Surgical shunts in congenital heart disease

Surgical shunts in congenital heart disease

Shunt surgeries are usually done as palliative procedures prior to surgical repair of cyanotic congenital heart disease, to improve the pulmonary blood flow.

Classic Blalock – Taussig shunt

This shunt was devised by cardiologist Helen B. Taussig and cardiac surgeon Alfred Blalock as a palliation for cases of Tetralogy of Fallot. The subclavian artery is divided and anastomosed to the pulmonary artery as an end to side anastomosis. Usually it is done on the side opposite to the aortic arch because of the presence of the brachiocephalic trunk on that side prevents kinking of the subclavian when it is pulled into the thorax. Unilateral rib notching due to collaterals which develop to supply the arm can be seen in those who have undergone the shunt several years later.

Modified Blalock – Taussig shunt

In modified Blalock – Taussig shunt a Gore – Tex graft is used to connect the subclavian artery to the pulmonary artery. Both these shunts are done to the branch pulmonary artery on the side of the shunt and approach is through a posterolateral thoracotomy.

Bidirectional Glenn shunt

Glenn shunt connects the superior vena cava to right pulmonary artery. A bidirectional Glenn shunt connects the superior vena cava to the right pulmonary artery in an end to side fashion so that superior vena caval blood can flow to both lungs.

Waterston shunt

Waterston shunt is one of the older central aortopulmonary shunts connecting ascending aorta to right pulmonary artery. Central shunts have a higher chance of producing pulmonary hypertension later.

Potts shunt

Potts shunt connects the descending aorta to left pulmonary artery. Both these central aortopulmonary shunts are side to side and prone for development of pulmonary hypertension and pulmonary vascular disease.

Davidson shunt

In Davidson shunt, a Gore-Tex graft is used to connect ascending aorta to main pulmonary artery. Important complications which can occur are shunt thrombosis, pulmonary artery stenosis or distortion at the anastomotic site and congestive heart failure due to excessive pulmonary blood flow [1].

Reference

  1. Tomasian A, Malik S, Shamsa K, Krishnam MS. Congenital heart diseases: post-operative appearance on multi-detector CT-a pictorial essay. Eur Radiol. 2009 Dec;19(12):2941-9.