Therapy Effect of Modified B-T Shunt for Complex Congenital Heart Disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANGLian-yong ,  DINGFang-bao , ZHANGJun-wen , HUANGjian-bing , LIUHao , WUshu-bin , MEIJu

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, P. R. China;

Corresponding?author：

DINGFang-bao, Email: drnail@sina.com

Keywords：

Congenital heart disease; Modified Blalock-Taussing shunt; Pulmonary-systemic shunt; Surgery

DOI：

10.7507/1007-4848.20150142

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Objective To analyze the effect of modified B-T shunt for the treatment of complex congenital heart disease. Methods We retrospectively analyzed the clinical data of 150 B-T case times performed in 143 patients with complex congenital heart disease in Shanghai Xinhua Hospital between July 2006 and January 2013.There were 100 case times for male patients and 50 case times for female patients with age of 2-756 (20.17 ±80.37) months and weight of 4-63 (8.86 ±9.69) kg. Results There were 5 in-hospital deaths (mortality at 3.50%). Three patients occurred abnormal bleeding (2.10%). Five patients (3.50%) performed the second B-T because of shunt occlusion. And the other patients recovered uneventfully. A total of 129 case times were followed up for 6-48 (14.38±10.05) months. Seven B-T case times (5.43%) were performed in 6 patients again because of shunt occlusion during the follow-up. Three patients died during the follow-up (mortality at 2.33%). A total of 88 patients of survival underwent corrective surgery or stage Ⅱ palliative surgery (68.22%). Main pulmonary artery have a significant increase in diameter during the follow-up(t=-15.18, P=0.00). Postoperative diameters of left pulmonary artery (t=-13.27, P=0.00), right pulmonary artery (t=-15.94, P=0.00), and right pulmonary artery (t=2.44, P=0.02) increased with statistical differences compared with preoperative values. Growth in ipsilateral pulmonary of B-T is better than that of the contralateral pulmonary (t=2.44, P=0.02). McGoon ratio increased significantly after B-T (t=10.10, P=0.00). Ejection fraction value was slightly lower than the preoperative value (t=2.77, P=0.00). Left ventricular mass index increased significantly compared with the preoperative value(t=-9.26, P=0.00). Conclusions The modified B-T shunt has been proved to be safe and effective in treating for complex congenital heart disease. It can significantly promote the development of pulmonary artery, especially the ipsilateral pulmonary of B-T. Small McGoon ratio and pulmonary atresia are the risk factors for limiting the further development of pulmonary. Appropriate diameter of B-T shunt choice according to preoperative pulmonary diameter and the weight of the patients is the basis to ensure successful operation and a good prognosis.

Citation： JIANGLian-yong, DINGFang-bao, ZHANGJun-wen, HUANGjian-bing, LIUHao, WUshu-bin, MEIJu. Therapy Effect of Modified B-T Shunt for Complex Congenital Heart Disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(6): 554-559. doi: 10.7507/1007-4848.20150142 Copy

1.	?Blalock A, Taussig HB. The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. JAMA, 1945, 128: 189-202.
2.	Moulton AL, Brenner JI, Ringel R, et al. Classic versus modified Blalock-Taussig shunts in neonates and infants. Circulation, 1985, 72(3 Pt 2): Ⅱ35-Ⅱ 44.
3.	Woolf PK, Stephenson LW, Meijboom E, et al. A comparison of Blalock-Taussig, Waterston, and polytetrafluoroethylene shunts in children less than two weeks of age. Ann Thorac Surg, 1984, 38(1): 26-30.
4.	Maghur HA, Ben-Musa AA, Salim ME, et al. The modified Blalock-Taussig shunt: a 6-year experience from a developing country. Pediatr Cardiol, 2002, 23(1): 49-52.
5.	Lawless C, Smith E, Hallidie-Smith K, et al. The modified Blalock-Taussig shunt using microporous expanded polytetrafluoroethylene (PTFE). J Cardiovasc Surg (Torino), 1982, 23(4): 287-292.
6.	Nanton M, Roy D, Murphy D, et al. Polytetrafluoroethylene shunts in congenital heart disease. Can J Surg, 1982, 25: 134-138.
7.	Ullom R, Sade R, Crawford F, et al. The Blalock-Taussig shunt in infants: standard versus modified. Ann Thorac Surg, 1987, 44(5): 539-543.
8.	Williams JA, Bansal AK, KimBJ, et al. Two thousand Blalock-Taussig shunts: a six-decade experience. Ann Thorac Surg, 2007, 84(6): 2070-2075.
9.	Petrucci O, O'Brien SM, Jacobs ML, et al. Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure. Ann Thorac Surg, 2011, 92(2): 642-651.
10.	Mohammadi S, Benhameid O, Campbell A, et al. Could we still improve early and interim outcome after prosthetic systemic-pulmonary shunt? A risk factors analysis. Euro J Cardio-thorac Surg, 2008, 34(3): 545-549.
11.	Alkhulaifi AM, Lacour-Gayet F, Serraf A, et al. Systemic pulmonary shunts in neonates: early clinical outcome and choice of surgical approach. Ann Thorac Surg, 2000, 69(5): 1499-1504.
12.	Ibawi MN, Grieco J, DeLeon SY, et al. Modified Blalock-Taussig shunt in newborn infants. J Thoracic Cardiovasc Surg, 1984, 88(5 Pt 1): 770-775.
13.	Tsai KT, Chang CH, Lin PJ. Modified Blalock-Taussig shunt: statis-tical analysis of potential factors influencing shunt outcome. J Cardio-vasc Surg (Torino), 1996, 37(2): 149-152.
14.	McKenzie ED, Khan MS, Samayoa AX, et al. The Blalock-Taussig shunt revisited: A contemporary experience. J Am Coll Surg, 2013, 216(4): 699-704.
15.	Chowdhury UK, Venugopal P, Kothari SS, et al. Criterions for selec-tion of patients for, and results of, a new technique for construction of the modified Blalock-Taussig shunt. Cardiol Young, 2006, 16(5): 463-473.
16.	Kim HK, Kim WH, Kim SC, et al. Surgical strategy for pulmonary coarctation in the univentricular heart. Eur J Cardiothorac Surg, 2006, 29(1): 100-104.
17.	Sivakumar K, Anil SR, Ravichandra M, et al. Emergency transca-theter balloon recanalization of acutely thrombosed modified Blalock-Taussig shunts. Indian Heart J, 2001, 53(6): 743-748.
18.	Al Jubair KA, Al Fagih MR, Al Jarallah AS, et al. Results of 546 Blalock–Taussig shunts performed in 478 patients. Cardiol Young, 1998, 8(4): 486-490.
19.	Gillespie MJ, Rome JJ. Transcatheter treatment for systemic-to-pulmonary artery shunt obstruction in infants and children. Catheter Cardiovasc Interv, 2008, 71(7):928-935.
20.	Kajihara N, Asou T, Takeda Y, et al. Impact of 3-mm Blalock-Taussig shunt in neonates and infants with a functionally single ventricle. Interact Cardiovasc Thorac Surg, 2009, 8(2): 211-215.

