Skip to main content

Palliative Procedures

  • Chapter
  • First Online:
Pediatric Critical Care Medicine

Abstract

Palliative procedures are performed on those patients who can never be completely repaired or who cannot be repaired safely at the time of their initial presentation whether it is due to complex anatomy, small birth weight, unfavorable hemodynamics, or a combination of these factors. Current techniques and procedures are varied and reflect the rapidly advancing technological achievements of designers and operators. This chapter will review indications for palliation, surgical palliations to either augment or limit pulmonary blood flow, catheter based palliations, as well as combined surgical and catheter based (hybrid) therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Blalock A, Taussig HB. Landmark article May 19, 1945: the surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. By Alfred Blalock and Helen B. Taussig. JAMA. 1984;251(16):2123–38.

    Article  CAS  PubMed  Google Scholar 

  2. Rashkind WJ, Miller WW. Creation of an atrial septal defect without thoracotomy. A palliative approach to complete transposition of the great arteries. JAMA. 1966;196(11):991–2.

    Article  CAS  PubMed  Google Scholar 

  3. Zellers TM, Dixon K, Moake L, Wright J, Ramaciotti C. Bedside balloon atrial septostomy is safe, efficacious, and cost-effective compared with septostomy performed in the cardiac catheterization laboratory. Am J Cardiol. 2002;89(5):613–5.

    Article  PubMed  Google Scholar 

  4. Brouwer RM, Cromme-Dijkhuis AH, Erasmus ME, et al. Decision making for the surgical management of aortic coarctation associated with ventricular septal defect. J Thorac Cardiovasc Surg. 1996;111(1):168–75.

    Article  CAS  PubMed  Google Scholar 

  5. Park JK, Dell RB, Ellis K, Gersony WM. Surgical management of the infant with coarctation of the aorta and ventricular septal defect. J Am Coll Cardiol. 1992;20(1):176–80.

    Article  CAS  PubMed  Google Scholar 

  6. Skovranek J, Goetzova J, Samanek M. Changes in muscle blood flow and development of the arm following the Blalock-Taussig anastomosis. Cardiology. 1976;61(2):131–7.

    Article  CAS  PubMed  Google Scholar 

  7. Zahka KG, Manolio TA, Rykiel MJ, Abel DL, Neill CA, Kidd L. Handgrip strength after the Blalock-Taussig shunt: 14 to 34 year follow-up. Clin Cardiol. 1988;11(9):627–9.

    Article  CAS  PubMed  Google Scholar 

  8. Alkhulaifi AM, Lacour-Gayet F, Serraf A, Belli E, Planche C. Systemic pulmonary shunts in neonates: early clinical outcome and choice of surgical approach. Ann Thorac Surg. 2000;69(5):1499–504.

    Article  CAS  PubMed  Google Scholar 

  9. Fenton KN, Siewers RD, Rebovich B, Pigula FA. Interim mortality in infants with systemic-to-pulmonary artery shunts. Ann Thorac Surg. 2003;76(1):152–6; discussion 156–7.

    Article  PubMed  Google Scholar 

  10. Al Jubair KA, Al Fagih MR, Al Jarallah AS, et al. Results of 546 Blalock-Taussig shunts performed in 478 patients. Cardiol Young. 1998;8(4):486–90.

    Article  CAS  PubMed  Google Scholar 

  11. Gold JP, Violaris K, Engle MA, et al. A five-year clinical experience with 112 Blalock-Taussig shunts. J Card Surg. 1993;8(1):9–17.

    Article  CAS  PubMed  Google Scholar 

  12. Arciniegas E, Farooki ZQ, Hakimi M, Perry BL, Green EW. Classic shunting operations for congenital cyanotic heart defects. J Thorac Cardiovasc Surg. 1982;84(1):88–96.

    CAS  PubMed  Google Scholar 

  13. Parenzan L, Alfieri O, Vanini V, et al. Waterston anastomosis for initial palliation of tetralogy of Fallot. J Thorac Cardiovasc Surg. 1981;82(2):176–81.

    CAS  PubMed  Google Scholar 

  14. Potts WJ, Smith S, Gibson S. Anastomosis of the aorta to a pulmonary artery; certain types in congenital heart disease. J Am Med Assoc. 1946;132(11):627–31.

