SHORT AND MEDIUM-TERM RESULTS OF SYSTEMIC PULMONARY SHUNTS IN THE NEONATAL-PERIOD

Systemic pulmonary shunts were performed in 41 consecutive neonates wi th congenital cyanotic heart disease between 1981 and 1992. The lesion s comprised pulmonary atresia with intact interventricular septum (16 cases), pulmonary atresia with ventricular septal defect (9 cases), te tralogy of Fallot (5 cases), transposition of the great arteries (3 ca ses) and different complex cardiac lesions (8 cases). A polytetrafluor oethylene tube was used in 40 neonates, 5 mm in diameter in 39 cases, anastomosed to be subclavian artery in 21 patients (group A) and on th e ascending aorta or innominate artery in 19 patients (group B). A ret rospective analysis of the results was undertaken in all patients with a mean follow-up period of 6.5 years (range: 19 months-12.5 years). T here were 4 early deaths (9.7 %) and 8 late deaths (19.5 %) giving a t otal mortality of 29.2 %. Of the late deaths, 4 occurred in the first year, 3 suddenly at home and 4 in relation with the surgical correctio n. Occlusion of the shunt was suspected in only one case. The actuaria l survival rate was 78 % at one year, 75.5 % at 7 years and 66 % at 10 years. Eleven of the 12 deaths were in children with pulmonary atresi a with intact interventricular septum (8 cases) and complex cardiac ma lformations (3 cases). Early complications were observed in 15 of the 37 survivors of the initial procedure. Cardiac failure occurred in 83 % of group B and 22 % of group A (p < 0.01). The probability of shunt efficacy was 89 % at 1 year, 63 % at 2 years and 45 % at 3 years. Ther e was a significant difference between group A and group B (p < 0.05) for the probability of an effective shunt at 2 years (62.5 % vs 92 %) and at 3 years (39 % vs 63 %) when prostheses of 5 mm diameter had not been surgically reduced in calibre. The 29 surviving children had a s ingle shunt (2 patients), 2 shunts (8 patients) or definitive correcti on (19 patients). This study shows that shunts with 5 mm tubes are ade quate for at least 2 years in most cases. The duration of the efficacy is longer in anastomoses on the aorta or innominate artery. However, the high incidence of complications due to high pulmonary flow with th ese types of anastomoses make subclavian anastomoses preferable. The h igh mortality in this group of patients is mainly due to the severity of the cardiac malformations.