1. ?Blalock A, Taussig HB. The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. JAMA, 1945, 128: 189-202.
2. Moulton AL, Brenner JI, Ringel R, et al. Classic versus modified Blalock-Taussig shunts in neonates and infants. Circulation, 1985, 72(3 Pt 2): Ⅱ35-Ⅱ 44.
3. Woolf PK, Stephenson LW, Meijboom E, et al. A comparison of Blalock-Taussig, Waterston, and polytetrafluoroethylene shunts in children less than two weeks of age. Ann Thorac Surg, 1984, 38(1): 26-30.
4. Maghur HA, Ben-Musa AA, Salim ME, et al. The modified Blalock-Taussig shunt: a 6-year experience from a developing country. Pediatr Cardiol, 2002, 23(1): 49-52.
5. Lawless C, Smith E, Hallidie-Smith K, et al. The modified Blalock-Taussig shunt using microporous expanded polytetrafluoroethylene (PTFE). J Cardiovasc Surg (Torino), 1982, 23(4): 287-292.
6. Nanton M, Roy D, Murphy D, et al. Polytetrafluoroethylene shunts in congenital heart disease. Can J Surg, 1982, 25: 134-138.
7. Ullom R, Sade R, Crawford F, et al. The Blalock-Taussig shunt in infants: standard versus modified. Ann Thorac Surg, 1987, 44(5): 539-543.
8. Williams JA, Bansal AK, KimBJ, et al. Two thousand Blalock-Taussig shunts: a six-decade experience. Ann Thorac Surg, 2007, 84(6): 2070-2075.
9. Petrucci O, O'Brien SM, Jacobs ML, et al. Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure. Ann Thorac Surg, 2011, 92(2): 642-651.
10. Mohammadi S, Benhameid O, Campbell A, et al. Could we still improve early and interim outcome after prosthetic systemic-pulmonary shunt? A risk factors analysis. Euro J Cardio-thorac Surg, 2008, 34(3): 545-549.
11. Alkhulaifi AM, Lacour-Gayet F, Serraf A, et al. Systemic pulmonary shunts in neonates: early clinical outcome and choice of surgical approach. Ann Thorac Surg, 2000, 69(5): 1499-1504.
12. Ibawi MN, Grieco J, DeLeon SY, et al. Modified Blalock-Taussig shunt in newborn infants. J Thoracic Cardiovasc Surg, 1984, 88(5 Pt 1): 770-775.
13. Tsai KT, Chang CH, Lin PJ. Modified Blalock-Taussig shunt: statis-tical analysis of potential factors influencing shunt outcome. J Cardio-vasc Surg (Torino), 1996, 37(2): 149-152.
14. McKenzie ED, Khan MS, Samayoa AX, et al. The Blalock-Taussig shunt revisited: A contemporary experience. J Am Coll Surg, 2013, 216(4): 699-704.
15. Chowdhury UK, Venugopal P, Kothari SS, et al. Criterions for selec-tion of patients for, and results of, a new technique for construction of the modified Blalock-Taussig shunt. Cardiol Young, 2006, 16(5): 463-473.
16. Kim HK, Kim WH, Kim SC, et al. Surgical strategy for pulmonary coarctation in the univentricular heart. Eur J Cardiothorac Surg, 2006, 29(1): 100-104.
17. Sivakumar K, Anil SR, Ravichandra M, et al. Emergency transca-theter balloon recanalization of acutely thrombosed modified Blalock-Taussig shunts. Indian Heart J, 2001, 53(6): 743-748.
18. Al Jubair KA, Al Fagih MR, Al Jarallah AS, et al. Results of 546 Blalock–Taussig shunts performed in 478 patients. Cardiol Young, 1998, 8(4): 486-490.
19. Gillespie MJ, Rome JJ. Transcatheter treatment for systemic-to-pulmonary artery shunt obstruction in infants and children. Catheter Cardiovasc Interv, 2008, 71(7):928-935.
20. Kajihara N, Asou T, Takeda Y, et al. Impact of 3-mm Blalock-Taussig shunt in neonates and infants with a functionally single ventricle. Interact Cardiovasc Thorac Surg, 2009, 8(2): 211-215.

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