    Article  CAS  PubMed  Google Scholar 

  15. Amato JJ, Marbey ML, Bush C, Galdieri RJ, Cotroneo JV, Bushong J. Systemic-pulmonary polytetrafluoroethylene shunts in palliative operations for congenital heart disease. Revival of the central shunt. J Thorac Cardiovasc Surg. 1988;95(1):62–9.

    CAS  PubMed  Google Scholar 

  16. Barragry TP, Ring WS, Blatchford JW, Foker JE. Central aorta-pulmonary artery shunts in neonates with complex cyanotic congenital heart disease. J Thorac Cardiovasc Surg. 1987;93(5):767–74.

    CAS  PubMed  Google Scholar 

  17. Bradley SM, Erdem CC, Hsia TY, Atz AM, Bandisode V, Ringewald JM. Right ventricle-to-pulmonary artery shunt: alternative palliation in infants with inadequate pulmonary blood flow prior to two-ventricle repair. Ann Thorac Surg. 2008;86(1):183–8; discussion 188.

    Article  PubMed  Google Scholar 

  18. Graham EM, Atz AM, Bradley SM, et al. Does a ventriculotomy have deleterious effects following palliation in the Norwood procedure using a shunt placed from the right ventricle to the pulmonary arteries? Cardiol Young. 2007;17(2):145–50.

    Article  PubMed  Google Scholar 

  19. Graham EM, Forbus GA, Bradley SM, Shirali GS, Atz AM. Incidence and outcome of cardiopulmonary resuscitation in patients with shunted single ventricle: advantage of right ventricle to pulmonary artery shunt. J Thorac Cardiovasc Surg. 2006;131(5):e7–8.

    Article  PubMed  Google Scholar 

  20. Ohye RG, Sleeper LA, Mahony L, et al. Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med. 2010;362(21):1980–92.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Albert HM, Fowler RL, Craighead CC, Glass BA, Atik M. Pulmonary artery banding. A treatment for infants with intractable cardiac failure due to interventricular septal defects. Circulation. 1961;23:16–20.

    Article  CAS  PubMed  Google Scholar 

  22. Horowitz MD, Culpepper 3rd WS, Williams 3rd LC, Sundgaard-Riise K, Ochsner JL. Pulmonary artery banding: analysis of a 25-year experience. Ann Thorac Surg. 1989;48(3):444–50.

    Article  CAS  PubMed  Google Scholar 

  23. Pinho P, Von Oppell UO, Brink J, Hewitson J. Pulmonary artery banding: adequacy and long-term outcome. Eur J Cardiothorac Surg. 1997;11(1):105–11.

    Article  CAS  PubMed  Google Scholar 

  24. Van Nooten G, Deuvaert FE, De Paepe J, Primo G. Pulmonary artery banding. Experience with 69 patients. J Cardiovasc Surg (Torino). 1989;30(3):334–7.

    Google Scholar 

  25. Verel D, Taylor DG, Emery JL. Failure of pulmonary artery banding due to migration of the band. Thorax. 1970;25(1):126–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Ahmadi A, Rein J, Hellberg K, Bastanier C. Percutaneously adjustable pulmonary artery band. Ann Thorac Surg. 1995;60(6 Suppl):S520–2.

    Article  CAS  PubMed  Google Scholar 

  27. Leeuwenburgh BP, Schoof PH, Steendijk P, Baan J, Mooi WJ, Helbing WA. Chronic and adjustable pulmonary artery banding. J Thorac Cardiovasc Surg. 2003;125(2):231–7.

    Article  PubMed  Google Scholar 

  28. Piluiko VV, Poynter JA, Nemeh H, et al. Efficacy of intraluminal pulmonary artery banding. J Thorac Cardiovasc Surg. 2005;129(3):544–50.

    Article  PubMed  Google Scholar 

  29. McFaul RC, Mair DD, Feldt RH, Ritter DG, McGoon DC. Truncus arteriosus and previous pulmonary arterial banding: clinical and hemodynamic assessment. Am J Cardiol. 1976;38(5):626–32.

