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Palliative Operations for Congenital Heart Disease

  • Masakazu Nakao
  • Roberto M. Di DonatoEmail author
Chapter
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Abstract

Palliations for congenital heart anomalies are surgical procedures meant to offset major hemodynamic derangements, usually in preparation for staged repair. They treat symptoms but cannot stop the progression of the disease. Palliative operations for congenital heart anomalies are classified into procedures aimed at: (1) reducing pulmonary blood flow (pulmonary artery banding); (2) increasing pulmonary blood flow (several methods of systemic-pulmonary shunt); (3) enhancing mixing at atrial level (atrial septectomy or septostomy); and (4) other (hybrid procedure). Hybrid procedure is an alternative to stage I Norwood operation for high-risk cases of hypoplastic left heart syndrome or similar left-sided obstructive lesions. This chapter provides an overview of commonly performed palliative operations for congenital heart disease.

Keywords

Atrial septectomy Modified Blalock-Taussig shunt Potts shunt Pulmonary artery banding 

References

  1. 1.
    Muller WH Jr, Danimann JF Jr. The treatment of certain congenital malformations of the heart by the creation of pulmonic stenosis to reduce pulmonary hypertension and excessive pulmonary blood flow; a preliminary report. Surg Gynecol Obstet. 1952;95:213–9.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Odim JN, Laks H, Drinkwater DC Jr, et al. Staged surgical approach to neonates with aortic obstruction and single-ventricle physiology. Ann Thorac Surg. 1999;68:962–7.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Boutin C, Jonas RA, Sanders SP, Wernovsky G, Mone SM, Colan SD. Rapid two-stage arterial switch operation. Acquisition of left ventricular mass after pulmonary artery banding in infants with transposition of the great arteries. Circulation. 1994;90:1304–9.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Mavroudis C, Backer CL. Arterial switch after failed atrial baffle procedures for transposition of the great arteries. Ann Thorac Surg. 2000;69:851–7.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Winlaw DS, McGuirk SP, Balmer C, et al. Intention-to-treat analysis of pulmonary artery banding in conditions with a morphological right ventricle in the systemic circulation with a view to anatomic biventricular repair. Circulation. 2005;111:405–11.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Devaney EJ, Charpie JR, Ohye RG, Bove EL. Combined arterial switch and Senning operation for congenitally corrected transposition of the great arteries: patient selection and intermediate results. J Thorac Cardiovasc Surg. 2003;125:500–7.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Trusler GA, Mustard WT. A method of banding the pulmonary artery for large isolated ventricular septal defect with and without transposition of the great arteries. Ann Thorac Surg. 1972;13:351–5.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Corno AF, Bonnet D, Sekarski N, Sidi D, Vouhé P, von Segesser LK. Remote control of pulmonary blood flow: initial clinical experience. J Thorac Cardiovasc Surg. 2003;126:1775–80.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Gibbs JL, Wren C, Watterson KG, Hunter S, Hamilton JR. Stenting of the arterial duct combined with banding of the pulmonary arteries and atrial septectomy or septostomy: a new approach to palliation for the hypoplastic left heart syndrome. Br Heart J. 1993;69:551–5.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Michel-Behnke I, Akintuerk H, Marquardt I, et al. Stenting of the ductus arteriosus and banding of the pulmonary arteries: basis for various surgical strategies in newborns with multiple left heart obstructive lesions. Heart. 2003;89:645–50.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Blalock A, Taussig HB. The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. JAMA. 1945;128:189–202.CrossRefGoogle Scholar
  12. 12.
    Moulton AL, Brenner JI, Ringel R, et al. Classic versus modified Blalock-Taussig shunts in neonates and infants. Circulation. 1985;72(3 Pt 2):II35–44.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Karpawich PP, Bush CP, Antillon JR, Amato JJ, Marbey ML, Agarwal KC. Modified Blalock-Taussig shunt in infants and young children. Clinical and catheterization assessment. J Thorac Cardiovasc Surg. 1985;89:275–9.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Yuan SM, Shinfeld A, Raanani E. The Blalock-Taussig shunt. J Card Surg. 2009;24:101–8.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    de Leval MR, McKay R, Jones M, Stark J, Macartney FJ. Modified Blalock-Taussig shunt. Use of subclavian artery orifice as flow regulator in prosthetic systemic-pulmonary artery shunts. J Thorac Cardiovasc Surg. 1981;81:112–9.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    LeBlanc J, Albus R, Williams WG, et al. Serous fluid leakage: a complication following the modified Blalock-Taussig shunt. J Thorac Cardiovasc Surg. 1984;88:259–62.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Odim J, Portzky M, Zurakowski D, et al. Sternotomy approach for the modified Blalock-Taussig shunt. Circulation. 1995;92(9 Suppl):II256–61.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Morales DL, Zafar F, Arrington KA, et al. Repeat sternotomy in congenital heart surgery: no longer a risk factor. Ann Thorac Surg. 2008;86:897–902.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Al Jubair KA, Al Fagih MR, Al Jarallah AS, et al. Results of 546 Blalock-Taussig shunts performed in 478 patients. Cardiol Young. 1998;8:486–90.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Potts WJ, Smith S, Gibson S. Anastomosis of the aorta to a pulmonary artery; certain types in congenital heart disease. JAMA. 1946;132:627–31.CrossRefGoogle Scholar
