Right ventricle-to-pulmonary artery shunt: alternative palliation in infants with inadequate pulmonary blood flow prior to two-ventricle repair.

BACKGROUND: Traditional palliation of infants with biventricular hearts and inadequate pulmonary blood flow is a modified Blalock-Taussig shunt. The aim of this report is to assess the results of an alternative, right ventricle-to-pulmonary artery (RV-PA) shunt.

METHODS: Between August 2004 and July 2007, 10 infants with biventricular hearts and inadequate pulmonary blood flow underwent palliation with an RV-PA shunt. Median age was 9 days (range, 4 to 86), weight was 3.0 kg (1.7 to 4.5), and 4 of 10 patients weighed less than 2.5 kg. Shunts were nonvalved Gore-Tex (W.L. Gore Assoc, Flagstaff, AZ), and size was 6 mm (n = 5) or 5 mm (n = 5).

RESULTS: There were no operative deaths. Median oxygen saturation at hospital discharge was 95% (87 to 98). In 2 patients the shunt was partially narrowed with a metal clip; they underwent successful balloon dilation 6 months after shunt placement. Eight patients have undergone two-ventricle repair 6 to 17 months after shunt placement. At the time of complete repair, oxygen saturation was 86 +/- 1% and weight was 7.7 +/- 1.7 kg. Repairs included a valved RV-to-PA conduit, 14 to 16 mm in diameter. There was one interstage death.

CONCLUSIONS: The RV-PA shunt provides successful palliation in infants with biventricular heart disease and inadequate pulmonary blood flow. It can be used in low birth weight infants and allows significant growth with protection of oxygen saturation prior to complete repair. Partial clipping of the shunt with subsequent balloon dilation is an option to prolong palliation. These results compare favorably with those of a modified Blalock-Taussig shunt or single stage complete repair.