Blalock-Taussig shunt: Difference between revisions
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==Overview== | ==Overview== | ||
The '''Blalock-Taussig shunt''' is a surgical procedure that are done as palliative procedures for [[cyanotic heart defect]]s which are common causes of [[blue baby syndrome]]. In modern surgery, this procedure is temporarily used to direct blood flow to the lungs and relieve cyanosis while the infant is waiting for corrective surgery. One branch of the [[subclavian artery]] (Arteria subclavia) or [[carotid artery]] (Arteria carotis) is separated and connected with the [[pulmonary artery]] (Arteria pulmonalis). The [[Human lung|lung]] receives more blood with low [[oxygenation]] from the body. The first area of application was [[tetralogy of Fallot]]. This procedure has been modified into modified Blalock-Taussing Shunt (mBTS). In this modified procedure a graft from innominate artery or subclavian artery is placed to the corresponding pulmonary artery. | The '''Blalock-Taussig shunt''' is a surgical procedure that are done as palliative procedures for [[cyanotic heart defect]]s which are common causes of [[blue baby syndrome]]. In modern surgery, this procedure is temporarily used to direct blood flow to the lungs and relieve cyanosis while the infant is waiting for corrective surgery. One branch of the [[subclavian artery]] (Arteria subclavia) or [[carotid artery]] (Arteria carotis) is separated and connected with the [[pulmonary artery]] (Arteria pulmonalis). The [[Human lung|lung]] receives more blood with low [[oxygenation]] from the body. The first area of application was [[tetralogy of Fallot]]. This procedure has been modified into modified Blalock-Taussing Shunt (mBTS). In this modified procedure a graft from innominate artery or subclavian artery is placed to the corresponding pulmonary artery. | ||
== Historical Prospective == | == Historical Prospective == | ||
[[File:Original-blalock-taussig-shunt-creative-commons.png|thumb|'''Original Blalock-Taussig shunt diagram,Case courtesy of Dr Laurent Bilodeau, https://radiopaedia.org/cases/74774">rID: 74774'''|left| | [[File:Original-blalock-taussig-shunt-creative-commons.png|thumb|'''Original Blalock-Taussig shunt diagram,Case courtesy of Dr Laurent Bilodeau, https://radiopaedia.org/cases/74774">rID: 74774'''|left|214x214px]] | ||
=== Original Shunt === | === Original Shunt === | ||
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=== Modified Blalock-Taussig Shunt === | === Modified Blalock-Taussig Shunt === | ||
[[File:Modified-blalock-taussig-shunt-creative-commons.png|left|thumb| | [[File:Modified-blalock-taussig-shunt-creative-commons.png|left|thumb|249x249px|'''Modified Blalock-Taussig shunt diagram Case courtesy of Dr Laurent Bilodeau.From the case https://radiopaedia.org/cases/74773 ,rID: 74773''']]A modified method of inserting a shunt was developed in 1962 by Klinner using teflon as prosthetic graft material between the subclavian artery and the pulmonary artery is used to prevent scarring of the subclavian artery. <ref name="pmid144570412">{{cite journal| author=KLINNER W, PASINI M, SCHAUDIG A| title=[Anastomosis between systemic and pulmonary arteries with the aid of plastic prostheses in cyanotic heart diseases]. | journal=Thoraxchirurgie | year= 1962 | volume= 10 | issue= | pages= 68-75 | pmid=14457041 | doi=10.1055/s-0028-1096482 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14457041 }}</ref> | ||
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Revision as of 03:55, 7 June 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The Blalock-Taussig shunt is a surgical procedure that are done as palliative procedures for cyanotic heart defects which are common causes of blue baby syndrome. In modern surgery, this procedure is temporarily used to direct blood flow to the lungs and relieve cyanosis while the infant is waiting for corrective surgery. One branch of the subclavian artery (Arteria subclavia) or carotid artery (Arteria carotis) is separated and connected with the pulmonary artery (Arteria pulmonalis). The lung receives more blood with low oxygenation from the body. The first area of application was tetralogy of Fallot. This procedure has been modified into modified Blalock-Taussing Shunt (mBTS). In this modified procedure a graft from innominate artery or subclavian artery is placed to the corresponding pulmonary artery.
Historical Prospective
Original Shunt
The original procedure was named for Alfred Blalock, surgeon, Baltimore, (1899–1964) and Helen B. Taussig, cardiologist, Baltimore/Boston, (1898–1986) who, along with Blalock's African American laboratory technician Vivien Thomas (1910–1985), developed the procedure. Taussig, who treated hundreds of infants and children with this disorder, had observed that children with a cyanotic heart defect and a patent ductus arteriosus (PDA) lived longer than those without the PDA. It therefore seemed to her that a shunt which mimicked the function of a PDA might relieve the tetralogy patients' poor oxygenation. In 1943, having broached the possibility of a surgical solution to Dr. Robert Gross of Boston without success, Dr. Taussig approached Blalock and Thomas in their Hopkins laboratory in 1943. Thomas, Vivien (1985). Partners of the heart : Vivien Thomas and his work with Alfred Blalock : an autobiography. Philadelphia: University of Pennsylvania Press. ISBN 0812216342.
