Risk factors to acute shunt occlusion in infants aged less than three months with congenital cyanotic heart disease after modified Blalock-Taussig shunt operation at King Chulalongkorn Memorial Hospital.
Keywords:
Shunt occlusion, modified Blalock-Taussig shunt, congenital heart disease, cardiac catheterization interventionAbstract
Background : Acute shunt occlusion in children after modified Blalock-Taussig shunt (MBTS) operation results in sudden reduction of pulmonary vascular perfusion causing oxygen saturation drop and cyanosis that may lead to death.
Objective : To identify potential risk factors to acute shunt occlusion that could be prevented and reduce morbidity and mortality in patients.
Methods : Data of congenital cyanotic heart disease patients aged 0 - 3 months that underwent MBTS operation at King Chulalongkorn Memorial Hospital from January 2002 to December 2010 were collected; clinical data, pre-, peri-, and post-operative data. Then data were analyzed to find potential risk factors to acute shunt occlusion.
Results : In total, 123 children that underwent MBTS operation with mean age of 28 days and mean body weight of 3.17 kg. The shunt sizes varied from 2.5 to 5.0 mm. Acute shunt occlusion was found in 22 of 123 patients (17.9%). The significant risk factors to shunt occlusion were low body weight, subclavian artery diameter, shunt size and prolonged use of Prostaglandin E1 (PGE1) (P value = 0.007, 0.00, 0.042 and 0.001, respectively.) The mean oxygen saturation at 4 hr after surgery was significantly lower in children whose shunt was occluded (P value = 0.012). Cardiac catheterization with intervention was performed in 13 cases of acute shunt occlusion with successful result. The other 7 cases that underwent surgery as well as the other 2 died, however, none of these was associated with shunt occlusion.
Conclusion : In this study, acute shunt occlusion mostly occurred within the first 24 hr after the operation. The risk factors to shunt occlusion were, namely: low body weight, subclavian artery diameter, shunt size and prolonged use of PGE1. Percutaneous cardiac catheterization with intervention was the effective method to recanalize the occluded shunt and might constitute the alternative to surgical treatment, especially in patients with life-threatening conditions.
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References
Alkhulaifi AM, Lacour-Gayet F, Serraf A, Belli E, Planche C. Systemic pulmonary shunts in neonates: early clinical outcome and choice of surgical approach. Ann Thorac Surg 2000; 69:1499-504.
https://doi.org/10.1016/S0003-4975(00)01078-X
Ahmad U, Fatimi SH, Naqvi I, Atiq M, Moizuddin SS, Sheikh KB, et al. Modified BlalockTaussig shunt: Immediate and short-term follow-up results in neonates. Heart Lung Circ 2008;17:54-8.
https://doi.org/10.1016/j.hlc.2007.06.003
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.
https://doi.org/10.1001/jama.1945.02860200029009
Klinner W, Pasini M, Schaudig A. Anastomosis between systemic and pulmonary arteries with the aid of plastic prostheses in cyanotic heart diseases. Thoraxchirurgie 1962;10: 68-75.
https://doi.org/10.1055/s-0028-1096482
deLeval MR, Mckay R, Jones M, Stark J, Macartney FJ. Modified Blalock-Taussig shunt. Use of subclavian artery orifice as flow regulator in prosthetic systemic-pulmonary artery shunts. J Thorac Cardiovasc Surg 1981;81:112-9. https://doi.org/10.1016/S0022-5223(19)37668-8
Moszura T, Zubrzycka M, Michalak KW, Rewers B, Dryzek P, Moll JJ, 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: 727-31. https://doi.org/10.1510/icvts.2009.219741
Gedicke M, Morgan G, Parry A, Martin R, Tulloh R. Risk factors for acute shunt blockage in children after modified Blalock-Taussig shunt operations. Heart Vessels 2010;25:405-9.
https://doi.org/10.1007/s00380-009-1219-1
Bove EL, Kohman L, Sereika S, Byrum CJ, Kavey RE, Blackman MS, et al. The modified Blalock-Taussig shunt: analysis of adequacy and duration of palliation. Circulation 1987;76:19-23.
Tsai KT, Chang CH, Lin PJ. Modified BlalockTaussig shunt: statistical analysis of potential factors influencing shunt outcome. J Cardiovasc Surg 1996;37:149-52.
Yokota M, Muraoka R, Aoshima M, Nomoto S, Shiraishi Y, Kyoku I, et al. Modified Blalock-Taussig shunt following longterm administration of prostaglandin E1 for ductusdependent neonates with cyanotic congenital heart disease. J Thorac Cardiovasc Surg 1985;90:399-403.
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