The Journal of Thoracic and Cardiovascular Surgery, Vol 90, 399-403, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Modified Blalock-Taussig shunt following long-term administration of prostaglandin E1 for ductus-dependent neonates with cyanotic congenital heart disease
M Yokota, R Muraoka, M Aoshima, S Nomoto, Y Shiraishi, I Kyoku, M Kitano, I Shimada, H Nakano and K Ueda
In the treatment of cyanotic heart diseases in neonates who are ductus
dependent, the small size of the pulmonary artery and/or subclavian artery
often precludes construction of a sufficient Blalock-Taussig shunt. To
avoid an emergency operation and to obtain pulmonary and subclavian
arteries of adequate size (3 mm), a low dose of prostaglandin E1 was given
to 16 neonates for a mean of 47 days (range 26 to 65 days), and a modified
Blalock-Taussig shunt operation was performed in neonates whose mean age
was 50 days. The pulmonary artery grew significantly (mean 4.5 mm) and the
mean diameter of the subclavian artery was 3 mm, which was large enough for
a good shunt at the time of operation. There were two late deaths and one
operative death. All surviving patients shunts at the mean follow-up period
of 22 months. The shunt was constructed on the same side as the ductus
arteriosus so that the ductus could be ligated at the same operation in
selected cases; the ductus may not close after discontinuation of
prostaglandin E1 infusion and may cause uncontrollable congestive heart
failure because of excessive pulmonary blood flow, particularly in patients
with a univentricular heart. The ductus, dissected in nine patients, was
enlarged and elongated in all and was ligated in four patients without
complication.
