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At least 19 recordsLinked to original sources
PubMed1976

The Blalock-Taussig operation: the procedure of choice in the hypoxic infant with tetralogy of Fallot.

From 1971 to 1975, 17 consecutive patients aged 1 day to 4 years underwent Blalock-Taussig shunts for severe tetralogy of Fallot. Three infants were under 6 weeks of age and 7 (41%) under 1 year. There were no hospital deaths. Modification of the shunt technique adapts it to any size infant. The subclavian artery is divided at its major branches and the end spatulated to enlarge it. The artery is occluded while the shunt is constructed. No intraoperative complications were encountered; all patients have a shunt murmur with no early or late closure. No child has had heart failure or hypoxic spells. Flows measured at operation equaled one-quarter to one-half of the child's normal cardiac output. Ligation of the shunt at subsequent repair is uncomplicated. One child died three years later at correction from causes unrelated to the shunt. With appropriate modifications in technique, the Blalock-Taussig shunt is the operation of choice, at any age, for palliation of severe tetralogy of Fallot.

Cardiac Output↗
PubMed1977

[Correction of tetralogy of Fallot and its influence to oxygen transport and lung changes. Part I. Oxygen transport (author's transl)].

30 patients with tetralogy of Fallot were examined before and after correction. 10 of whom had previous procedures including 13 Blalock-Taussig shunts, 1 Cooley anastomosis and 6 pulmonary valvulotomies (Brock) with a dilator. Hemoglobin and blood gases were measured in 22 patients pre- and postoperatively on the 7th respectively 14th day and finally after 12 months. In 8 children the concentration of 2,3-DPG was accessed (pre-, postoperatively, immediately in ICU, on the 1st, 7th, 14th day and after 21 months). Hypoxia of various degrees was found at any time of the investigation, verified by a low venous oxygen saturation, high 2,3-DPG concentration and an erythrocytosis. The 2,3-DPG concentration was always elevated (preoperatively 18.2 +/- 1.8 muMol/g Hb; postoperatively 1st till 14th day 19.0 +/- 2.2; after 21 months 16.3 +/- 1.2 muMol/g Hb). Preoperatively hypoxia was correlated to the degree of the heart disease expressed by the hight of the Hb-concentration. In contrary after the correction signs of hypoxia (decreased venous oxygen saturation, increased 2,3 DPG-concentration) appeared with a low Hb as found in patients with anemia. The long term check-ups are indicative for slight cardiac residual disorders as there are hypoxic myocardial damage, residual gradients over the right ventricular outlet, reopened VSD's, and ventriculotomy scar tissue. Though the elevated 2,3-DPG-concentration and the consecutive rightward shift of the oxygen saturation curve obviously compensate these cardiac handi-caps as the excellent physical condition of the children shows.

Adolescent↗
PubMed1979

Aorta-pulmonary artery shunts with expanded polytetrafluoroethylene (PTFE) tube.

Ten patients underwent an aortapulmonary artery shunt with a polytetrafluoroethylene (PTFE) tube between December, 1976, and October, 1977. Five of them were less than 1 month old. The diameter of the PTFE tube was 5 mm in 9 patients and 4 mm in 1 patient. Seven patients survived the operation. One of them had a clotted shunt, which was reoperated on successfully. Three patients died in the postoperative period, and all had a patent shunt. Overall patency was 90% (9/10). Congestive heart failure refractory to medical treatment developed in 1 patient with a patent Blalock-Taussig and PTFE shunt. In our institution, the Blalock-Taussig shunt is the procedure of choice. The PTFE shunt is used when the anatomy of a patient is unsuitable for a Blalock-Taussig shunt. A tube diameter of 5 mm is optimal for infants when further growth is considered, even if digitalization is necessary to control congestive heart failure.

Aorta↗
PubMed1977

[Correction of tetralogy of Fallot and its influence to oxygen transport and lung changes. Part II: Lung changes (author's transl)].

22 children got lung scans 3 weeks respectively 12 months after the correction of a tetralogy of Fallot. In 18 cases previous operations were done: 12 times a Blalock-Taussig shunt and 6 times a Brock procedure. For the scan 20-70 mu diameter albumin macrospheres were used, which were labeled with Technetium 99m. The following pathologicla lung changes were seen: 1. Loss of perfusion, typical after Blalock-Taussig shunt procedure; these findings were always on the left side, the site of the anastomosis. 2. Anomalous flow distrubution (=more spheres in the upper than in the lower lobe) in the left lung; these changes were also caused by the Blalock-Taussing shunts, but disappeared within the one year follow-up after the correction. 3. Intrapulmonary rigt-left shunts (according to the dilatation of the alveolar capillaries). These decreased within one year from 9.9+/-1.3 to 4.6+/-0.9%.

