The Journal of Thoracic and Cardiovascular Surgery, Vol 83, 422-426, Copyright © 1982 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Intrapericardial Blalock-Taussig shunt
G Pappas and CR Hawes
The standard Blalock-Taussig (B-T) shunt is preferred over other shunts in
the treatment of infants with cyanotic heart disease and reduced pulmonary
blood flow. The B-T shunt is not, however, without problems such as phrenic
nerve injury and excessive bleeding. It is a time- consuming procedure
owing to the degree of lateral mediastinal dissection required (the latter
is especially important in critically hypoxic infants). An alternative
procedure is described in which an intrapericardial approach is used. This
approach requires minimal dissection of the subclavian artery and the
anastomosis is performed to the pulmonary artery, medial to the superior
vena cava (SVC) and lateral to the aorta. The procedure was performed on 17
infants from 1 day to 2 years of age (average age of 9.4 months, with seven
of the 17 infants being less than 6 months of age). Follow-up ranged from 1
to 44 months (average of 17 months). In 94%, the shunt was functioning
well. The potential advantages of this approach include: elimination of
phrenic nerve injury, easy dissection with reduced operating time, reduced
intraoperative hemorrhage, and perhaps a larger anastomosis with improved
patency rate.
