Systemic Pulmonary Shunt Performed with Shelhigh Internal Mammary Artery: Early Results


  • H. Hakan Poyrazoglu
  • M. Kemal Av?ar
  • Funda Tor
  • Sevcan Erdem
  • U?ur Göçen
  • Ihsan Bayraktar
  • Cem Kayhan
  • Nazan Ozbarlas
  • O. Kemal Salih



Objective. The purpose of this study was to evaluate early findings for aortopulmonary shunts using bovine internal mammary artery grafting.

Methods. Bovine internal mammary artery grafts biomodified with glutaraldehyde and the Shelhigh No-React process were used between May 2005 and April 2006 in our clinic for 20 cases of aorta-pulmonary artery shunts. We implanted 2 sizes of grafts, either a graft with 4-mm proximal and 5-mm distal diameters or a graft with 5-mm proximal and 6-mm distal diameters. Patients were between 20 days and 7 years of age, and the sex distribution was 55% female and 45% male. A Blalock-Taussig shunt with left thoracotomy was performed in patients 2 years of age and older, and a central shunt with sternotomy was performed for patients younger than 2 years. Eight patients underwent operation under emergency conditions. Nine patients had tetralogy of Fallot and/or pulmonary atresia (PA); 3 had transposition of the great arteries, ventricular septal defect, and pulmonary stenosis (PS); 3 had tricuspid atresia; 3 had PS and double-inlet left ventricle; and 2 had PA.

Results. After the operation, immediate recovery of oxygen saturation and partial oxygen pressure was observed in all patients. Pulse oximetry measurements showed patient oxygen saturation to be between 84% and 100%. One patient underwent reoperation at the third postoperative hour because of bleeding. Two patients died from causes unrelated to the graft. The hospitalization period was between 7 and 29 days. Echocardiography evaluations showed no shunt obstruction for the early (first postoperative week) or middle (postoperative week 24) period.

Conclusion. With this study, we assessed the use of the Shelhigh internal mammary artery graft instead of synthetic (polytetrafluoroethylene) tubular grafts in shunt operations for congenital heart diseases with decreased pulmonary blood flow and no evidence of calcification. Further investigation involving a larger number of cases and longer-term results for patency are needed to confirm our findings.


Abolhoda A, Yu S, Oyarzun JR, Bogden JD, Gabbay S. 1996. Calcification of bovine pericardium: glutaraldehyde versus No-React biomodification. Ann Thorac Surg 62:169-74.nAmato JJ, Marbey ML, Bush C, Cotroneo JV, Bushong J. 1988. Systemic-pulmonary polytetrafluoroethylene shunts in palliative operations for congenital heart disease: revival of the central shunt. J Thorac Cardiovasc Surg 95:62-9.nBerger RMF. 1998. Heparin as a risk factor for perigraft seroma complicating the modified Blalock-Taussig shunt. J Thorac Cardiovasc Surg 116:286-92.nBove EL, Kohman L, Sereika S, et al. 1987. The modified Blalock-Taussig shunt: analysis of adequacy and duration of palliation. Circulation 76(suppl 2):III19-23.nCalder A, Chan N, Clarkson P, Kerr AR, Neutze JM. 1991. Progress of patients with pulmonary atresia after systemic to pulmonary arterial shunts. Ann Thorac Surg 51:401-7.nFermanis GG, Ekangaki AK, Salmon AP, et al. 1992. Twelve year experience with the modified Blalock-Taussig shunt in neonates. Eur J Cardiothorac Surg 6:586-9.nGates RN, Laks H, Johnson K. 1998. Side-to-side aorto-Gore-Tex central shunt. Ann Thorac Surg 65:515-6.nGazzaniga A, Lamberti JJ, Siewers RD, et al. 1976. Arterial prosthesis of microporous expanded polytetrafluoroethylene for construction of aorta-pulmonary shunts. J Thorac Cardiovasc Surg 72:357-63.nGladman G, McCrindle BW, Williams WG, Freedom RM, Benson LN. 1997. The modified Blalock-Taussig shunt: clinical impact and morbidity in Fallot's tetralogy in the current era. J Thorac Cardiovasc Surg 114:25-30.nGodart F, Qureshi SA, Simha A, et al. 1998. Effects of modified and classic Blalock-Taussig shunts on the pulmonary arterial tree. Ann Thorac Surg 66:512-8.nPotapov EV, Alexi-Meskishvili VV, Dähnert I, Ivanitskaia EA, Lange PE, Hetzer R. 2001. Development of pulmonary arteries after central aortopulmonary shunt in newborns. Ann Thorac Surg 71:899-906.nSilveira WL, Sousa M, Peixoto FA, et al. 2005. Initial analysis of the use of the L-D-Hydro (Eato L-D-Hydro) organic tubular graft for performing the modified Blalock-Taussig procedure in congenital heart diseases with decreased pulmonary blood flow [in Portuguese]. Arq Bras Cardiol 84:233-6.nSousa Uva M, Lancour-Gayet F, Komiya T, et al. 1994. Surgery for tetralogy of Fallot at less than six months of age. J Thorac Cardiovasc Surg 107:1291-300.nUllom RL, Sade RM, Crawford FA Jr, et al. 1987. The Blalock-Taussig shunt in infants: standard versus modified. Ann Thorac Surg 44:539-43.n



How to Cite

Poyrazoglu, H. H., Av?ar, M. K., Tor, F., Erdem, S., Göçen, U., Bayraktar, I., Kayhan, C., Ozbarlas, N., & Salih, O. K. (2008). Systemic Pulmonary Shunt Performed with Shelhigh Internal Mammary Artery: Early Results. The Heart Surgery Forum, 11(1), E50-E53.