Systemic to pulmonary arterial shunts in neonates

Abstract

Background: The major strategy for palliation of cyanotic lesions in neonates is the systemic to pulmonary arterial shunt.Methods: Between May 1995, and December 2002, 48 consecutive neonates underwent systemic to pulmonary arterial shunts for cyanosis with reduced pulmonary blood flow. The mean age was 11.6 days (_+SD 7.38) and the mean weight, 3.2kg (+SD 0.52). The babies were classified into three groups: Group I -Tetralogy -pulmonary Atresia (n=18), Group II -Single Ventricle -Pulmonary atresia without (n=19) and with (n=5) isomerism, Group III-Pulmonary Atresia with Intact ventricular septum (n=6). Diagnosis was made by 2D echocardiography. Indication for cardiac catheterization was delineation of pulmonary anatomy / ductus laterality (n=4) or balloon atrial septostomy (n=4). The surgical procedure was a modified Blalock-Taussig shunt on the side of the situs. Post-operatively, no anti-coagulation or anti-platelet medication was employed.Results: There was no mortality. Four cases required revision of the shunt in the immediate post-operative period for shunt thrombosis. The mean follow up was 17.54 months (_+SD 8.36). In Group I, nine patients have undergone total correction with or without a conduit, while three required new arterial shunts for shunt/pulmonary artery stenosis. In Group II, nine patients have undergone bi-directional Glenn with atrial septectomy (n=2) and pulmonary artery plasty (n=4) and one patient underwent Fontan completion. In Group III, two patients underwent bi-directional Glenn and two had pulmonary valvotomy with/without right ventricular outflow tract widening. All the remaining babies are waiting for the second/final stage palliation or total correction.Conclusion: Systemic to pulmonary arterial shunts in neonates is a gratifying and reasonably safe surgical procedure. Most babies become candidates for eventual univentricular / bi-ventricular repair. (Ind J Thorac Cardiovasc Surg, 2003; 19: 159-162)

Developing congenital heart surgery in India: The travails and triumphs of a pioneer

“…Important contributions of the Mafraq group continued. [ 22 23 24 25 ] In 2002, Drs. Anil Kumar Dharmapuram and IM Rao pioneered single-patch technique of A_V canal septal defect in 15 infants.…”

“…[ 24 ] In 2003, they reported on 48 consecutive neonates who underwent systemic to pulmonary arterial shunts for cyanosis with reduced pulmonary blood flow, concluding that these shunts in neonates are a gratifying and reasonably safe surgical procedure, before eventual univentricular/biventricular repair. [ 25 ]…”