  21. 21.
    Daniel FJ, Clarke CP, Richardson JP, Westlake GW, Jones PG. An evaluation of Potts’ aortopulmonary shunt for palliation of cyanotic heart disease. Thorax. 1976;31:394–7.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Kirklin JW, Devloo RA. Hypothermic perfusion and circulatory arrest for surgical correction of tetralogy of Fallot with previously constructed Potts’ anastomosis. Dis Chest. 1961;39:87–91.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Blanc J, Vouhé P, Bonnet D. Potts shunt in patients with pulmonary hypertension. N Engl J Med. 2004;350:623.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Esch JJ, Shah PB, Cockrill BA, et al. Transcatheter Potts shunt creation in patients with severe pulmonary arterial hypertension: initial clinical experience. J Heart Lung Transplant. 2013;32:381–7.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Schranz D, Kerst G, Menges T, et al. Transcatheter creation of a reverse Potts shunt in a patient with severe pulmonary arterial hypertension associated with Moyamoya syndrome. EuroIntervention. 2015;11:121.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Waterston DJ. Treatment of Fallot’s tetralogy in children under 1 year of age. Rozhl Chir. 1962;41:181–3.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Wilson JM, Mack JW, Turley K, Ebert PA. Persistent stenosis and deformity of the right pulmonary artery after correction of the Waterston anastomosis. J Thorac Cardiovasc Surg. 1981;82:169–75.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Amark KM, Karamlou T, O’Carroll A, et al. Independent factors associated with mortality, reintervention, and achievement of complete repair in children with pulmonary atresia with ventricular septal defect. J Am Coll Cardiol. 2006;47:1448–56.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Watterson KG, Wilkinson JL, Karl TR, Mee RB. Very small pulmonary arteries: central end-to-side shunt. Ann Thorac Surg. 1991;52:1132–7.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Glenn WW. Circulatory bypass of the right side of the heart. IV. Shunt between superior vena cava and distal right pulmonary artery; report of clinical application. N Engl J Med. 1958;259:117–20.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Dogliotti AM, Actis-Dato A, Venere G, Tarquini A. The operation of vena cava-pulmonary artery anastomosis in Fallot’s tetralogy and in other heart diseases. Minerva Cardioangiol. 1961;9:577–93.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Sano S, Ishino K, Kawada M, et al. Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 2003;126:504–9.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Reemtsen BL, Pike NA, Starnes VA. Stage I palliation for hypoplastic left heart syndrome: Norwood versus Sano modification. Curr Opin Cardiol. 2007;22:60–5.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Quandt D, Ramchandani B, Stickley J, et al. Stenting of the right ventricular outflow tract promotes better pulmonary arterial growth compared with modified Blalock-Taussig shunt palliation in tetralogy of Fallot-type lesions. JACC Cardiovasc Interv. 2017;10:1774–84.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Schneider M, Zartner P, Sidiropolous A, Konertz W, Hausdorf G. Stent implantation of the arterial duct in newborns with duct-dependent circulation. Eur Heart J. 1998;19:1401–9.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Rashkind WJ, Miller WW. Creation of an atrial septal defect without thoracotomy. A palliative approach to complete transposition of the great arteries. JAMA. 1966;196:991–2.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Leanage R, Agnetti A, Graham G, Taylor J, Macartney FJ. Factors influencing survival after balloon atrial septostomy for complete transposition of great arteries. Br Heart J. 1981;45:559–72.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Blalock A, Hanlon CR. The surgical treatment of complete transposition of the aorta and the pulmonary artery. Surg Gynecol Obstet. 1950;90:1–15, illust.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Dunn JM, Donner R, Black I, Balsara RK. Palliative repair of transposition of the great arteries with criss-cross heart: ventricular septal defect and hypoplastic right (systemic) ventricle. J Thorac Cardiovasc Surg. 1982;83:755–60.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Burkhart HM, Dearani JA, Williams WG, et al. Late results of palliative atrial switch for transposition, ventricular septal defect, and pulmonary vascular obstructive disease. Ann Thorac Surg. 2004;77:464–8.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Yun TJ, Cho WC, Jung SH, Seo DM, Goo HW, Kim YH. Reverse Blalock-Taussig shunt facilitates the growth of the ascending aorta after hybrid palliation. Ann Thorac Surg. 2007;83:1886–8.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Bacha EA, Daves S, Hardin J, et al. Single-ventricle palliation for high-risk neonates: the emergence of an alternative hybrid stage I strategy. J Thorac Cardiovasc Surg. 2006;131:163–171.e2.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Pizarro C, Derby CD, Baffa JM, Murdison KA, Radtke WA. Improving the outcome of high-risk neonates with hypoplastic left heart syndrome: hybrid procedure or conventional surgical palliation? Eur J Cardiothorac Surg. 2008;33:613–8.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Akintürk H, Michel-Behnke I, Valeske K, et al. Hybrid transcatheter-surgical palliation: basis for univentricular or biventricular repair: the Giessen experience. Pediatr Cardiol. 2007;28:79–87.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Al Jalila Children’s HospitalDubaiUnited Arab Emirates
  2. 2.Paediatric Cardiac SurgeryAl Jalila Children’s HospitalDubaiUnited Arab Emirates

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