    Article  CAS  PubMed  Google Scholar 

  30. Smith GW, Thompson Jr WM, Dammann Jr JF, Muller Jr WH. Use of the pulmonary artery banding procedure in treating type II truncus arteriosus. Circulation. 1964;29(Suppl):108–13.

    PubMed  Google Scholar 

  31. Alwi M, Choo KK, Latiff HA, Kandavello G, Samion H, Mulyadi MD. Initial results and medium-term follow-up of stent implantation of patent ductus arteriosus in duct-dependent pulmonary circulation. J Am Coll Cardiol. 2004;44(2):438–45.

    Article  PubMed  Google Scholar 

  32. Coe JY, Olley PM. A novel method to maintain ductus arteriosus patency. J Am Coll Cardiol. 1991;18(3):837–41.

    Article  CAS  PubMed  Google Scholar 

  33. Michel-Behnke I, Akintuerk H, Thul J, Bauer J, Hagel KJ, Schranz D. Stent implantation in the ductus arteriosus for pulmonary blood supply in congenital heart disease. Catheter Cardiovasc Interv. 2004;61(2):242–52.

    Article  PubMed  Google Scholar 

  34. Tyagi S, Dwivedi G, Gupta MD, Kaul UA. Stent implantation in right-sided patent ductus arteriosus to relieve severe cyanosis in adult patient with pulmonary atresia and ventricular septal defect. Catheter Cardiovasc Interv. 2004;61(2):271–4.

    Article  PubMed  Google Scholar 

  35. Gewillig M, Boshoff DE, Dens J, Mertens L, Benson LN. Stenting the neonatal arterial duct in duct-dependent pulmonary circulation: new techniques, better results. J Am Coll Cardiol. 2004;43(1):107–12.

    Article  PubMed  Google Scholar 

  36. Godart F, Rey C, Prat A, et al. Early and late results and the effects on pulmonary arteries of balloon dilatation of the right ventricular outflow tract in tetralogy of Fallot. Eur Heart J. 1998;19(4):595–600.

    Article  CAS  PubMed  Google Scholar 

  37. Baylen BG, Grzeszczak M, Gleason ME, et al. Role of balloon atrial septostomy before early arterial switch repair of transposition of the great arteries. J Am Coll Cardiol. 1992;19(5):1025–31.

    Article  CAS  PubMed  Google Scholar 

  38. Rashkind WJ, Miller WW. Transposition of the great arteries. Results of palliation by balloon atrioseptostomy in thirty-one infants. Circulation. 1968;38(3):453–62.

    Article  CAS  PubMed  Google Scholar 

  39. Atz AM, Feinstein JA, Jonas RA, Perry SB, Wessel DL. Preoperative management of pulmonary venous hypertension in hypoplastic left heart syndrome with restrictive atrial septal defect. Am J Cardiol. 1999;83(8):1224–8.

    Article  CAS  PubMed  Google Scholar 

  40. Vlahos AP, Lock JE, McElhinney DB, van der Velde ME. Hypoplastic left heart syndrome with intact or highly restrictive atrial septum: outcome after neonatal transcatheter atrial septostomy. Circulation. 2004;109(19):2326–30.

    Article  PubMed  Google Scholar 

  41. Ashburn DA, McCrindle BW, Tchervenkov CI, et al. Outcomes after the Norwood operation in neonates with critical aortic stenosis or aortic valve atresia. J Thorac Cardiovasc Surg. 2003;125(5):1070–82.

    Article  PubMed  Google Scholar 

  42. Gibbs JL, Wren C, Watterson KG, Hunter S, Hamilton JR. Stenting of the arterial duct combined with banding of the pulmonary arteries and atrial septectomy or septostomy: a new approach to palliation for the hypoplastic left heart syndrome. Br Heart J. 1993;69(6):551–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  43. Akintuerk H, Michel-Behnke I, Valeske K, et al. Stenting of the arterial duct and banding of the pulmonary arteries: basis for combined Norwood stage I and II repair in hypoplastic left heart. Circulation. 2002;105(9):1099–103.