Adolescent↗
PubMed1975

Correction of tricuspid atresia.

Although Fontan and Baudet in 1971 described a physiological correction procedure for tricuspid atresia, very few successful operations have been reported. Two patients corrected 20 and 10 months ago at the Brompton Hospital are presented. These two patients exhibit many of the problems in the management of tricuspid atresia. The first patient aged 20 had undergone three previous palliative operations, a Blalock-Taussig shunt, a Glenn procedure, and an infundibular resection, and therefore presented a number of operative problems. In contrast the second patient, aged 8, whose condition had deteriorated considerably over the previous year, had had no previous surgical treatment. At operation he was found, in addition, to have a partial atrioventricular canal. Details of the operative procedures and the patients' postoperative course are described. The criteria for selection of patients for the Fontan operation are discussed as are the possible long-term hazards of homograft failure, atrial dysrhythmias, and hepatic dysfunction. The successful outcome of these two patients suggests that palliative surgery in infancy should allow for this form of correction in later life.

Adult↗
PubMed1978

The Blalock-Taussig shunt in the first two years of life: a safe and effective procedure.

Many surgeons have been reluctant to perform Blalock shunts in patients who are in infancy or early childhood (less than 24 months old) and have done instead direct aortopulmonary anastomoses. Recently, others have advocated complete repair of tetralogy of Fallot in early infancy because of the high mortality of direct aortopulmonary shunts. We believe the Blalock-Taussig anastomosis is a safe and effective palliative procedure for all infants with inadequate pulmonary blood flow regardless of size. During the past nine years, 24 babies less than 2 years old who were followed had construction of Blalock-Taussig anastomosis for inadequate pulmonary blood flow. There were no operative deaths and no shunt-related late deaths. Of the 24 babies, 12 were less than 12 months old. Eighteen of the 24 had tetralogy of Fallot. The remaining 6 had a variety of lesions with inadequate pulmonary blood flow. The mean weight of the entire group was 7.3 +/- 1.6 kg. Of those infants less than 12 months old, the mean weight was 6.8 +/- 2.0 kg. More than 6 months following construction of the shunt, 2 babies died from sepsis unrelated to cardiovascular status. All infants had adequate but not excessive pulmonary blood flow after shunting. There were no late shunt failures.

Female↗
PubMed1979

Results of systemic-to-pulmonary artery anastomosis for tricuspid atresia with reduced pulmonary blood flow.

Fifty-six patients with tricuspid atresia and decreased pulmonary blood flow received a systemic-to-pulmonary artery anastomosis as a preliminary operation. Thirty-five had a Waterston shunt, 12 a Blalock-Taussig anastomosis, and nine various other procedures. The age at operation ranged from 2 days to 10 years (median 4.5 months). Pulmonary atresia was present in eight newborn infants. Four patients (7%), all less than 3 months old, died in hospital from persistent servere hypoxia despite the palliative procedure. By actuarial methods, 93% of the survivors were alive at and after one year (longest follow-up:9.8 years), while 83% had not required further palliation at and after four years from the first operation. None of the patients subsequently restudied had raised pulmonary pressure or resistances, and in most of them the pulmonary arterial tree was deemed adequate for the Fontan operation.

Age Factors↗
PubMed1975

[The tetralogy of Fallot: surgical treatment. 145 cases (author's transl)].

1. The overall operative risk for the palliative procedures for Tetralogy was 3,2% (93 cases). The Blalock-Taussig shunt remains the intervention of choice in older children. The Waterston shunt gives optimal results in the infants under six months of age but on long term the hasard of pulmonary hypertension still exists. 2. Before 1965, the mortality rate for the total repair was 43,7% (16 cases). During the last 8 years, the mortality rate decreased to 5,7% (36 cases). One operative death after total correction with a Potts shunt is not included in this figure. This type of shunt was replaced by the Waterston shunt after 1966, because of the high operative risk total correction and the high frequency of pulmonary hypertension on long term. 3. The long-term results were excellent in 85% of the survivors (mean follow-up of 4,1 years). A pulmonary insufficiency was found on clinical examination in 35% of the cases. This insufficiency was well tolerated by all patients. The long-term consequences, however, are uncertain. 4. It seams rational to proceed to an earlier total correction in these cases when well defined criteria are fullfilled, as the mortality figures of the palliative and corrective procedures have a tendency to reach each other: (3,2 versus 5,7%).