Modified Blalock-Taussig Shunt
A modified method of inserting a shunt was developed in 1962 by Klinner using teflon as prosthetic graft material between the subclavian artery and the pulmonary artery is used to prevent scarring of the subclavian artery. [1]
Indications
- Tricuspid atresia
- Teratology of Fellot
- Ebstein's Anomly
- Hypoplastic Left Heart syndrome
- Pulmonary atresia
Procedure
Classic/Orginal Blalock-Taussig Shunt [2]
- For classic Blalock-Taussig shunt end to end anastomosis between the subclavian and pulmonary arteries is performed on opposite to the aortic arch to minimize the kinking of subclavian artery as it crosses aortic prominence
| Advantages | Disadvantages |
|---|---|
| The relative diameter of subclvian artery prevents excessive blood flow to lungs | Thrombosis of shunt due to less diameter |
| Easily Reversible | Risk of Dissection |
| Increased rate of anastomosis growth | Subclavian artery is lost during the procedure |
Modified Blalock Taussig Shunt [2]
It is the most commonly used procedure now a days. First described and performed by Klinner et. al in 1962, this procedure hold superb prognosis over classic one. An Interposition PTFE or Gore-Tex graft is placed between the subclvian artery and the pulmonary artery. Hence no scarring of subclavian artery results.
| Advantages | Disadvantages |
|---|---|
| It can be done on the same side of the arch | Thrombosis |
| More patency than Classic BT shunt i.e >90 % at 2 years | Pseudoaneurysm |
| Pulmonary artery is less disorted | Chylothorax, Chylopericardium, chylous ascites |
Complications
The immediate post-operative complications include [3]
- Development of chylothorax, chylopericardium and chylous ascites
- Phrenic nerve resection leading to paralysis
- Anemia
- Congestive Heart faliure resulting from excessive blood flow
- Modified PTFE grafts can result in formation seroma or shunt occlusion due to hyperplasia of neointima
- Stenosis of innominate artery
Prognosis
Modified Blalock-Taussig Shunt has superior prognostic value over classic Blalock-Taussig Shunts. Following prognostic factors are compared between the two procedures in multiple studies. [4] [5] [6] [7] [8] [9]
- Rise in saturation of oxygen is greater in modified than in classic shunt
- Shunt patency is 88.8 % in modified for 3-5 years versus 90 % in first year, 62 % in two years and 78.0 % in 3 years for classic shunt.
- The risk of early shunt faliure is 20.8 % in modified and 51.7% in classic shunt.
- Post-shunt increase in pulmonary arterial index (mm2/m2) is 158 +/- 21 versus 117 +/- 52 in classic Blalock-Taussig shunt.
References
- ↑ KLINNER W, PASINI M, SCHAUDIG A (1962). "[Anastomosis between systemic and pulmonary arteries with the aid of plastic prostheses in cyanotic heart diseases]". Thoraxchirurgie. 10: 68–75. doi:10.1055/s-0028-1096482. PMID 14457041.
- ↑ 2.0 2.1 Kiran U, Aggarwal S, Choudhary A, Uma B, Kapoor PM (2017). "The blalock and taussig shunt revisited". Ann Card Anaesth. 20 (3): 323–330. doi:10.4103/aca.ACA_80_17. PMC 5535574. PMID 28701598.
- ↑ Yuan SM, Shinfeld A, Raanani E (2009). "The Blalock-Taussig shunt". J Card Surg. 24 (2): 101–8. doi:10.1111/j.1540-8191.2008.00758.x. PMID 19040408.
- ↑ Al Jubair KA, Al Fagih MR, Al Jarallah AS, Al Yousef S, Ali Khan MA, Ashmeg A; et al. (1998). "Results of 546 Blalock-Taussig shunts performed in 478 patients". Cardiol Young. 8 (4): 486–90. doi:10.1017/s1047951100007150. PMID 9855103.
- ↑ Kim HK, Kim WH, Kim SC, Lim C, Lee CH, Kim SJ (2006). "Surgical strategy for pulmonary coarctation in the univentricular heart". Eur J Cardiothorac Surg. 29 (1): 100–4. doi:10.1016/j.ejcts.2005.10.032. PMID 16337132.
- ↑ Karpawich PP, Bush CP, Antillon JR, Amato JJ, Marbey ML, Agarwal KC (1985). "Modified Blalock-Taussig shunt in infants and young children. Clinical and catheterization assessment". J Thorac Cardiovasc Surg. 89 (2): 275–9. PMID 3968910.
- ↑ Kulkarni H, Rajani R, Dalvi B, Gupta KG, Vora A, Kelkar P (1995). "Effect of Blalock Taussig shunt on clinical parameters, left ventricular function and pulmonary arteries". J Postgrad Med. 41 (2): 34–6. PMID 10707705.
- ↑ Bove EL, Kohman L, Sereika S, Byrum CJ, Kavey RE, Blackman MS; et al. (1987). "The modified Blalock-Taussig shunt: analysis of adequacy and duration of palliation". Circulation. 76 (3 Pt 2): III19–23. PMID 2441893.
- ↑ Ullom RL, Sade RM, Crawford FA, Ross BA, Spinale F (1987). "The Blalock-Taussig shunt in infants: standard versus modified". Ann Thorac Surg. 44 (5): 539–43. doi:10.1016/s0003-4975(10)62119-4. PMID 3675059.