Midterm Follow-up of Modified Blalock-Taussing Shunts in the Treatment of Children with Tetralogy of Fallot_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; Tetralogy of Fallot; Modified Blalock-Taussing shunts

DOI：

10.7507/1007-4848.20150204

Video：

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Objective To explore the midterm therapeutic effect of modified Blalock-Taussing shunts (MBTs) in the treatment of tetralogy of Fallot. Methods We retrospectively analyzed the clinical data of 69 children with tetralogy of Fallot undergoing MBTs in Shanghai Xinhua Hospital between July 2006 and January 2013. There were 44 males and 25 females with mean age of 17.97±24.73 months (ranged from 2 months to 10 years). The patients weighted from 4 to 24 (9.00±4.03) kg. All the MBTs between subclavian artery and pulmonary artery were performed through right or left posterior lateral incision. Results The patients were followed up for 6-36 months including 57 patients with 6 months following-up, 33 patients with 6 months and 12 months following-up, 16 patients with 12 months and 24 months following-up, and 11 patients with 24 months and 36 months following-up. There was significant growth in McGoon ratio during the first 12 months follow-up (preoperative vs. 6 months:1.09 ±0.33 vs. 1.40 ±0.40, P=0.00; 6 months vs. 12 months:1.29±0.31 vs. 1.36±0.33, P=0.00). There was no obvious growth in McGoon ratio after 12 months (12 months vs. 24 month:1.22±0.31 vs. 1.19±0.32, P=0.14; 24 months vs. 36 months:1.22±0.23 vs. 1.23±0.20, P=0.45). The left ventricular end diastolic volume index (LVEDVI) increased significantly in 6 months after MBTs (preoperative vs. 6 months:29.60±10.12 ml/m² vs. 49.18±11.57 ml/m², P=0.00), but there was no significant growth after 6 months. There was no significant decline in left ventricular ejection fraction (LVEF) after MBTs. Conclusion The MBTs can significantly promote the growth of McGoon ratio in 12 months of patients with tetralogy of Fallot, but there is no obvious growth of McGoon ratio after 12 months. MBTs can significantly improve left ventricular development within 6 months, and it won't lead to excessive expansion of the left ventricle when we extend follow-up time. The MBTs affects little on cardiac function of patients with tetralogy of Fallot.

Citation： JIANGLian-yong, DINGFang-bao, ZHANGJun-wen, HUANGJian-bing, LIUHao, WUShu-bin, MEIJu. Midterm Follow-up of Modified Blalock-Taussing Shunts in the Treatment of Children with Tetralogy of Fallot. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(9): 812-815. doi: 10.7507/1007-4848.20150204 Copy

1.	Moulton AL, Brenner JI, Ringel R, et al. Classic versus modified Blalock-Taussig shunts in neonates and infants. Circulation, 1985, 72(3 Pt 2):Ⅱ35-44.
2.	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.
3.	Maghur HA, Ben-Musa AA, Salim ME, et al. The modified BlalockTaussig shunt:a 6-year experience from a developing country. Pediatr Cardiol, 2002, 23(1):49-52.
4.	Lawless CE, Smith EE, Hallidie-Smith K, et al. The modified BlalockTaussig shunt using microporous expanded polytetrafluoroethylene(PTFE). J Cardiovasc Surg(Torino), 1982, 23(4):287-292.
5.	Nanton MA, Roy DL, Murphy DM, et al. Polytetrafluoroethylene shunts in congenital heart disease. Can J Surg, 1982, 25(2):134-138.
6.	Ullom RL, Sade RM, Crawford FA Jr, et al. The Blalock-Taussig shunt in infants:standard versus modified. Ann Thorac Surg, 1987, 44(5):539-543.
7.	Zahorec M, Hrubsova Z, Skrak P, et al. A comparison of BlalockTaussig shunts with and without closure of the ductus arteriosus in neonates with pulmonary atresia. Ann Thorac Surg, 2011, 92(2):653-658.
8.	Rana JS, Ahmad KA, Shamim AS, et al. Blalock-Taussig shunt:experience from the developing world. Heart Lung Circ, 2002, 11(3):152-156.
9.	Mohammadi S, Benhameid O, Campbell A, et al. Could we still improve early and interim outcome after prosthetic systemicpulmonary shunt? A risk factors analysis. Eur J Cardiothorac Surg, 2008, 34(3):545-549.
10.	Fiore AC1, Tobin C, Jureidini S, et al. A comparison of the modified Blalock-Taussig shunt with the right ventricle-to-pulmonary artery conduit. Ann Thorac Surg, 2011, 91(5):1479-1485.
11.	Moszura T, Zubrzycka M, Michalak KW, et al. Acute and late obstruction of a modified Blalock-Taussig shunt:a two-center experience in different catheter-based methods of treatment. Interact Cardiovasc Thorac Surg, 2010, 10(5):727-731.
12.	Myers JW, Ghanayem NS, Cao Y, et al. Outcomes of systemic to pulmonary artery shunts in patients weighing less than 3 kg:analysis of shunt type, size, and surgical approach. J Thorac Cardiovasc Surg, 2014, 147(2):672-677.
13.	Gillespie MJ, Rome JJ. Transcatheter treatment for systemicto-pulmonary artery shunt obstruction in infants and children. Catheter Cardiovasc Interv, 2008, 71(7):928-935.
14.	Kogon B, Villari C, Shah N, et al. Occlusion of the modified BlalockTaussig shunt:unique methods of treatment and review of catheterbased intervention.Congenit Heart Dis, 2007, 2(3):185-190.
15.	方敏華, 王輝山, 汪曾煒, 等. 體-肺動脈分流術后早期分流失效的危險因素分析. 中國胸心血管外科臨床雜志, 2012, 19(4):354-357.
16.	Dirks V, Prêtre R, Knirsch W, et al. Modified Blalock Taussig shunt:a not-so-simple palliative procedure. Eur J Cardiothorac Surg, 2013, 44(6):1096-1102.
17.	Fenton KN, Siewers RD, Rebovich B, et al. Interim mortality in infants with systemic to pulmonary artery shunts. Ann Thorac Surg, 2003, 76(1):152-157.
18.	Wells WJ, Yu RJ, Batra AS, et al. Obstruction in modified Blalock shunts:a quantitative analysis with clinical correlation. Ann Thorac Surg, 2005, 79(6):2072-2076.
19.	Tsai KT, Chang CH, Lin PJ. Modified Blalock-Taussig shunt:statistical analysis of potential factors influencing shunt outcome. J Thorac Cardiovasc Surg, 1996, 37(2):149-152.
20.	趙科研, 候曉明, 柳克明, 等. 法洛四聯癥并小左室行體肺分流術效果分析. 中國綜合臨床, 2010, 26(8):849-851.