Aorta↗
PubMed1979

[Retrograde carotid approach to aortography in neonates and babies: technique and results in 21 cases (author's transl)].

A new radiological technique is described for opacification of the thoracic aorta in neonates and babies weighing less than 10 kg. The exploration method is described: injection of a contrast medium after retrograde carotid puncture, and increased endothoracic pressure. The results obtained in 21 babies aged from 3 to 157 weeks, and weighing 3.3 to 10 kg are discussed. Radiographic results were excellent in 17 cases, satisfactory in 3 cases, and only moderate in 1 case. The procedure was perfectly well tolerated, and enabled visualization of an arterial canal in 4 cases, stenosis of a Blalock-Taussig anastomosis in 1 case, aortic stenosis in 7 cases (2 tubular hypoptasias, 1 coarctation, 3 segmentary interruptions, 1 recoarctation), coronary-cardiac fistula in 1 case, and a normal aorta in 9 cases. The authors review the advantages, inconveniences, and risks of the other methods of opacification of the thoracic aorta in neonates and babies. They conclude that when right cardiac catheterization cannot give, in babies under 10 kg of weight, a satisfactory radiological assessment of the thoracic aorta in the following clinical conditions: coarctation syndrome, badly tolerated left-right shunt, or possible abnormality of the aortic arch or coronaries, the technique of opacification of the thoracic aorta by retrograde puncture of the common carotid is the best radiological method for establishing a definite diagnosis.

Age Factors↗
PubMed1978

Use of microporous expanded polytetrafluoroethylene grafts for aorta-pulmonary shunts in infants with complex cyanotic heart disease. A report of seven cases.

Seven cyanotic infants in our institution have undergone central aorta--pulmonary artery shunt operations with a microporous expanded polytetrafluoroethlene (PTFE) graft. All of these patients have had pulmonary atresia, in four cases associated with endocardial cushion type defects. Four patients have had excellent palliation for up to 13 months. Congestive heart failure and kinking of the pulmonary artery, frequently seen with other types of central aorta-pulmonary shunts, have not been a problem. Until further experience is gained with this procedure, however, we reserve its use to the occasional cyanotic infant in whom neither open-heart repair or the Blalock-Taussig shunt is feasible.

Aorta↗
PubMed1976

An alternative approach to the closure of the Blalock-Taussig anastomosis at open-heart surgery.

Dissection for closure of a Blalock-Taussig shunt can occasionally be difficult or hazardous at the time of corrective operation. The technique traditionally used for closure of a Potts anastomosis, in which profound hypothermia and circulatory arrest are used, has been applied successfully in 11 operations for control of 12 Blalock-Taussig anastomoses. The technique is described.

Adolescent↗
PubMed1975

Palliation of tricuspid atresia. Potts-Smith, Glenn, and Blalock-Taussig shunts.

Aortopulmonary (Potts-Smith), subclavian-pulmonary (Blalock-Taussig), and cavopulmonary (Glenn) shunts are the commonly performed operations for palliation of tricuspid atresia. A total of 104 patients with tricuspid atresia have undergone these procedures, either alone or in combination over a 28-year-period at the Hospital for Sick Children, Toronto. Operative risk is high in the first six months of life (44%), reasonable after six months of age (7.4%), and low for reoperation (3.5%). Long-term palliation of the 75 survivors (mean follow-up, 8,5 years) is compared for the three operative groups and charted on an actuarial table. Potts shunt offers superior long-term palliation. Therefore, as an overall plan of management, a Potts shunt with restriction of its anastomotic growth is the initial procedure of choice. When the patient outgrows the Potts shunt, a Glenn anastomosis is constructed. Ideally, the combination of these two shunts will produce a balanced circulation offering excellent long-term palliation.

Adolescent↗
PubMed1978

The Blalock-Taussig shunt in the neonate.

