Comparisons of Arterial and Venous Palliative Shunts in Adult Patients With Cyanotic Congenital Heart Diseases

Document Type: Original Article

Authors

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: Generally, 2 types of surgical operations are available for the treatment of cyanotic heart diseases: corrective and palliative. The goal of palliative surgery is to increase the pulmonary blood flow via systemic-to-pulmonary arterial shunting.
 
Methods: In this case-series study, we evaluated patients older than 15 years old with documented cyanotic heart diseases who underwent palliative shunting in Rajaie Cardiovascular Medical and Research Center between 2001 and 2015.
 
Results: Forty-seven patients at a mean age of 24.74 ± 5.67 years were enrolled in this study. Twenty-two (46.8%) patients were male. Nearly half of the study population (23 patients) had central shunting, 23 patients Glenn shunting, and 1 patient Blalock–Taussig shunting. Following surgery, there was a significant rise in the mean partial pressure of O2 and O2 saturation, a significant drop in the hemoglobin concentration, and a significant increase in the platelet count. Five (10.6%) patients expired during the study period. The mortality rate of Blalock–Taussig shunting and Glenn shunting was 12.5% and 8.69%, respectively.
 
Conclusions: In this case-series study, all the patients showed dramatic improvements in the New York Heart Association functional class, O2 saturation, the partial pressure of O2, the partial pressure of carbon dioxide, hemoglobin levels, and ferritin levels in the first postoperative year; however, these improvements were greater in arterial shunts. The following 10 years saw a decline in these improvements; nonetheless, the clinical status and lab data were good by comparison with the baseline.
In adults with congenital cyanotic heart diseases, palliative shunting is a good option and should be considered in patients who are inoperable due to structural problems or high risk of anesthesia or surgery. (Iranian Heart Journal 2020; 21(4): 60-66)
 
 

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  1. Trojnarska O. Adolescents with congenital heart diseases. Cardiol J. 2010;17(1):11-9.
  2. Dolbec K, Mick NW. Congenital heart disease. Emerg Med Clin North Am. 2011 Nov; 29(4):811-27, vii.
  3. Colonna P, Manfrin M, Cecconi M, Perna GP, Picchio FM. Follow-up and physical activity in postoperative congenital heart disease. J Cardiovasc Med (Hagerstown). 2007 Jan; 8(1):83-7.
  4. Foster E. Congenital heart disease in adults. West J Med. 1995 Nov; 163(5):492-8.
  5. Cooley DA. Palliative surgery for cyanotic congenital heart disease. Surg Clin North Am. 1988 Jun; 68(3):477-96.
  6. 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.
  7. Brogan TV, Alfieris GM. Has the time come to rename the Blalock-Taussig shunt? Pediatr Crit Care Med 2003; 4:450 –3.
  8. Taussig HB, Crocetti A, Eshaghpour E, et al. Long-time observations on the Blalock-Taussig operation. I. Results of first operation. Johns Hopkins Med J 1971; 129:243–57.
  9. Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax 1971 26 (3): 240–8.
  10. Kreutzer G, Galindez H, Bono H, (1973). "An operation for the correction of tricuspid atresia". Journal of Thoracic and cardiovascular Surgery 66 (3): 613–21. PMID 4518787.
  11. Boshoff D, Budts W, Daenen W, Gewillig M. Transcatheter closure of a Potts' shunt with subsequent surgical repair of tetralogy of fallot". Catheter Cardiovasc Interv 2005, 64 (1): 121–3.
  12. Daehnert I, Wiener M, Kostelka M. Covered stent treatment of right pulmonary artery stenosis and Waterston shunt. Ann. Thorac. Surg. 2005 79 (5): 1754–5.
  13. Petrucci O, O'Brien SM, Jacobs ML, Jacobs JP, Manning PB, Eghtesady P. Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure. Ann Thorac Surg. 2011 Aug; 92(2):642-51; discussion 651-2.
  14. Williams JA, Bansal AK, Kim BJ, et al. Two thousand Blalock-Taussig shunts: a six-decade experience.  Ann Thorac Surg. 2007 Dec; 84(6):2070-5; discussion 2070-5.
  15. Le Gloan L, Marcotte F, Leduc H, et al. Impaired arm development after Blalock-Taussig shunts in adults with repaired tetralogy of Fallot. Int J Cardiol. 2012 Nov 15. pii: S0167-5273(12)01409-X. doi: 10.1016/j.ijcard.2012.10.034.
  16. Berdjis F, Brandl D, Uhlemann F et al. Adults with congenital heart defects--clinical spectrum and surgical management. Herz. 1996 Oct; 21(5):330-6.
  17. Peries A, Al-Hay AA, Shinebourne EA. Outcome of the construction of a Blalock-Taussig shunt in adolescents and adults. Cardiol Young. 2005 Aug; 15(4):368-72.