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Patency and development of stenosis in modified Blalock-Taussig shunts constructed using expanded polytetrafluoroethylene

Published online by Cambridge University Press:  19 August 2008

François Godart ,
Shakeel A. Qureshi ,
Ary Simha ,
Nuala Fagg ,
Philip B. Deverall ,
David Anderson ,
Edward Baker  and
Michael Tynan
François Godart
Affiliation:
Department of Paediatric Cardiology, Guy's Hospital, St Thomas Street, London SE1 9RT, United Kingdom
Shakeel A. Qureshi*
Affiliation:
Department of Paediatric Cardiology, Guy's Hospital, St Thomas Street, London SE1 9RT, United Kingdom
Ary Simha
Affiliation:
Department of Paediatric Cardiology, Guy's Hospital, St Thomas Street, London SE1 9RT, United Kingdom
Nuala Fagg
Affiliation:
Department of Paediatric Cardiology, Guy's Hospital, St Thomas Street, London SE1 9RT, United Kingdom
Philip B. Deverall
Affiliation:
Department of Paediatric Cardiology, Guy's Hospital, St Thomas Street, London SE1 9RT, United Kingdom
David Anderson
Affiliation:
Department of Paediatric Cardiology, Guy's Hospital, St Thomas Street, London SE1 9RT, United Kingdom
Edward Baker
Affiliation:
Department of Paediatric Cardiology, Guy's Hospital, St Thomas Street, London SE1 9RT, United Kingdom
Michael Tynan
Affiliation:
Department of Paediatric Cardiology, Guy's Hospital, St Thomas Street, London SE1 9RT, United Kingdom
*
Dr S.A. Qureshi, Department of Paediatric Cardiology, Guys Hospital, St Thomas Street, London SE1 9RT, United Kingdom. Tel: 0171 955 4616; Fax: 0171 955 4614.
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Abstract

Construction of a modified Blalock-Taussig shunt using polytetrafluroethylene is frequently used for palliation in infants with complex cyanotic heart disease. This study was performed to assess angiographically the late patency rate of such prosthetic shunts. A modified Blalock-Taussig shunt had been constructed in 82 children and, of these, 63 (77%) patients had post-operative angiography and were included in this study. There were 29 males and 34 females, ranging in age from 1 day to 164 months. A second shunt was needed in 7 patients. Thus, 70 shunts were studied. Of the shunts, 16 were 4 mm in diameter, 28 shunts 5 mm in diameter, and 26 shunts 6 mm in diameter. Postoperative angiography was performed on 1 day to 132 months (median 39 months) after construction of the shunts. Acute post operative occlusion occurred in 2(3%) patients, who had 5 and 6 mm shunts, respectively. At the latest follow-up (median 39 ± 26 months), 6(9%) late occlusions were noticed. Overall patency was 89% for all the shunts, with 94% of the 4 mm shunts, 85% of the 5 mm and 88% of the 6 mm shunts being patent. Regression analysis showed a progressive reduction in diameter of the graft with time. This narrowing of the graft may have been related to the formation of a ‘neointima’ due to fibrous hyperplasia.

Keywords

Modified Blalock-Taussig shuntsneointima
Type
Original Articles
Information
Cardiology in the Young , Volume 7 , Issue 2 , April 1997 , pp. 153 - 159
Copyright
Copyright © Cambridge University Press 1997

