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Reduced frequency of occlusion of aorto-pulmonary shunts in infants receiving Aspirin

Published online by Cambridge University Press:  19 August 2008

Reinald Motz ,
Armin Wessel ,
Wofgang Ruschewski  and
Jochen Bürsch
Reinald Motz*
Affiliation:
Clinic for Paediatric Cardiology, Georg-August-University, Göttingen, Germany
Armin Wessel
Affiliation:
Clinic for Paediatric Cardiology, Georg-August-University, Göttingen, Germany
Wofgang Ruschewski
Affiliation:
Clinic of Paediatric Cardio-thoracic Surgery, Georg-August-University, Göttingen, Germany
Jochen Bürsch
Affiliation:
Clinic for Paediatric Cardiology, Georg-August-University, Göttingen, Germany
*
Reinald Motz, FRACP MD, Clinic for Paediatric Cardiology, University of Innsbruck, Anichstr 35, 6020 Innsbruck, Austria. Tel: 0043-5125043511; Fax: 0043-5125044929; E-mail: [email protected]
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Abstract

Objective

Infants with severely reduced pulmonary perfusion due to complex congenital cardiac malformations are in need of an improved flow of blood to the lungs. One option for treatment is to construct a systemic-to-pulmonary arterial shunt. Although such shunts have been used since 1945, their spontaneous occlusion remains a major problem in the long-term.

Design

We studied all infants in whom a systemic-to-pulmonary arterial shunt had been constructed using a Gore-Tex tube graft between December 1989 and March 1996.

Patients

Of 46 infants undergoing construction of a shunt, 7 (15°) died within 30 days of surgery. The shunts had to be taken down in 2 infants. Thus, 37 infants were included in the study. All but three infants received Aspirin. Aspirin was discontinued on the personal decision of individual physicians. Of 22 infants, 3 never received Aspirin, and in 19 it was stopped well before undertaking subsequent surgery. Aspirin was administered continuously to 15 infants until further surgery.

Results

Those in whom Aspirin was discontinued, or not given, and those receiving Aspirin until further surgery, were comparable concerning their age, time of follow-up, severity of the cardiac lesions, and size and type of shunt. Partial or complete occlusion of the shunt occurred in 2 of 15 (13°) infants taking Aspirin, but was seen in 12 of 22 (54°) infants in whom Aspirin was discontinued. Of these, 3 died due to acute occlusion of the shunt.

Conclusions

Aspirin reduced effectively the rate of occlusion of systemic-to-pulmonary arterial shunts, and should be continued as long as the shunt is in place.

Keywords

Aspirinaorto-pulmonary shuntocclusioninfancy
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 5 , September 1999 , pp. 474 - 477
Copyright
Copyright © Cambridge University Press 1999

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References

1.Blalock, A, Taussig, HB. The surgical treatment of malformations of the heart in which there is pulmonary stenosis of pulmonary atresia. JAMA. 1945; 128: 189–202CrossRefGoogle Scholar
2.Kessler, RM, Wernly, JA, Akl, BF, Rode, R.Ascending aorta to right pulmonary artery interposition shunt in critically ill infants. J Catd Surg. 1994; 9: 37–42Google ScholarPubMed
3.McKay, R, de Leval, MR, Rees, P, Taylor, JFN, Macartney, FJ, Stark, J. Postoperative angiographic assessment of modified Blalock-Taussig shunts using expanded polytetrafluoroethylene (Gore-Tex). Ann Thorac Surg. 1980; 30(2): 137–145CrossRefGoogle ScholarPubMed
4.Kay, PH, Capuani, A, Franks, R, Lincoln, C.Experience with the modified Blalock-Taussig operation using polytetrafluoroethylene (Impra) grafts. Br Heart J. 1983; 49: 359–363CrossRefGoogle ScholarPubMed
5.Barrargy, TP, Ring, S, Blatchford, JW, Foker, JE. Central aortapulmonary artety shunts in neonates with complex cyanotic congenital heart disease. J Thorac Cardiovasc Surg. 1987; 93: 767–774CrossRefGoogle Scholar
6.Tamisier, D, Vouhé, PR, Vernant, F, Leca, F, Massot, C, Neveux, JYModified Blalock-Taussig shunts: Results in infants less than 3 months of age. Ann Thorac Surg. 1990; 49: 797–801CrossRefGoogle ScholarPubMed
7.de Leval, MR, McKay, R, Jones, M, Stark, J, Macartney, FJ. Modified Blalock-Taussig shunt. Use of subclavian artery orifice as flow regulatot in prosthetic systemic-pulmonary artery shunts. J Thorac Cardiovasc Surg. 1981; 81: 112–119CrossRefGoogle ScholarPubMed
8.Moulton, AL, Brenner, JI, Ringel, R, Nordenberg, A, Berman, MAAli, S, Burns, J. Classic versus modified Blalock-Taussig shunts in neonates and infants. Circulation. 1985; 72 suppl: II 35–44Google ScholarPubMed
9.Al Jubair, K, Al Fagih, MR, Al Jarallah, AS, Al Yousef, S, Khan, MAA, Ashmeg, A, Al Faraidi, Y, Sawyer, WResults of 546 Blalock-Taussig shunts performed in 478 patients. Cardiol Young 1998; 8: 486–490CrossRefGoogle ScholarPubMed
10.Lamberti, JJ, Carlisle, J, Waldman, JD, Lodge, FA, Kirkpatrick, SE, George, L, Mathewson, JW, Turner, SW, Pappelbaum, SJ. Systemic-pulmonary shunts in infants and children. Early and late results. J Thorac Catdiovasc Surg. 1984; 88: 76–81CrossRefGoogle ScholarPubMed
11.Handin, RI. Anticoagulant, fibrinolytic, and antiplatelet therapy. In: Fauci, AS, Braunwald, E, Isselbacher, KJ, Wilson, JD, Martin, JB, Kasper, DL et al. , Harrisons principles of internal medicine. New York, NY: McGraw-Hill, 1998: 746–747Google Scholar
12. Antiplatelet Ttialists' Collaboration. Collaborative overview of randomised trials of antiplatelet therapy – II: Maintenance of vascular graft or arterial patency by antiplatelet therapy. Br Med J. 1994; 308: 159–168CrossRefGoogle Scholar