Unilateral chronic pulmonary edema and pleural effusion after systemic-pulmonary artery shunts for cyanotic congenital heart disease∗

Albers, William H.; Nadas, Alexander S.

doi:10.1016/0002-9149(67)90509-7

Cited by 43 publications

(6 citation statements)

References 6 publications

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“…There was no evidence of contralateral pulmonary artery hypoplasia, as judged by cardiac catheterization and angiography, in contrast to the three cases reported by Albers and Nadas (1967).…”

Section: Discussioncontrasting

confidence: 71%

“…Young patients who have such heart disease for example, Fallot's anomaly (or tetralogy), pulmonary atresia, or transposition of the great arteries with pulmonary stenosis-frequently benefit from these shunts prior to final corrective surgery. Albers and Nadas (1967) have recently reported three patients with chronic unilateral pulmonary oedema and pleural effusion after systemic pulmonary artery shunts for cyanotic congenital heart disease. These three were controlled with medical therapy.…”

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confidence: 99%

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Constriction (banding) of Blalock--Taussig anastomosis for intractable congestive cardiac failure and pulmonary oedema

Lincoln

Stark

Tynan

et al. 1968

Thorax

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Two young patients with complex congenital heart disease developed congestive cardiac failure and unilateral pulmonary oedema following palliative Blalock-Taussig pulmonary artery to systemic artery shunts. Following the failure of medical therapy these shunts were constricted by using braided silk ligature material, after which the heart failure and pulmonary oedema resolved.A transient degree of congestive cardiac failure is not uncommon after a systemic artery to pulmonary artery shunt performed as a palliative procedure for complex congenital heart disease. Young patients who have such heart disease for example, Fallot's anomaly (or tetralogy), pulmonary atresia, or transposition of the great arteries with pulmonary stenosis-frequently benefit from these shunts prior to final corrective surgery. Albers and Nadas (1967) have recently reported three patients with chronic unilateral pulmonary oedema and pleural effusion after systemic pulmonary artery shunts for cyanotic congenital heart disease. These three were controlled with medical therapy. The contralateral pulmonary artery was hypoplastic in two patients and in the third it was completely occluded.We report two patients who had palliative systemic-pulmonary artery shunts performed for cyanotic heart disease and who subsequently developed chronic congestive cardiac failure and unilateral pulmonary oedema despite intensive medical therapy. Because these patients were not controlled by medical therapy the subclavian artery used for the systemic-pulmonary artery shunt was constricted (banded), with good effect.CASE REPORTS CASE 1 Hospital No. P.P. A 31-year-old boy, 14 kg. in weight, was referred to the Hospital for Sick Children, Great Ormond Street, London, with a diagnosis of transposition of the great arteries. Subsequent investigations confirmed this diagnosis and in addition demonstrated a ventricular septal defect and infundibular and valvar pulmonary stenosis. The child's exercise tolerance was limited. He was cyanosed and had clubbing of the fingers. The chest radiograph showed an enlarged heart with oligaemic lung fields (Fig. I a).On 25 May 1967 a Blalock-Hanlon atrial septostomy (Blalock and Hanlon, 1950) and a right Blalock-Taussig systemic-pulmonary artery shunt were performed (Blalock and Taussig, 1945), the latter giving an 8 mm. shunt at the anastomosis. Within 36 hours signs of congestive cardiac failure and unilateral pulmonary oedema were present (Fig. lb). The child was immediately digitalized and given chlorothiazide and a low salt diet, but this regime had little effect. The heart failure continued to increase and one month after the operation he was in intractable congestive cardiac failure despite rigorous antifailure therapy, which then included frusemide (Fig. lc). The jugular venous pressure was higher than the angle of the mandible when measured in the routine way, and there was pitting oedema of the legs up to the knees and a pad of sacral oedema. As the medical therapy had failed it was assumed that the flow through the Blaloc...

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Section: Discussioncontrasting

confidence: 71%

mentioning

confidence: 99%

Constriction (banding) of Blalock--Taussig anastomosis for intractable congestive cardiac failure and pulmonary oedema

Lincoln

Stark

Tynan

et al. 1968

Thorax

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show abstract

“…Examples include unilateral hypoplasia or obstruction of the pulmonary veins, infusion of fluids into a pulmonary artery branch or pulmonary vein, and systemic to pulmonary artery shunts in congenital heart diseased 1 Unilateral aspiration, lung injuries such as pulmonary contusion, and even prolonged decubitus positioning can cause unilateral pulmonary edema. In such cases the etiology is easy to understand, although a high index of suspicion may be helpful in making the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Unilateral Pulmonary Edema in Children

Audenaert

1993

Clin Pediatr (Phila)

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“…There is a tendency for all types of anastomotic operations to perfuse the ipsilateral lung better than the other side,'1 and pulmonary edema has been reported with the Blalock operation. 12 Since it was easy to make the anastomosis too large, as shown by the frequency of heart failure, there must be potential risk of irreversible pulmonary vascular disease as with Pott's anastomosis. Although the distal right pulmonary artery pressures have not been found to be seriously elevated, the studies are inadequate.…”

Section: Discussionmentioning

confidence: 99%

Aorta to Right Pulmonary Artery Anastomosis (Waterston's Operation) for Cyanotic Heart Disease

et al. 1969

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Thirty patients with cyanotic heart disease, including Fallot's tetralogy, transposition of the great arteries, and tricuspid atresia had Waterston's anastomosis for gross effort intolerance or cyanotic attacks. The results were good in 28. Spontaneous closure of the anastomosis occurred in one patient. There was a tendency for preferential perfusion of the right lung, and unilateral pulmonary edema occurred in nine patients. Congestive heart failure appeared when the stoma was too large. Surgical technic to avoid kinking of the right pulmonary artery has been modified, and the importance of limiting the size of the anastomosis has been emphasized. Transaortic closure of the anastomosis through the aorta at the time of definitive correction was simple in three patients. Additional Indexing Words: ComplicationsCongenital heart disease Cardiac failure Arterial oxygen saturation Pulmonary edema Timing of complete correction Transaortic closure of anastomosis 593 From the National

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Unilateral chronic pulmonary edema and pleural effusion after systemic-pulmonary artery shunts for cyanotic congenital heart disease∗

Cited by 43 publications

References 6 publications

Constriction (banding) of Blalock--Taussig anastomosis for intractable congestive cardiac failure and pulmonary oedema

Constriction (banding) of Blalock--Taussig anastomosis for intractable congestive cardiac failure and pulmonary oedema

Unilateral Pulmonary Edema in Children

Aorta to Right Pulmonary Artery Anastomosis (Waterston's Operation) for Cyanotic Heart Disease

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