1. Moulton AL, Brenner JI, Ringel R, et al. Classic versus modified Blalock-Taussig shunts in neonates and infants. Circulation, 1985, 72(3 Pt 2):Ⅱ35-44.
2. 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.
3. Maghur HA, Ben-Musa AA, Salim ME, et al. The modified BlalockTaussig shunt:a 6-year experience from a developing country. Pediatr Cardiol, 2002, 23(1):49-52.
4. Lawless CE, Smith EE, Hallidie-Smith K, et al. The modified BlalockTaussig shunt using microporous expanded polytetrafluoroethylene(PTFE). J Cardiovasc Surg(Torino), 1982, 23(4):287-292.
5. Nanton MA, Roy DL, Murphy DM, et al. Polytetrafluoroethylene shunts in congenital heart disease. Can J Surg, 1982, 25(2):134-138.
6. Ullom RL, Sade RM, Crawford FA Jr, et al. The Blalock-Taussig shunt in infants:standard versus modified. Ann Thorac Surg, 1987, 44(5):539-543.
7. Zahorec M, Hrubsova Z, Skrak P, et al. A comparison of BlalockTaussig shunts with and without closure of the ductus arteriosus in neonates with pulmonary atresia. Ann Thorac Surg, 2011, 92(2):653-658.
8. Rana JS, Ahmad KA, Shamim AS, et al. Blalock-Taussig shunt:experience from the developing world. Heart Lung Circ, 2002, 11(3):152-156.
9. Mohammadi S, Benhameid O, Campbell A, et al. Could we still improve early and interim outcome after prosthetic systemicpulmonary shunt? A risk factors analysis. Eur J Cardiothorac Surg, 2008, 34(3):545-549.
10. Fiore AC1, Tobin C, Jureidini S, et al. A comparison of the modified Blalock-Taussig shunt with the right ventricle-to-pulmonary artery conduit. Ann Thorac Surg, 2011, 91(5):1479-1485.
11. Moszura T, Zubrzycka M, Michalak KW, et al. Acute and late obstruction of a modified Blalock-Taussig shunt:a two-center experience in different catheter-based methods of treatment. Interact Cardiovasc Thorac Surg, 2010, 10(5):727-731.
12. Myers JW, Ghanayem NS, Cao Y, et al. Outcomes of systemic to pulmonary artery shunts in patients weighing less than 3 kg:analysis of shunt type, size, and surgical approach. J Thorac Cardiovasc Surg, 2014, 147(2):672-677.
13. Gillespie MJ, Rome JJ. Transcatheter treatment for systemicto-pulmonary artery shunt obstruction in infants and children. Catheter Cardiovasc Interv, 2008, 71(7):928-935.
14. Kogon B, Villari C, Shah N, et al. Occlusion of the modified BlalockTaussig shunt:unique methods of treatment and review of catheterbased intervention.Congenit Heart Dis, 2007, 2(3):185-190.
15. 方敏華, 王輝山, 汪曾煒, 等. 體-肺動脈分流術后早期分流失效的危險因素分析. 中國胸心血管外科臨床雜志, 2012, 19(4):354-357.
16. Dirks V, Prêtre R, Knirsch W, et al. Modified Blalock Taussig shunt:a not-so-simple palliative procedure. Eur J Cardiothorac Surg, 2013, 44(6):1096-1102.
17. Fenton KN, Siewers RD, Rebovich B, et al. Interim mortality in infants with systemic to pulmonary artery shunts. Ann Thorac Surg, 2003, 76(1):152-157.
18. Wells WJ, Yu RJ, Batra AS, et al. Obstruction in modified Blalock shunts:a quantitative analysis with clinical correlation. Ann Thorac Surg, 2005, 79(6):2072-2076.
19. Tsai KT, Chang CH, Lin PJ. Modified Blalock-Taussig shunt:statistical analysis of potential factors influencing shunt outcome. J Thorac Cardiovasc Surg, 1996, 37(2):149-152.
20. 趙科研, 候曉明, 柳克明, 等. 法洛四聯癥并小左室行體肺分流術效果分析. 中國綜合臨床, 2010, 26(8):849-851.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Midterm Follow-up of Modified Blalock-Taussing Shunts in the Treatment of Children with Tetralogy of Fallot

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