With improvements in the techniques of microvascular surgery, the Blalock-Taussig shunt has been applied to smaller infants. We report our experience in 17 neonates (mean age 9 days, mean weight 3.2 kg) who underwent emergency shung operations. The early mortality was 17.6% (3 of 17), with only 1 death (7%) from renal failure and sepsis, in the last 14 patients. Three shunts were patent but inadequate and required a secondary procedure, which was successful in all 3. There were 3 patients with late shunt failures at a mean of 15 months postoperatively, while 2 are still doing well at 15 and 18 months. No patients developed congestive cardiac failure. The late mortality was high (5 of 14), but was due to late shunt failure and was preventable in only 1 patient. These results are encouraging, and we continue to perform the Blalock-Taussig shung in neonates. It is hoped that improvements in technique will reduce the incidence of inadequate shunts.

Adolescent↗
PubMed1978

Clinical implications of postoperative unilateral phrenic nerve paralysis.

Unilateral phrenic nerve paralysis (PNP) folowed 32 (1.7 percent) of 1,891 consecutive cardiac surgical procedures during an 8 year peroid. Diagnosis was based on radiographic criteria with comparison of preoperative and postoperative chest radiographs and was confirmed in all 21 evaluated by fluoroscopy. Six had persistent radiographic abnormality more than 12 months postoperatively. PNP occurred most frequently in association with Blalock-Taussig shunts. These operations represented 22 percent of this series, and PNP complicated 7 percent of all Blalock-Taussig shunts. PNP was less well tolerated in the 14 infants than in the 18 older children. Eleven infants had serious difficulties during weaning from mechanical ventilatory support. Five infants required tracheostomy, one underwent diaphragmatic plication, and three died. Infants had a mean duration of mechanical ventilation of 24 days and required prolonged intensive care and long-term hospitalization. In comparison, older children had a more benign postoperative course. Diaphragmatic plication should be considered in infants with paradoxical motion of the hemidiaphragm who remain dependent on mechanical ventilatory support for more than 2 weeks postoperatively.

Adolescent↗
PubMed1979

Subclavian arterioplasty for the ipsilateral subclavian-to-pulmonary artery shunt.

A new technique is described to avoid kinking and improve flow in the ipsilateral subclavian-to-pulmonary artery shunt. Experience with this procedure is reviewed in 35 infants and children with a variety of cyanotic congenital heart disease, including 10 with tricuspid atresia. Of these, 17 had had previous shunts: a Waterston shunt in six, a Glenn shunt in six, and a contralateral Blalock-Taussig shunt in five. The mean age was 5.6 years (range, 1 day to 16 years), and the mean follow-up was 24 months (range, 11 months to 4.5 years). There were no early deaths (less than 30 days), but there were two late deaths. There were three shunt failures at 2 weeks, 1 month, and 10 months; two of the failures were in infants aged 1 day and 4 days at operation. There were no late shunt failures. The patency by the life table method was 91.4% at 6 months, 88.5% at 1 year, with no further drop-off. It is concluded that subclavian arterioplasty can be performed safely and offers improved shunt patency in comparing to the ipsilateral Blalock-Taussig shunt.

Adolescent↗
PubMed1975

Ascending aorta-right pulmonary artery anastomosis in children with complex cardiac malformations. Long-term results in 30 cases.

In this report, we shall analyze the results obtained with palliative treatment in 30 patients with congenital heart disease who were operated upon at the University Hospital of Caracas during the period 1968 to 1972. In all cases, an ascending aorta-right pulmonary artery anastomosis was performed. Although we believe that the Blalock-Taussig and Potts shunt are satisfactory operations in some cases, at the present time we prefer the aorta-right pulmonary branch anastomosis in Fallots tetralogy and other congenital heart diseases such as single ventricle. In Fallot's tetralogy, particularly, this procedure provides better results, because the anastomosis can be closed through the aorta when these patients are later subjected to total correction with extracorporeal circulation.

Adolescent↗
PubMed1979

[Fibrinolytic treatment. First results during the early postoperative period].

Fibrinolytic treatment during the early post-operative period is associated with a real danger of hemorrhage. On the other hand, in palliative shunt procedures in Fallot's disease, especially in small children, the anastomoses may thrombose. In such cases the therapeutic lysis of the thrombus improves the child's condition and may defer further surgery. The authors describe five cases of children with Fallot's disease and thrombosis of Blalock-Taussig anastomoses who were successfully treated by streptokinase. They conclude that fibrinolytic treatment should be considered in early thrombosis following anastomosing operations.

Child, Preschool↗