    Article  PubMed  Google Scholar 

  44. Akinturk H, Michel-Behnke I, Valeske K, et al. Hybrid transcatheter-surgical palliation: basis for univentricular or biventricular repair: the Giessen experience. Pediatr Cardiol. 2007;28(2):79–87.

    Article  PubMed  Google Scholar 

  45. Galantowicz M, Cheatham JP. Lessons learned from the development of a new hybrid strategy for the management of hypoplastic left heart syndrome. Pediatr Cardiol. 2005;26(2):190–9.

    Article  Google Scholar 

  46. Michel-Behnke I, Akintuerk H, Marquardt I, et al. Stenting of the ductus arteriosus and banding of the pulmonary arteries: basis for various surgical strategies in newborns with multiple left heart obstructive lesions. Heart. 2003;89(6):645–50.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  47. Gutgesell HP, Lim DS. Hybrid palliation in hypoplastic left heart syndrome. Curr Opin Cardiol. 2007;22(2):55–9.

    Article  PubMed  Google Scholar 

  48. DiBardino DJ, McElhinney DB, Marshall AC, Bacha EA. A review of ductal stenting in hypoplastic left heart syndrome: bridge to transplantation and hybrid stage I palliation. Pediatr Cardiol. 2008;29(2):251–7.

    Article  CAS  PubMed  Google Scholar 

  49. Guleserian KJ, Barker GM, Sharma MS, et al. Bilateral pulmonary artery banding for resuscitation in high-risk, single-ventricle neonates and infants: a single-center experience. J Thorac Cardiovasc Surg. 2013;145(1):206–13; discussion 213–4.

    Article  PubMed  Google Scholar 

  50. Lim DS, Peeler BB, Matherne GP, Kron IL, Gutgesell HP. Risk-stratified approach to hybrid transcatheter-surgical palliation of hypoplastic left heart syndrome. Pediatr Cardiol. 2006;27(1):91–5.

    Article  CAS  PubMed  Google Scholar 

  51. Recto MR, Doyle S, Guerra VC, Yang SG, Yeh Jr T. Morphology of the patent ductus arteriosus (PDA) does not preclude successful PDA stent implantation in high risk patients undergoing hybrid stage I palliation: recommendations to optimize ductal stent positioning. Catheter Cardiovasc Interv. 2013;82(4):519–25.

    PubMed  Google Scholar 

  52. Kitaichi T, Chikugo F, Kawahito T, Hori T, Masuda Y, Kitagawa T. Suitable shunt size for regulation of pulmonary blood flow in a canine model of univentricular parallel circulations. J Thorac Cardiovasc Surg. 2003;125(1):71–8.

    Article  PubMed  Google Scholar 

  53. Booth KL, Roth SJ, Perry SB, del Nido PJ, Wessel DL, Laussen PC. Cardiac catheterization of patients supported by extracorporeal membrane oxygenation. J Am Coll Cardiol. 2002;40(9):1681–6.

    Article  PubMed  Google Scholar 

  54. Klinge J, Hofbeck M, Ries M, Schaf J, Singer H, von der Emde J. Thrombolysis of modified Blalock-Taussig shunts in childhood with recombinant tissue-type plasminogen activator. Z Kardiol. 1995;84(6):476–80.

    CAS  PubMed  Google Scholar 

  55. Malm TK, Holmqvist C, Olsson CG, et al. Successful thrombolysis of an occluded modified Blalock shunt three days after operation. Ann Thorac Surg. 1998;65(5):1453–5.

    Article  CAS  PubMed  Google Scholar 

  56. Ries M, Singer H, Hofbeck M. Thrombolysis of a modified Blalock-Taussig shunt with recombinant tissue plasminogen activator in a newborn infant with pulmonary atresia and ventricular septal defect. Br Heart J. 1994;72(2):201–2.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  57. Singh V, Pillai S, Kulkarni S, et al. Thrombolysis with percutaneous transluminal balloon angioplasty of a blocked modified Blalock-Taussig shunt. Indian Heart J. 2004;56(6):673–6.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew M. Atz MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Do, T.B., Scheurer, M.A., Atz, A.M. (2014). Palliative Procedures. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6359-6_24

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-6359-6_24

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6358-9

  • Online ISBN: 978-1-4471-6359-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics