Therapy Effect Of Modified BT Shunt In Treating For Complex Congenital Heart Disease

Objective: To analyze the effect of modified BT shunt for the treatment of complexcongenital heart disease.Methods: From July2006to January2013, there were150BTs performed in143patients with complex congenital heart disease in Shanghai Xinhua Hospital.Therewere100cases of male and50cases of female;aged from2-756months (mean20.17±80.37months); weighted from4-63kg (mean8.86±9.69kg). All the BTs betweensubclavian artery and pulmonary artery were performed through right or left posteriorlateral incision, including75cases of tetralogy of Fallot,8cases of tetralogy ofFallot with pulmonary atresia,34cases of ventricular septal defect with pulmonaryatresia,19cases of functional single ventricle with pulmonary stenosis or atresia (7cases with pulmonary atresia),7cases of transposition of great arteries (3patients withpulmonary atresia),6cases of double outlet right ventricle,and1case of pulmonaryatresia with intact ventricular septum. A retrospective review was done to observe theincrease of pulmonary after the BTs, the increasing differences between the ipsilateraland contralateral pulmonary of the BTs,differences in therapy effects of differentdiameter used in BTs, and the changes of cardiac function and left ventricular massindex after BTs.Results: There were5in-hospital deaths (mortality3.33%), three patients haveabnormal bleeding(2%),5cases (3.33%) performed a second BTs because of shuntocclusion, and the other patients recovered uneventfully.129patients werefollowed up for6-48months (mean14.38±10.05months),7BTs (5.43%) wereperformed in6patients again because of shunt occlusion during the follow-up,3patients died during follow-up (mortality2.33%),88patients of survival underwentcorrective surgery or stage II palliative surgery (68.22%). Main pulmonary artery(MPA) have a significant increase in diameter (MPAvsMPA follow-up,0.55±0.28mmvs0.83±0.33mm, t=-15.18, p=0.00);the diameter of left pulmonary artery(LPA) postoperative have significantly increased compared with preoperative(LPAvsLPA follow-up,0.32±0.22mmvs0.50±0.26mm, t=-13.27, p=0.00); the diamenter of right pulmonary artery (RPA) increase significantly compared withpreoperative(RPAvsRPA follow-up,0.38±0.23mmvs0.61±0.27mm, t=-15.94, p=0.00); growth in ipsilateral pulmonary of BTs is better than that of the contralateralpulmonary (ipsilateral growth vs contralateral growth,0.23±0.16mmvs0.18±0.15mm, t=2.44, p=0.015); McGoon ratio increased significantly after BTS (1.25±0.38vs1.57±0.49, t=-10.10, p=0.00), EF value is slightly lower than thepreoperative value before (preoperative EFvs postoperative EF,64.44±5.98%vs62.90±4.84%, t=2.77, p=0.00), left ventricular mass index increased significantlycompared with the preoperative (preoperative vs postoperative,35.85±18.10ml/m2vs54.46±18.75ml/m2, t=-9.26, p=0.00).Conclusion: The modified BT shunt has been proved to be safe and effective intreating for complex congenital heart disease,it can significantly promote thedevelopment of pulmonary artery,especially the ipsilateral pulmonary of BTs.SmallMcGoon ratio, pulmonary atresia are risk factors to limit the further development ofpulmonary. Appropriate diameter of BT shunt choose according to pulmonarydiameter and the weight of patients preoperative is the basis to ensure successfuloperation and a good prognosis.