Article

lock Open Access lock Peer-Reviewed

2

Views

ORIGINAL ARTICLE

Internal mammary-pulmonary artery anastomosis for cyanotic congenital heart disease

João J CarneiroI; Walter V. A VicenteI; Olair A QueirozII; João M Tannús FilhoII; José A Marin NetoI; João A Granzotti; Albert A SaderI

DOI: 10.1590/S0102-76381990000200003

ABSTRACT

The systemic-pulmonary shunts are an important procedure to treat and prepare, for the final correction, cyanotic patients with hypoplastic pulmonary arteries. All of them have advantages and disadvantages, and the results will depend on the age and weight of the patients and the complexity of their heart disease. The present study reports seven internal mammary-pulmonary anastomosis, made through right (2) or left (5) thoracotomies, in patients with Tetralogy of Fallot and hypoplastic pulmonary arteries, from 2 to 63 months of age (m = 18,4) and mean weight of 7.9 kg. There were two deaths (1st and 2nd days), due to thrombosis of the internal mammary, where it was clamped. Two patients went to total correction (1 month and 3 years later). In the first case, the shunt was made due to the general conditions of the child, despite the good size of the pulmonary arteries. In the second case (a 15 months old boy, in whom a classical Blalock-Taussig shunt was made and thrombosed in the 3rd month of life) was possible to follow the progressive enlargement of the pulmonary arteries. In both the shunts were well functioning and the total correction was successful. Three patients are waiting for their best time for final procedures. Despite the small number and the short period of observations, the authors do believe that the internal mammary-pulmonary artery anastomisis is palliative option for these patients. The best results are obtained among the eldest children that are not in an emergency situation and not involving small pulmonary arteries.

RESUMO

As anastomoses sistêmico-pulmonares continuam sendo um importante procedimento no tratamento e na preparação dos cardiópatas cianóticos, com hipoplasia das artérias pulmonares, para a correção total. Todas têm vantagens e desvantagens e os resultados dependerão de idade e peso dos pacientes e da complexidade da cardiopatia. O presente estudo relata a experiência com sete casos de anastomoses mamária-artéria pulmonar, realizadas através de toracotomia direita (5) e esquerda (2), em pacientes portadores de tetralogía de Fallot (quatro femininos e três masculinos). A idade variou de dois a 63 meses (m = 18,4), com peso médio de 7,9 kg. Seis apresentavam graus variados de hipoplasia pulmonar. Houve dois óbitos pós-operatórios (1º e 2º dias), devidos a trombose da artéria mamária, no local de seu clampleamento. Dois pacientes foram submetidos a correção total (um mês e três anos após): no 1º (menina de 24 meses, 10 kg de peso), a anastomose foi feita pelas más condições gerais, apesar do bom tamanho das pulmonares. No 2º (menino de 15 meses, 8,1 kg, no qual uma operação de Blalock-Taussig clássica foi feita e trombosou no 3º mês de vida), foi possível observar o progressivo desenvolvimento das artérias pulmonares, por estudo hemodinâmico. Em ambos, o funcionamento da anastomose era perfeito e a correção foi bem sucedida. Três outros pacientes aguardam o momento oportuno para a correção final. Apesar do reduzido número e do curto tempo de observação, acredita-se que a anastomose mamáriapulmonar possa ser outra opção paliativa para os portadores de cardiopatias congênitas cianogênicas, com hipoplasia das artérias pulmonares e que os melhores resultados devam ser obtidos nos pacientes maiores, fora de situações de emergência e com pequenas artérias pulmonares.
Full text available only in portuguese PDF format.

REFERENCES

1. ARCINIEGAS, E.; FAROOKI, Z. Q.; HAKIMI, M.; PERRY, B. L.; GREEN, E. W. - Classic shunting operations for congenital cyanotic heart defects. J. Thorac. Cardiovasc. Surg., 84: 88-96, 1982. [MedLine]

2. BARRAGRY, T. P.; RING, S. W.; BLATCHFORD, J. W.; FOKER, J. E. - Central aorta-pulmonary artery shunts in neonates with complex cyanotic congenital heart disease. J. Thorac. Cardiovasc. Surg., 93: 767-774, 1987. [MedLine]

3. BERNHARD, W. F.; JONES, J. E.; FRIEDBERG, D. Z.; LITWIN, S. B. - Ascending aorta-right pulmonary artery shunt in infants and older patients with certain types of cyanotic congenital heart disease. Circulation, 43: 580-584, 1971. [MedLine]

4. BLALOCK, A. & TAUSSIG, H. B. - The surgical treatment of malformations of the heart, in which there is pulmonary stenosis or pulmonary atresia. JAMA, 128: 189-202, 1945.

5. BOVE, E. L.; SONDHEIMER, H. M.; KAVEY, R. E. W.; BYRUM, C. J.; BLACKMAN, M. S.; PARKER Jr., F. B. - Subclavian-pulmonary artery shunts with polytetrafluorethylene interposition grafts. Ann. Thorac. Surg., 37: 88-91, 1984. [MedLine]

6. COBANOGLU, A.; ABBRUZZESE, P.; BRAUNER, D. O.; FERRE, B.; ISSENBERG, H.; STARR, A. - Therapeutic considerations in congenital absence of the right pulmonary artery. J. Cardiovasc. Surg., 25: 241-245, 1984.

7. COOLEY, D. A. & HALLMAN, G. L. - Intrapericardial aortic-right pulmonary arterial anastomosis. Surg. Gynec. Obstet., 122: 1084-1086, 1966.

8. DONAHOO, J. S.; GARDNER, T. J.; ZAHKA, K.; KIDD, B. S. L. - Systemic-pulmonary shuns in neonates and infants using microporous expanded polytetrafluorethylene: immediate and late results. Ann. Thorac. Surg., 30: 146-150, 1980. [MedLine]

9. EBERT, P. A.; GAY Jr., W. A.; OLDHAM, H. N. - Management of aorta-pulmonary artery anastomosis during total correction of tetralogy of Fallot. Surgery, 71: 231-234, 1972. [MedLine]

10. EDMUNDS Jr., L. H.; STEPHENSON, L. W.; GADZIK, J. P. - The Blalock-Taussig anastomosis in infants younger than 1 week of age. Circulation, 62: 597-603, 1980. [MedLine]

11. GAZZANIGA, A. B.; LAMBERTI, J. J.; SIEWERS, R. D.; SPERLING, D. R.; DIETRICK, W. R.; ARCILLA, R. A.; REPLOGLE, R. L. - Arterial prosthesis of microporous expanded polytetrafluorethylene for construction of aorta-pulmonary shunts. J. Thorac Cardiovasc. Surg., 72: 357-363, 1976. [MedLine]

12. ILBAWI, M. N.; GRIECO, J.; DeLEON, S. Y.; IDRISS, F. S.; MUSTER, A. J.; BERRY, T. E.; KLICH, J. - Modified Blalock-Taussig shunt in newborn infants. J. Thorac. Cardiovasc. Surg., 88: 770-775, 1984. [MedLine]

13. KUSUHARA, K.; MIKI, S.; UEDA, Y.; OHKITA, Y.; TAHATA, T.; KOMEDA, M. - Optimal flow of aorta-pulmonary artery shunt in patients with cyanotic heart disease. Ann. Thorac. Surg., 44: 128-134, 1987. [MedLine]

14. LAKS, H.; FAGAN, L.; BARNER, H. B.; WILLMAN, V. L. - The Blalock-Taussig shunt in the neonate. Ann. Thorac. Surg., 25: 220-224, 1978. [MedLine]

15. LAMBERTI, J. J.; CAMPBELL, C.; REPLOGLE, R. L.; ANAGNOSTOPOULOS, C.; LIN, C. Y.; CHIEMMONGKOLTIP, P.; ARCILLA, R. - The prosthetic (Teflon) central aortopulmonary shunt for cyanotic infants less than three weeks old: results and long-term follow-up. Ann. Thorac. Surg., 28: 568-577, 1979. [MedLine]

16. LAMBERTI, J. J.; CARLISLE, J.; WALDMAN, J. D.; LODGE, F. A.; KIRKPATRICK, S. E.; GEORGE, L.; MATHEWSON, J. W.; TURNER, S. W.; PAPPELBAUM, S. J. - Systemic-pulmonary shunts in infants and children: early and late results. J. Thorac. Cardiovasc. Surg., 88: 76-81, 1984. [MedLine]

17. LONGAKER, M. T.; MERRICK, S.; CROMBLEHOLME, T. M.; LANGER, J. C.; VERRIER, E. D.; TURLEY, K. - Systemic-to-pulmonary artery shunt using the internal mammary artery. Ann. Thorac. Surg., 47: 464-465, 1989. [MedLine]

18. MEARNS, A. J.; DEVERALL, P. B.; KESTER, R. C. - Revascularization of an arm for incipient gangrene after Blalock-Taussig anastomosis. Br. J. Surg., 65: 467-468, 1978. [MedLine]

19. MOULTON, A. L.; BRENNER, J. I.; RINGEL, R.; NORDENBERG, A.; BERMAN, M. A.; ALI, S.; BURNS, J. - Classic versus modified Blalock-Taussig shuns in neonates and infants. Circulation, 72 (Supl. 2): 35-44, 1985.

20. NORBERG, W. J.; TADAVARTHY, M.; KNIGHT, L.; NICOLOFF, D. M.; MOLLER, J. H. - Late hemodynamic and angiographic findings after ascending aorta-pulmonary artery anastomosis. J. Thorac. Cardiovasc. Surg., 76: 345-352, 1978. [MedLine]

21. POTTS, W. J.; SMITH, S.; GIBSON, S. - Anastomosis of the aorta to a pulmonary artery: certain types in congenital heart disease. JAMA, 132: 627-631, 1946.

22. SIEVERS, H.; LANGE, P.; HEINTZEN, P. - Internal mammary artery as a palliative systemic-pulmonary shunt in order to develop diminutive pulmonary arteries. Thorac. Cardiovasc. Surgeron, 33: 51-61, 1984.

23. SKOVRÁNEK, J.; GOETZOVÁ, J.; SAMÁNEK, M. - Changes in muscle blood flow and development of the arm following the Blalock-Taussig anastonosis. Cardiology, 61: 131-137, 1975.

24. SOMERVILLE, J.; YACOUB, M.; ROSS, D. N.; ROSS, K. - Aorta-to-right pulmonary artery anastomosis (Waterston's operation) for cyanotic heart disease. Circulation, 39: 593-602, 1969. [MedLine]

25. STEWART, S.; HARRIS, P.; MANNING, J. - Current results with construction and interruption of the Waterston anastomosis. Ann. Thorac. Surg., 25: 431-437, 1978.

26. TRUCCONE, N. J.; BOWMAN Jr., F. O.; MALM, J. R.; GERSONY, W. M. - Systemic-pulmonary arterial shunts in the first year of life. Circulation, 49: 508-511, 1974. [MedLine]

27. VETTER, V. L.; RASHKIND, W. J.; WALDHAUSEN, J. A. - Ascending aorta-right pulmonary artery anastomosis: long-term results in 137 patients with cyanotic congenital heart disease. J. Thorac. Cardiovasc. Surg., 76: 115-125, 1978. [MedLine]

28. WATERSTON, D. J. - The treatment of Fallot's tetralogy in infants under the age of one year. Rozhl. Chin., 41: 181-183, 1962.

29. WATERSTON, D. J.; STARK, J.; ASHCRAFT, K. W. - Ascending aorta to right pulmonary artery shunts: experience with 100 patients. Surgery, 72: 897-905, 1972.

30. WILSON, J. M.; MACK, J. W.; TURLEY, K.; EBERT, P. A. - Persistent stenosis and deformity of the right pulmonary artery after correction of the Waterston anastomosis. J. Thorac. Cardiovasc. Surg., 82: 169-175, 1981. [MedLine]

CCBY All scientific articles published at bjcvs.org are licensed under a Creative Commons license

Indexes

All rights reserved 2017 / © 2024 Brazilian Society of Cardiovascular Surgery DEVELOPMENT BY