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References

1.Neches, WH, Naifeh, JG, Park, SC, Lenox, CC, Zuberbuhler, JR, Siewers, RD, Pontius, RG, Bahnson, HT. Systemic pulmonary artery anastomoses in infancy. J Thorac Cardiovasc Surg. 1975; 70: 921–927.Google Scholar
2.Moulton, AL, Brenner, JI, Ringel, R, Nordenberg, A, Berman, MA, Ali, S, Burns, J. Classic versus modified Blalock-Taussig shunts in neonates and infants. Circulation 1985; 72(suppl II): 35–44.Google Scholar
3.De Leval, 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 arcery shunts. J Thorac Cardiovasc Surg 1981; 81: 112–119.CrossRefGoogle ScholarPubMed
4.Naton, MA, Roy, DL, Murphy, DM, Finley, JP, Lau, H, Gillis, DA, Murphy, DA. Polytetrafluoroethylene shunts in congenital hreart disease. Can J Surg 1982; 25: 134–138.Google Scholar
5.LeBlanc, J, Albus, R, Williams, WG, Moes, CAF, Wilson, G, Freedom, RM, Trusler, GA. Serous fluid leakage: a complication following the modified Blalock-Taussig shunt. J Thorac Cardiovasc Surg 1984; 88: 259–262.CrossRefGoogle ScholarPubMed
6.McKay, R, deLeval, MR, Rees, P, Taylor, JFN, Macarcney, FJ, Stark, J. Postoperative angiographic assessment of modified Blalock-Taussig shunts using expanded polytetrafluoroethylene (Gore-Tex). Ann Thorac Surg 1980; 30: 137–145.CrossRefGoogle ScholarPubMed
7.Woolf, PK, Stephenson, LW, Meijboom, E, Bavinck, JH, Gardner, TJ, Donahoo, JS, Edie, RN, Edmunds, LH. A comparison of Blalock-Taussig, Waterson, and polytetrafluroethylene shunts in children less than two weeks of age. Ann Thorac Surg 1984; 38: 26–30.CrossRefGoogle Scholar
8.Soyer, T, Lempinen, M, Cooper, P, Norton, L, Eiseman, B. A new venous prosthesis. Surgery 1972; 72: 864–872.Google Scholar
9.Sottiurai, VS, Yao, JST, Flinn, WR, Bacson, RC. Intimal hyperplasia and neointima: an ulcrascructural analysis of thrombosed grafts in humans. Surgery 1983; 93: 809–817.Google Scholar
10.Matsumoto, H, Hasegawa, T, Fuse, K, Yamamoto, M, Saigusa, M. A new vascular prosthesis for a small caliber artery. Surgery 1973; 74: 519–523.Google ScholarPubMed
11.Gazzaniga, AB, Lamberti, JJ, Siewers, RD, Dietrick, WR, Arcilla, RA, Replogle, RL. Arterial prosthesis of microporous expanded polytetrafluoroethylene for consturccion of aorta-pulmonary shunts. J Thorac Cardiovasc Surg 1976; 72: 357–363.Google Scholar
12.Smith, DE, Hammon, J, Anane-Sefah, J, Richardson, RS, Trimble, C. Segmental Venous replacement. A comparison of biological and synthetic substitutes. J Thorac Cardiovasc Surg 1975; 69: 589–598.CrossRefGoogle Scholar
13.Gomez, R, Frenandez, R, Guttierez, J, Perez, J, Verduras, MJ, Sanchez, P, Quero, M, Brito, JM. Emploi de prothèses en polytértrafluroéthylène expansé microporeux (PTFE) pour la réalisation de shunts systémo-pulmonaires chez les nourrissons. Ann Chir: Chir thorac cardio-vasc 1983; 37: 169–174.Google Scholar
14.Imparato, AM, Bracco, A, Kim, GE, Zeff, R. Intimal and neointimal fibrous proliferation causing failure of arterial reconstructions. Surgery 1972; 72: 1007–1017.Google Scholar
15.Opie, JC, Traverse, L, Hayden, RI, Ho, CY, Culham, JAG, Ashmore, PG. Experience with polytetrafluoroethylene grafts in children with cyanotic congenital heart disease. Ann Thorac Surg 1986; 41: 164–168.CrossRefGoogle ScholarPubMed
16.Kay, PH, Capuani, A, Franks, R, Lincoln, C. Experience with the modified Blalock-Taussig operation using polycecrafluroethylene (Impra) grafts. Br Heart J 1983; 49: 359–363.CrossRefGoogle ScholarPubMed
17.Oblath, RW, Buckley, FO, Green, RM, Schwartz, SI, De Weese, JA. Prevention of plarelet aggregation and adherence to prosthetic vascular grafts by aspirin and dipyridamole.Surgery 1978; 84: 37–44.Google Scholar
18.Bertolini, A, Dalmonte, P, Bava, GL, Calza, G, Borini, I, Moretti, R, Pongiglione, G. The modified Blalock-Taussig shunt: late results and duration of palliation. J Cardiovasc Surg 1990; 31: 4.Google Scholar
19.Fermanis, GG, Ekangaki, AK, Salmon, AP, Keeton, BR, Shore, DF, Lamb, RK, Monoro, JL. Twelve year experience with the modified Blalock-Taussig shunt. Eur J Cardio-thorac Surg 1992; 6: 586–589.CrossRefGoogle ScholarPubMed
20.Bove, EL, Sondheimer, HM, Byrum, CJ, Kavey, REW, Blackman, MS. Pulmonary hemodynamics and maintenance of palliation following polytetrafluoraethylene shunts for cyanotic congenital heart disease. Am Heart J 1984; 108; 366–369.Google Scholar
21.Bove, EL, Kohman, L, Byrum, CJ, Kavey, RE, Blackman, M, Sereika, S, Sondheimer, H. The modified Blalock-Taussig shunt: analysis of adequacy and duration of palliation. Circulation 1986; 74 Suppl II: 49.Google Scholar
22.Karpawich, PP, Bush, CP, Antillon, JR, Amato, JJ, Marbey, ML, Agarwal, KC. Modified Blalock-Taussig shunt in infants and young Children. Clinical and catheterization assessment. J Thorac Cardiovasc Surg 1985; 89: 275–279.CrossRefGoogle ScholarPubMed
23.Lamberti, JJ, Carlisle, J, Waldman, JD, Lodge, FA, Kirkpatrick, SE, George, L, Mathewson, JW, Turner, SW, Pappelbaum, SJ. Systemic-pulomonary shunts in infants and children. Early and late results. J Thorac Cardiovasc Surg 1984; 88: 76–81.Google Scholar
24.Kulik, TJ, Foker, JE, Lucas, RV, Anderson, RW, Lock, JE. Postoperative hemodynamics in children with polycetrafluoroethylene shunts. Circulation 1981; 64 (suppl II): 123–130.Google ScholarPubMed
25.Donahoo, JS, Gardner, TJ, Zahka, K, Kidd, BSL. Systemicpulmonary shunts in neonates and infants using microporous expanded polytetrafluoroethylene: immediate and late results. Ann Thorac Surg 1980; 30: 146–150.CrossRefGoogle ScholarPubMed
26.Genton, E, Gent, M, Hirsh, J, Harker, LA. Plarelet-inhibiting durgs in the prevention of clinical thrombotic disease. New Eng J Med 1975; 293: 1174–1178.Google Scholar