Application of modified Blalock-Taussig shunts in patients with complex congenital heart malformations and follow-up of 110 cases

Objective The modified Blalock-Taussig shunt (MBTS) is considered a low-risk management option for palliation in patients with severely cyanotic heart anomalies in advanced heart centers in western countries.But the morbidity and mortality associated with MBTS remains challenge in developing countries.Methods 106 patients with severely cyanotic complex heart anomalies underwent 110 modified Blalock-Taussig shunts(B-T shunts) between October 2000 and August 2012.The mean age was (3.8 ± 1.1) months (1 day-37.2 months).The mean weight of the babies was (5.0 ± 2.1) kg (2.3 kg-12.0 k g).The cardiac anatomy was as follows:pulmonary atresia with intact ventricular septum in 25,pulmonary atresia with ventricular septum defects in 45,tricuspid atresia in 11,tetralogy of Fallot in 7,complex single ventricle physiology in 18.All patients were deeply cyanotic,and preoperative prostaglandin E1 was needed in 78 patients to ensure ductus patent and maintain oxygen saturations prior to the shunt operation.The shunts were accomplished with 3.0 mm polytetrafluoroethylene grafts in 8 patients,3.5 mm in 11,4 mm in 65,5mm in 26.Results The duration of mechanical ventilation was 4 hours-7 days,cardiac intensive care unit stay was 1-12 days,hospital stay after operation was 1-18 days.There were 3 deaths (2.6％),immediate post-operative shunt block in 1,severe hypoxidosis in 1 and heart failure in 1.Oxygen saturation increased from 68.5％ preoperatively to 79.2％ postoperatively.Four patients had shunt block,additional shunt was created respectively.There was 2 late death.Follow-up of 94 patients revealed satisfactory systemic oxygen saturation of 0.81 ± 0.10 (0.63-0.92).86 cases received further operations,including 7 in TOF radical operation,31 in Rastelli,25 in Glenn,18 in Fontan.Conclusion With an encouraging early shunt patent rate and oxygen saturation increasing,we can now adopt MBTS as an alternative in patients with severely cyanotic heart anomalies.Modified B-T shunt is a good palliation for patients with cyanoti cheart anomalies,which can increase pulmonary blood flow.Excellent surgical skills and perioperative treatment contribute to good operation results,and to low morbidity and low mortality. Key words: Heart defect, congenital ;  Cardiac surgical procedures;  Follow-up studies