Modified Blalock-Taussig Shunt in Palliative Cardiac Surgery

Background: Cyanotic congenital heart diseases present early in life with poor general condition of the patient. Majority of deaths occurs within one year of life before surgical intervention due to severe cyanosis and metabolic acidosis. Modified Blalock-Taussig Shunt (MBTS) is one of the palliative cardiac surgeries done for cyanotic congenital heart diseases. It improves the general condition of the patient before definitive surgery is done. The aim of this study was to determine the commonest indications, post-operative anticoagulation and early complications following MBTS at CARE Hospital, India. Methods: This was a retrospective study from January 2004 to December 2006 including all patients who underwent Posterolateral Thoracotomy for MBTS. All patients had deep cyanosis, oxygen saturation of 65% or less and small pulmonary vasculature due to congenital heart defects. Acyanotic patients and those with oxygen saturation more than 65% were excluded from the study. All patients received a single dose of heparin intra-operatively and oral aspirin as anticoagulant regimen post-operatively. No heparin given post-operatively. Results: A total of 20 children with a mean age of 27.4 months were studied. Two patients had pre-operative ICU admission due to severe cyanosis (both had oxygen saturation of 35%), hypotension and severe body weakness. The commonest indications for MBTS included Tetralogy of Fallot (70%), pulmonary atresia (10%) with or without Ventricular Septal Defect (VSD), tricuspid atresia (10%) with pulmonary atresia or stenosis and Double Outlet Right Ventricle (DOVR) with pulmonary atresia or stenosis (10%). Mean duration of ICU stay was 2 days, mean duration of mechanical ventilation was four and half hours, mean duration of hospital stay was 7 days and mean systemic oxygen saturation improved significantly from 46% to 84% ( x2 = 7.03, p = 0.0080). No post-operative bleeding, seroma, shunt thrombosis or death occurred in this study. Conclusion: The commonest indication for MBTS is TOF. Intra-operative single dose of heparin followed by post-operative oral aspirin as anticoagulant regimen was not associated with a major complication in terms of bleeding, seroma, shunt thrombosis, or death

Patterns of Anomalous pulmonary Venous Connection as Seen at Care Hospital, Hyderabad - India.

Background: Anomalous pulmonary venous connection (APVC) is a rare, life threatening congenital heart disease presenting early in life. It may be partial (PAPVC) or total (TAPVC). PAPVC mainly involve the right pulmonary arteries and is associated with sinus venosus atrial septal defect with a low morbidity and mortality. TAPVC is classified into supracardiac, intracardiac, infracardiac and mixed types. It carries a high morbidity and mortality. The aim of this study was to determine the morphological patterns and surgical outcome of APVC at CARE hospital, Hyderabad-India. Methods: This was a prospective study form January 2004 to December 2006. Study included all patients who underwent surgery for anomalous pulmonary venous connection and followed up to the time of discharge. Results: A total of 65 patients with APVC were studied where the results revealed 60% had TAPVC and 40% had PAPVC. Mean age of presentation was 21.6 months for TAPVC compared to 135.2 months for PAPVC. Among all patients with PAPVC 84.6 % had sinus venosus atrial septal defect. Supra-cardiac and intra-cardiac anomalous were the commonest type of TAPVC representing 43.6% and 35.9% respectively. Among all patients with TAPVC 51.35% were associated with ostium secundum atrial septal defect, 74.4% had moderate to severe pulmonary hypertension. Overall mortality was 9.25%. Mortality within TAPVC group was 15.4% and none from PAPVC. Conclusion: It was concluded that TAPVC present early in life and is associated with ostium secundum atrial septal defect, pulmonary hypertension, high morbidity and mortality. Accurate diagnosis and early correction improves the surgical outcome