative ventilation, Rao et al [17] identified restrictive atrial septal defect, univentricular physiology and postoperative intervention as risk factors for mortality.…”

Section: Mortalitymentioning

confidence: 99%

“…Tsai et al [18] and Tamisier et al [12] have suggested that young age and smaller size are significantly related to shunt thrombosis. Other reports have also linked weight <2 kg [16] and weight <3.6 kg [19] to shunt thrombosis. Gedicke et al [14] have found weight <3 kg, high preoperative haemoglobin (>18 g/dl) and a postoperative patent duct as significant factors for shunt thrombosis.…”

Section: Shunt Thrombosismentioning

confidence: 99%

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Modified Blalock Taussig shunt: a not-so-simple palliative procedure

Dirks

Prêtre²,

Knirsch

et al. 2013

European Journal of Cardio-Thoracic Surgery

107

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OBJECTIVES: Thirty-two consecutive isolated modified Blalock Taussig (BT) shunts performed in infancy since 2004 were reviewed and analysed to identify the risk factors for shunt intervention and mortality. METHODS:Sternotomy was the only approach used. Median age and weight were 10.5 (range 1-74) days and 2.9 (1.9-4.4) kg, respectively. Shunt palliation was performed for biventricular hearts (Tetralogy of Fallot/double outlet right ventricle/transposition of great arteries_ventricular septal defect_pulmonary stenosis/pulmonary atresia_ventricular septal defect/others) in 21, and univentricular hearts in 11, patients. Hypoplastic left heart syndrome patients were excluded. Two procedures required cardiopulmonary bypass. Median shunt size was 3.5 (3-4) mm and median shunt size/kg body weight was 1.2 (0.9-1.7) mm/kg. Reduction in shunt size was necessary in 5 of 32 (16%) patients. RESULTS:Three of 32 (9%) patients died after 3 (1-15) days due to cardiorespiratory decompensation. Lower body weight (P = 0.04) and bigger shunt size/kg of body weight (P = 0.004) were significant risk factors for mortality. Acute shunt thrombosis was observed in 3 of 32 (9%), none leading to death. Need for cardiac decongestive therapy was associated with univentricular hearts (P < 0.001), bigger shunt size (P = 0.054) and longer hospital stay (P = 0.005). Twenty-eight patients have undergone a successful shunt takedown at a median age of 5.5 (0.5-11.9) months, without late mortality.CONCLUSIONS: Palliation with a modified BT shunt continues to be indicated despite increased thrust on primary corrective surgery. Though seemingly simple, it is associated with significant morbidity and mortality. Effective over-shunting and acute shunt thrombosis are the lingering problems of shunt therapy.

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Section: Mortalitymentioning

confidence: 99%

Section: Shunt Thrombosismentioning

confidence: 99%

Modified Blalock Taussig shunt: a not-so-simple palliative procedure

Dirks

Prêtre²,

Knirsch

et al. 2013

European Journal of Cardio-Thoracic Surgery

107

View full text Add to dashboard Cite

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“…Advances in perioperative care, surgical and perfusion techniques have allowed early primary repair of many cardiac anomalies without the need for palliative shunts. Nonetheless, the use of mBTS continues to be required in several infants with biventricular cardiac anomalies who are not deemed to be candidates to receive early complex repair, and more importantly in neonates with various single ventricle (SV) anomalies associated with restricted pulmonary blood flow as the first surgery in the multistage palliation strategy of their SV anomaly [1][2][3][4][5][6]. Although the total number of infants who receive mBTS has decreased in the current era, the proportion of those with underlying SV cardiac anomalies has increased [1][2][3].…”

mentioning

confidence: 99%

Results of Palliation With an Initial Modified Blalock-Taussig Shunt in Neonates With Single Ventricle Anomalies Associated With Restrictive Pulmonary Blood Flow

Alsoufi

Gillespie

Kogon

et al. 2015

The Annals of Thoracic Surgery

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“…Clinical predictors leading to shunt occlusion remains unclear. Some investigators showed that younger age and smaller shunt size were associated with shunt failure [1,2,4,12]. Al Jubair et al and Guzetta et al reported that the size of the pulmonary artery being shunted had a significant impact in predicting shunt occlusion [13,14].…”

