The efficiency of systemic‐to‐pulmonary shunts in older children with hypoplastic pulmonary arteries

Abstract

Background: To investigate the effects of systemic-to-pulmonary shunts (SPSs) in older children with hypoplastic pulmonary arteries and the factors affecting the development of the pulmonary arteries.Methods: Eighty-six children (older than 3 years) who received SPSs were retrospectively analyzed. The perioperative parameters, the postoperative diameter of the pulmonary artery were collected, and the factors influencing the growth of the pulmonary arteries after an initial palliative shunt operation were analyzed.Results: Two patients died postoperatively (2.33%), and the pulse oxygen saturation (SpO 2 ) increased from 71.70 ± 6.75% preoperatively to 85.20 ± 11.07% at discharge.During the follow-up period of 56 (10-99) months, 37 patients (43.02%) underwent subsequent procedures, and in the remaining patients, the McGoon ratio was increased from 0.96 ± 0.48 at the surgery to 1.30 ± 0.31 at the final assessment (P < 0.05). Univariate analysis indicated that age younger than 5 years old (P < 0.05), pulmonary artery forward flow (P < 0.05) and a diagnosis of tetralogy of Fallot (P < 0.05) played positive roles in the growth of the pulmonary artery after surgery, while children with a McGoon ratio less than 0.6 showed poor development of the pulmonary arteries (P < 0.05). Multivariate analysis showed that age younger than 5 years old (P < 0.05) and pulmonary artery forward flow (P < 0.05) were positive effectors on the growth of the pulmonary artery. Conclusions: Older children with cyanotic congenital heart disease benefited from a systemic-pulmonary shunt and showed increased postoperative oxygen saturation and development of the pulmonary arteries. Age younger than 5 years and pulmonary artery antegrade flow were the positive factors influencing the growth of the pulmonary arteries postoperatively. K E Y W O R D S children, congenital heart disease, pulmonary hypoplasia, systemic-to-pulmonary shunts (SPSs) 1 | INTRODUCTION Pulmonary artery development is one of the determinants of the surgical indications for many complex congenital heart diseases and an intractable problem in clinical treatment. Systemic-to-pulmonary shunts (SPSs) can increase pulmonary blood flow and improve the growth of the pulmonary artery and have been applied in clinical work for more than seventy years. Recently, with the advancement of surgery, anesthesia, and intensive care, SPSs have been rarely used in patients with biventricular repair, but SPSs have been more commonly

Central Shunting for Tetralogy of Fallot After Original Blalock-Taussig Shunt in a 34-Year-Old Woman

“…The 25-year survival rate of patients with the tetralogy of Fallot who undergo palliative surgery alone is approximately 50% [3]. Case reports on central palliative shunting in adulthood are rare; we have reported a case wherein cyanosis improved in adulthood after central shunting [4,5].…”

Percutaneous stent implantation for occluded central shunts in adults: A case report and review of current evidence

“…Surgical SPSs usually provide short-term palliation, yet they may be associated with early and late complications leading to significant morbidity and mortality (10)(11)(12). Regardless of the type of shunt, short-and long-term failure could occur (13,14). Shunt stenosis and occlusion have been frequently reported in infants and adults with complex cyanotic CHDs and are most commonly secondary to thrombosis, vascular distortion, suture line stricture, and intimal proliferation (15)(16)(17).…”

A summary of second systemic pulmonary shunt for congenital heart disease with pulmonary hypoxemia

“…With the steady improvement of the comprehensive strength in medicine, congenital heart disease continues to develop in a small, difficult, and in-depth direction while operative indications continue to expand and many forbidden zones have been constantly examined in terms of systemic-pulmonary shunt [1][2][3][4][5][6][7]. The number of children that undergo one or more systemicpulmonary shunt is increasing, however, there are few reports on the second systemic pulmonary shunt.…”