Ascending Aorta-Right Pulmonary Artery Shunt in Infants and Older Patients with Certain Types of Cyanotic Congenital Heart Disease

Abstract

A side-to-side anastomosis between the ascending aorta and the right pulmonary artery was created in 80 infants (less than 1 year of age) and in 61 older children with a variety of cyanotic cardiac abnormalities in which there is pulmonary stenosis or atresia. Seventy-one per cent of the infant group and 90% of patients over 1 year of age were long-term survivors (up to 6 years). Tetralogy of Fallot was the most commonly encountered anomaly in all 141 patients (66%); transposition of the great vessels and pulmonary stenosis occurred in 18%; and tricuspid atresia with pulmonary stenosis in 10%. The presence of an excessively large shunt anastomosis (55% of deaths) and additional (unrecognized) other anomalies (26%) were major causes of postoperative deaths. In patients in whom a systemic-pulmonary artery anastomosis is required, this operation is the procedure of choice in infants under 1 year of age. It is also of value in older patients if a Blalock-Taussig shunt cannot be performed.