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Eur J Cardiothorac Surg 2006;30:414
© 2006 Elsevier Science NL

Letter to the Editor

Reply to Talwar et al.

Department of Pediatric Cardiac Surgery of Guatemala (UNICARP), 9a Avenida, 8-00 Zone 11, Guatemala City, Guatemala

Received 4 May 2006; accepted 5 May 2006.

^_* Corresponding author. (Email: vladimirovida{at}interfree.it).

Key Words: Prosthetic graft • Innominate vein • Cavopulmonary shunt

Our experience with modified Blalock–Taussig shunts into very small pulmonary artery branches has not been good. The shunts can cause distortion, kinking, etc., and they do not always allow for increases in pulmonary artery size. Also, since we were envisioning a future ‘Fontan-type’ repair, the right pulmonary artery was extremely important to preserve, as well as the protection of the pulmonary arteries from pulmonary vascular obstructive disease.

The wisdom of this strategy was proven by the increase in size of the right pulmonary artery after the goretex interposition [1] from 3 mm to 6 mm (Z-value of the right pulmonary artery from –3.8 to –0.5) by 10 months. Excellent flow was also achieved from the right superior vena cava via the enlarged right pulmonary artery to the right lung.

The risk of thrombosis of a systemic-to-pulmonary artery shunt is certainly lower than that of a vascular graft interposed in venous position, but it is still reported to be high (up to 20%) at intermediate follow-up [2,3]. Continued postoperative oral anticoagulation with coumadin preserved the patency of the goretex prosthesis allowing the growth of the right pulmonary artery branch.

References

1. Vida VL, Leon-Wyss J, Garcia F, Castaneda AR. A Goretex "new-innominate" vein: a surgical option for complicated cavopulmonary anastomosis. Eur J Cardiothorac Surg 2005;29:112-113.
2. Sivakumar K, Shivaprakasha K, Rao SG, Kumar RK. Operative outcome and intermediate term follow-up of neonatal Blalock–Taussig shunts. Indian Heart J 2001;53(1):66-70.[Medline]
3. Shintani Y, Ohta M, Minami M, Shiono H, Hirabayashi H, Inoue M, Matzumiya G, Matzuda H. Long-term graft patency after replacement of the brachiocephalic veins combined with resection of mediastinal tumors. J Thorac Cardiovasc Surg 2005;129(4):809-812.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Aldo R. Castañeda Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Vida, V. L. Articles by Castañeda, A. R. Search for Related Content PubMed Articles by Vida, V. L. Articles by Castañeda, A. R. Related Collections Congenital - cyanotic