Hostname: page-component-669899f699-tpknm Total loading time: 0 Render date: 2025-04-27T20:47:23.671Z Has data issue: false hasContentIssue false

Role of BT shunt in tetralogy of Fallot

Published online by Cambridge University Press:  10 October 2024

Faiz Rasool*
Affiliation:
Children Hospital Lahore, Lahore, Punjab, Pakistan
Amna Zafer Qureshi
Affiliation:
Children Hospital Lahore, Lahore, Punjab, Pakistan
Asim Khan
Affiliation:
The Children’s Hospital and University of Child Health Sciences, Lahore, Punjab, Pakistan
Tehmina Kazmi
Affiliation:
Department of Paediatric Cardiology, The Children’s Hospital University of Child Health Sciences, Lahore, Punjab, Pakistan
Salman Ahmad Shah
Affiliation:
Children Hospital Lahore, Lahore, Punjab, Pakistan
*
Corresponding author: Faiz Rasool; Email: [email protected]

Abstract

Introduction:

Modified Blalock-Taussig shunt (BT shunt) is a palliative operation used for cyanotic heart diseases with decreased pulmonary blood supply. The definitive management of tetralogy of Fallot (TOF) is total corrective surgery, but these patients can be palliated with BT shunt. In the modern world, the BT shunt is getting out of favour in patients with TOF. In this article, we will share our 5-year experience at our institute, which also shows a decreasing trend.

Patients and methods:

It is a retrospective study. Files of all the patients admitted in our department from January 2019 to December 2023 were reviewed. Age, weight, hospital stay, inotropic support duration, mechanical ventilation duration, and outcomes were studied.

Results:

From January 2019 to December 2023, 173 patients underwent BT shunt for TOF. The mean age was 31 months, and the mean weight was 9.3 kg. The overall mortality for BT shunt was 15% after BT shunt. Hypercyanotic spell not controlled by medical management was the most common indication for BT shunt in our setup. Most of the patients with hypercyanotic spells were also candidates for total correction but due to the emergency, BT shunt was performed.

Conclusion:

The role of BT shunt in patients with TOF is decreasing due to PDA/RVOT stenting, it is likely that the BT shunt in TOF will become a thing of the past in the future even in developing countries like ours.

Type
Original Article
Copyright
© The Author(s), 2024. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Mainwaring, RD, Mainwaring, S. The retirement years of Doctor Helen B. Taussig: an intersection of art and medicine. Cardiol Young 2023; 34: 114.Google Scholar
Yuan, SM, Shinfeld, A, Raanani, E. The Blalock-Taussig shunt. J Card Surg 2009; 24: 101108.CrossRefGoogle ScholarPubMed
Starr, JP. Tetralogy of Fallot: yesterday and today. World J Surg 2010; 34: 658668.CrossRefGoogle Scholar
Li, D, Zhao, T, Hu, S, Zhang, W, Wu, Z, Liu, J. Comparison between the modified Blalock-Taussig shunt and right ventricular outflow tract stent in the palliative treatment for tetralogy of Fallot. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2023; 48: 13251332. DOI: 10.11817/j.issn.1672-7347.2023.230105.Google ScholarPubMed
Remadevi, KS, Vaidyanathan, B, Francis, E, Kannan, BR, Kumar, RK. Balloon pulmonary valvotomy as interim palliation for symptomatic young infants with tetralogy of fallot. Ann Pediatr Cardiol 2008; 1: 27. DOI: 10.4103/0974-20694.1049 .Google ScholarPubMed
Ilyas, S, Rehman, Y, Hussain, I, Khan, A, Ahmed, T, Akbar, A. Emergency department presentation and outcome of children with cyanotic congenital heart diseases. Cureus 2021; 13: e17960. DOI: 10.7759/cureus.17960.Google ScholarPubMed
Moorjani, N. Tetralogy of Fallot, Key Questions in Congenital Cardiac Surgery. In: Moorjani, N (ed). TFM Publications, 2022: 697.Google Scholar
Singh, SP, Chauhan, S, Choudhury, M et al. Modifed Blalock Taussig shunt: comparison between neonates, infants and older children. Ann Card Anaesth 2014; 17: 191197.CrossRefGoogle Scholar
Petrucci, O, Brien, O’, Jacobs, SM et al. Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure. Ann Thorac Surg. 2011; 92: 642651.CrossRefGoogle ScholarPubMed
Ashraf, SS, Tian, Y, Zacharrias, S, Cowan, D, Martin, P, Watterson, K. Effects of cardiopulmonary bypass on neonatal and paediatric inflammatory profiles. Eur J Cardiothorac Surg. 1997; 12: 862868.CrossRefGoogle ScholarPubMed
Riyandi, M, Lilyasari, O, Juzar, DA, Rahmat, B. Age criteria as operative mortality predictor after modified Blalock-Taussig shunt. Indones J Cardiol. 2019; 40: 216221. DOI: 10.30701/ijc.v40i1.763.CrossRefGoogle Scholar
Odim, J, Portzky, M, Zurakowski, D et al. Sternotomy approach for the modified Blalock-Taussig shunt. Circulation. 1995; 92: 256261. DOI: 10.1161/01.CIR.92.9.256.CrossRefGoogle ScholarPubMed
Talwar, S, Kumar, MV, Muthukkumaran, S, Airan, B. Is sternotomy superior to thoracotomy for modified Blalock-Taussig shunt? Interact Cardiovasc Thorac Surg. 2014; 18: 371375. DOI: 10.1093/icvts/ivt513.CrossRefGoogle ScholarPubMed
Akay, TH, Ozkan, S, Gultekin, B et al. Diaphragmatic paralysis after cardiac surgery in children: incidence, prognosis and surgical management. Pediatr Surg Int. 2006; 22: 341346. DOI: 10.1007/s00383-006-1663-2.CrossRefGoogle ScholarPubMed
Glatz, AC, Petit, CJ, Goldstein, BH et al. Comparison between patent ductus arteriosus stent and modified Blalock-Taussig shunt as palliation for infants with ductal-dependent pulmonary blood flow: insights from the congenital catheterization research collaborative. Circulation 2018; 137: 589601.CrossRefGoogle ScholarPubMed
Tseng, SY, Truong, VT, Peck, D et al. Patent ductus arteriosus stent versus surgical aortopulmonary shunt for initial palliation of cyanotic congenital heart disease with ductal-dependent pulmonary blood flow: a systematic review and meta-analysis. J Am Heart Assoc 2022; 11: e024721. DOI: 10.1161/JAHA.121.024721.CrossRefGoogle ScholarPubMed
Shaath, GA, Jijeh, AM, Fararjeh, M et al. What could be better for children with duct dependent pulmonary circulation? J Saudi Heart Assoc 2021; 33: 306312. DOI: 10.37616/2212-5043.1274.CrossRefGoogle ScholarPubMed
Nasser, BA, Abdulrahman, M, Qwaee, AAL, Alakfash, A, Mohamad, T, Kabbani, MS. Impact of stent of ductus arteriosus and modified Blalock-Taussig shunt on pulmonary arteries growth and second-stage surgery in infants with ductus-dependent pulmonary circulation. J Saudi Heart Assoc 2020; 32: 8692. DOI: 10.37616/2212-5043.1014.Google ScholarPubMed
Al Kindi, H, Al Harthi, H, Al Balushi, A et al. Blalock-Taussig shunt versus ductal stenting as palliation for duct-dependent pulmonary circulation. Sultan Qaboos Univ Med J 2023; 23: 1015. DOI: 10.18295/squmj.12.2023.073.CrossRefGoogle ScholarPubMed