Summary
A saphenous vein allograft was used to create an aortopulmonary communication in 16 infants with cyanotic congenital heart disease and ductus-dependent pulmonary blood flow. These grafts measured from 3 to 8 mm in diameter and were placed between the aorta and main pulmonary artery in eight patients, between aorta and right pulmonary artery in eight, and between aorta and left pulmonary artery in one (one child had two grafts). Before heparin was used, early in the series, four of these grafts occluded and three of the four infants died during attempted revision. Another infant died early from renal failure. Late mortality has claimed four: one from cerebral hemorrhage, two from hypoxia, and one at open-heart surgery for repair. There are eight late survivors (50%).
Most of the allografts were used before small diameter Gore-Tex was available; in more recent patients, 4- to 6-mm Gore-Tex grafts have been used. In our most recent patient, however, the attempt to place a Gore-Tex graft was unsuccessful, but the more pliable saphenous vein graft was readily placed and an adequate shunt obtained. Both the saphenous vein graft and the Gore-Tex have the advantage of providing pulmonary flow without the higher risk of congestive failure or pulmonary hypertension seen in patients with a Waterston or Potts anastomosis. They are easier to perform, require less anesthesia time than the Blalock-Taussig shunt, last as long as the Blalock-Taussig when done under similar conditions, and are easy to take down at the time of total repair.
Similar content being viewed by others
References
Aziz KU, Olley PM, Rowe RD, Trusler GA, Mustard WF (1975) Survival after systemic to pulmonary arterial shunts in infants less than 30 days old with obstructive lesions of the right heart chambers.Am J Cardiol 36:479–483
Ebert PA, Gay WJ Jr, Oldham HN (1972) Management of aorta-right pulmonary artery anastomosis during total correction of tetralogy of Fallot.Surgery 71:231–234
Edmunds LH Jr, Fischman NH, Heymann MA, Rudolph AM (1971) Anastomoses between aorta and right pulmonary artery (Waterston) in neonates.N Engl J Med 284:464–471
Gazzaniga AB, Lamberti JJ, Siewers RD, Sperling DR, Dietrick WR, Arcilla RA, Reglogle RL (1976) Arterial prosthesis of microporous expanded polytetrafluoroethylene for construction of aorta-pulmonary shunts.J Thorac Cardiovasc Surg 72:357–363
Griffith LSC, Bulkley BH, Hutchins GM, Brawley RK (1977) Occlusive changes at the coronary artery-bypass graft anastomosis.J Thorac Cardiovasc Surg 73:668–679
Hamaker WR, Doyle WF, O'Connell TJ, Gomez AC (1971) Subintimal obliterative proliferation in saphenous vein grafts.Ann Thorac Surg 13:488–493
Heymann MA, Rudolph AM (1977) Ductus arteriosus dilatation by prostaglandin E1 in infants with pulmonary atresia.Pediatrics 59:325–329
Jennings RB Jr, Innes BJ, Brickman RD (1978) Use of microporous expanded polytetrafluoroethylene grafts for aorta-pulmonary shunts in infants with complex cyanotic heart disease.J Thorac Cardiovasc Surg 76:489–494
Laks H, Fagan L, Barner HB, Willman VL (1978) The Blalock-Taussig shunt in the neonate.Ann Thorac Surg 25:220–224
Lawrie GM, Morris GC Jr, Howell JF, Spencer WH III, Cashion WR, Winters WL, Beazley HL, Chapman DW, Peterson PK, Lie JT (1977) Results of coronary bypass more than 5 years after operation in 434 patients.Am J Cardiol 40:665–572
Marbarger JP Jr, Sandza JG, Hartman AF Jr, Weldon CS (1978) Blalock-Taussig anastomosis: the preferred shunt in infants and newborns.Circulation (Suppl 1)58:73–77
Neches WH, Naifeh JG, Park SC, Lenox CC, Zuberbuhler JR, Siewers RD, Pontius RG, Bahnson HT (1975) Systemic-pulmonary artery anastomoses in infancy.J Thorac Cardiovasc Surg 76:921–927
Newfeld EA, Waldman JD, Paul MH, Muster AJ, Cole RB, Idriss F, Riker W (1977) Pulmonary vascular disease after systemic-pulmonary arterial shunt operations.Am J Cardiol 39:715–730
Starr A, Bonchek LI, Sunderland CO (1973) Total correction of tetralogy of Fallot in infancy.J Thorac Cardiovasc Surg 65:45–57
Somerville J, Yacoub M, Ross DN, Ross K (1969) Aorta to right pulmonary artery anastomosis (Waterston's operation) for cyanotic heart disease.Circulation 39:593–602
Tay DJ, Engle KH, Levin AR (1974) Early results and late developments of the Waterston anastomosis.Circulation 50:220–229
Turley K, Tucker WY, Ebert PA (1980) The changing role of palliative procedures in the treatment of infants with congenital heart disease.J Thorac Cardiovasc Surg 79:194–201
Von Bernuth G, Ritter DG, Frye RL, Weidman WH, David GD, McGoon DC (1971) Evaluation of patients with tetralogy of Fallot and Potts anastomosis.Am J Cardiol 27:259–263A0946017 00004 CS-SPJRNPDF [HEADSUP]
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Danilowicz, D., Ishmael, R.G., Doyle, E.F. et al. Use of saphenous vein allografts for aortopulmonary artery anastomoses in neonates with complex cyanotic congenital heart disease. Pediatr Cardiol 5, 13–17 (1984). https://doi.org/10.1007/BF02306742
Issue Date:
DOI: https://doi.org/10.1007/BF02306742