Systemic Pulmonary Shunt Performed with Shelhigh Internal Mammary Artery: Early Results
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
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).