Section: Discussionmentioning

confidence: 99%

The role of mean platelet volume as a predictor of postoperative shunt occlusion in children who underwent modified blalock-Taussig shunt surgery

Kumbasar¹,

Temel²,

Saydam³

et al. 2017

Pau Med J

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Purpose:Backgrounds:The modified Blalock-Taussig shunt (mBTS) is a palliative procedure which is often performed to maintain additional pulmonary blood flow. Postoperative shunt patency is critical in order to provide adequate systemic oxygenation. Mean platelet volume (MPV) correlates with platelet function and there is a possible correlation between an increase in MPV and the risk of thrombosis. Aim:The aim of this study was to determine the role of MPV as a potential risk factor in postoperative early shunt occlusion in children underwent mBTS surgery. Materials and methods:This study was carried out with 1117 women. Body Mass Index was calculated by the formula: body weight/height (kg/m²), body composition was assessed by bioelectrical impedance analysis; waist circumference was measured and waist/height ratio was calculated. For determining the physical activity status of individuals, individual physical activity records were investigated. In addition, the variables associated with obesity were assessed in relation to BMI. Results:In the majority of cases the operation was performed via thoracotomy (89.7%). The shunt was constructed between the subclavian artery and pulmonary artery in 187 cases. In the remaining 8 patients the shunt was connected to the innominate artery. Twenty-three patients (11.8%) experienced early shunt occlusion. Preoperative MPV levels were 8.2 (6.2-14.0) in no occlusion group and 8.3 (6.9-10.7) in occlusion group. Neither MPV nor other variables showed a statistically significant association with early shunt occlusion Conclusion:Despite some other studies demonstrating an association between high MPV levels and thrombosis, we could not find any statistically significant association between MPV and early shunt occlusion. Pam Med J 2017;10(3):258-263Keywords:Mean platelet volume, Modified Blalock-Taussig shunt, Occlusion. ÖzetAmaç:Modifiye Blalock-Taussig (mBTS) şantı pulmoner kan akımını arttırmak amacı ile yapılan palyatif bir prosedürdür.Yeterli sistemik oksijenasyonu sağlayabilmek için şant açıklığının kritik önemi vardır. Ortalama trombosit hacmi (OTH),trombosit fonksiyonu ile ilişkilidir. Bu ilişki aynı zamanda artmış OTH ve tromboz riski arasında da olduğu düşünülmektedir. Çalışmamızın amacı mBTS operasyonu geçiren çocuklarda OTH'nin potansiyel bir risk faktörü olarak erken şant oklüzyonundaki rolünü belirlemektedir. Gereç ve yöntem:Çalışma Planı:Retrospektif kesitsel çalışma. Bu vaka kontrol çalışması Ocak 2006 ve Mart 2013 tarihleri arasında tıbbi kayıtlardan derlenmiştir. Toplamda 195 hasta çalışmaya dahil edilmiştir. Fonksiyonel tek ventrikül, Konoventriküler septum malalignment'i olan veya olmayan pulmoner atrezi ve pulmoner stenoz tanısı olan çocuklar dahil edilmiştir. Bulgular:Operasyonların büyük çoğunluğu torakotomi ile yapılmıştır (%89,7). 187 hastada şant subklavyen arter ve pulmoner arter arasında oluşturulmuştur. Kalan 8 hastada ise şant innominate arter ve pulmoner arter arasında oluşturulmuştur.23 hastada (%11,8) erken şant oklüzyonu izlenmiştir. Preoper...

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Systemic pulmonary shunts in neonates: early clinical outcome and choice of surgical approach

Cited by 81 publications

References 16 publications

Modified Blalock Taussig shunt: a not-so-simple palliative procedure

Modified Blalock Taussig shunt: a not-so-simple palliative procedure

Results of Palliation With an Initial Modified Blalock-Taussig Shunt in Neonates With Single Ventricle Anomalies Associated With Restrictive Pulmonary Blood Flow

The role of mean platelet volume as a predictor of postoperative shunt occlusion in children who underwent modified blalock-Taussig shunt surgery

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