Hassan A. Maghur, Abdul-Matloub A. Ben-Musa, Salah S. Abuzakhar, Mohamed E Salim
Cardiothoracic Department, Misillata Hospital, Libya
JMJ Vol. 1, No. 1 (June 2001): 17-20
Background: Since 1992 we started performing the modified Blalock-Taussing shunt (MBTS) for cyanotic children in Libya. This retrospective study reviews our results, comparing them with those in the literature and proposes suggestions to improve the results further. Methods: Between May 1992 and May 1998, 94 children (58 M, 36 F) underwent 100 MBTS at Misillata Cardiothoracic Centre, Libya. The age ranged from 4 days to 15 years with a median of 12 months and 25 patients were neonates. Patients’ weights ranged from 3 to 31 kg (median 6.4 kg). Eighty-nine shunts were performed on the left side and 11 on the right. A 6 mm polytetrafluoroethylene graft was used in 68 children and a 4mm graft in 32 cases. Tetralogy of Fallot (TOF) comprised the majority of cases (63.67%), the remaining 31(33%) included tricuspid atrisia (TA)(13), pulmonary atresia (pa) (9), univentricular heart complex (UVH) (6), and others (3). Results: Acute shunt failure occurred in 3 cases (2 with 4mm, 1 with 6 mm graft), all of which had not received preoperative heparin. Hospital mortality was 6 patients (6%); risk factors being 1. neonates, 2. A diagnosis other than TOF, and 3. Emergency surgery.
There were 12 late deaths, 6 of which were due to sepsis. Follow up was achieved in 82 out of 88 early survivors for a period of 2-60 months (median 26 months). All surviving patients had subjective and objective improvement. Conclusions: We concluded that the MBTC is an excellent palliative procedure for children requiring a systemic-pulmonary shunt. This series shows an early mortality rate comparable to other studies, but the late mortality is higher, mainly due to sepsis, which warrants further evaluation.
Keywords: Modified BT shunt