Modified central aortopulmonary shunt with end-to-end anastomosis of the shunt to the pulmonary trunk: Early results of a novel shunt procedure for first-stage palliation of infants with pulmonary atresia and hypoplastic pulmonary arteries.

OBJECTIVE: The aim was to investigate a novel palliative shunt performed between the ascending aorta and the main pulmonary artery in patients with pulmonary atresia.

PATIENTS AND METHODS: Thirteen patients with intracardiac defects [tetralogy of Fallot (seven patients); tetralogy of Fallot and major aortopulmonary collateral arteries (one patient); ventricular septal defect and major aortopulmonary collateral arteries (two patients); tricuspid atresia (three patients)] and pulmonary atresia underwent shunt operation. Patient selection was made based on preoperative echocardiography and perioperative findings. Eight of the patients were female and five were male. Ages and weight ranged between 1-235 days and 2,950-7,900 g, respectively. Preoperative room air oxygen saturation ranged between 68-83 %.

RESULTS: Operations were performed through a median sternotomy. The main pulmonary artery was transected from the right ventricular outflow tract and using a 3-3.5 mm diameter graft, a modified central aortopulmonary shunt was created (graft anastomosis was end-to-end to the pulmonary artery and side-to-side to the aorta). Postoperative oxygen saturation increased 5-10% and diastolic blood pressure decreased by 3-6 mmHg. One hospital mortality occurred, due to sepsis, and two late deaths, one due to pneumonia and one sudden death, occurred in the follow-up period. Patients were followed up for 3-16 months after the operations. During the follow-up period four patients received corrective operations, one unifocalization and three total corrections.

CONCLUSION: Modified central aortopulmonary shunt with end-to-end anastomosis of the shunt to the pulmonary trunk is a novel palliative shunt operation. Our early results with this technique indicate rapid palliation and early achievement of bilateral homogenous adequate pulmonary artery size with a low incidence of overflow to pulmonary circulation and minimal arterial distortion.