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Palliation of Tricuspid Atresia: Potts-Smith, Glenn, and Blalock-Taussig Shunts

Palliation of Tricuspid Atresia: Potts-Smith, Glenn, and Blalock-Taussig Shunts Abstract • Aortopulmonary (Potts-Smith), subclavian-pulmonary (Blalock-Taussig), and cavopulmonary (Glenn) shunts are the commonly performed operations for palliation of tricuspid atresia. A total of 104 patients with tricuspid atresia have undergone these procedures, either alone or in combination over a 28-year-period at the Hospital for Sick Children, Toronto. Operative risk is high in the first six months of life (44%), reasonable after six months of age (7.4%), and low for reoperation (3.5%). Long-term palliation of the 75 survivors (mean follow-up, 8.5 years) is compared for the three operative groups and charted on an actuarial table. Potts shunt offers superior long-term palliation. Therefore, as an overall plan of management, a Potts shunt with restriction of its anastomotic growth is the initial procedure of choice. When the patient outgrows the Potts shunt, a Glenn anastomosis is constructed. Ideally, the combination of these two shunts will produce a balanced circulation offering excellent long-term palliation. (Arch Surg 110:1383-1386, 1975) References 1. Keith JD, Vlad P, Rowe RD: Heart Disease in Infancy and Childhood , ed 2. New York, Macmillan Co, 1967, p 644. 2. Tandon R, Edwards JE: Tricuspid atresia: A reevaluation and classification . J Thorac Cardiovasc Surg 67:530-541, 1967. 3. Fontan F, Baudet E: Surgical repair of tricuspid atresia . Thorax 26:240-248, 1971.Crossref 4. Kreutzer G, Galindez E, Bono H, et al: An operation for the correction of tricuspid atresia . J Thorac Cardiovasc Surg 66:613-621, 1973. 5. Glenn WWL, Brown M, Whittemore R: Circulatory bypass of the right side of the heart: Cava-pulmonary artery shunt—indications and results , in Cassels DE: The Heart and Circulation in the Newborn and Infant . New York, Grune & Stratton Inc, 1966, pp 345-357. 6. Trusler GA, MacGregor D, Mustard WT: Cavopulmonary anastomosis for cyanotic congenital heart disease . J Thorac Cardiovasc Surg 62:803-809, 1971. 7. Laks H, Castaneda AR: Subclavian arterioplasty for the ipsilateral Blalock-Taussig shunt . Ann Thorac Surg 19:319-321, 1975.Crossref 8. Rashkind W, Waldhausen J, Miller W, et al: Palliative treatment in tricuspid atresia . J Thorac Cardiovasc Surg 57:812-818, 1969. 9. Trusler GA, Kanzaki Y: Controlling the growth of aortopulmonary anastomoses in piglets . Arch Surg 106:72-74, 1973.Crossref 10. Bargeron LM Jr, Karp RB, Barcia A, et al: Late deterioration of patients after superior vena cava to right pulmonary artery anastomosis . Am J Cardiol 30:211-216, 1972.Crossref 11. Boruchow IB, Swenson EW, Elliott LP, et al: Study of the mechanisms of shunt failure after superior vena cava-right pulmonary artery anastomosis . J Thorac Cardiovasc Surg 60:531-539, 1970. 12. Trusler GA, Williams WG: Long-Term Results of the Glenn Procedure for Tricuspid Atresia. New York, Futura Publications, to be published. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Palliation of Tricuspid Atresia: Potts-Smith, Glenn, and Blalock-Taussig Shunts

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Publisher
American Medical Association
Copyright
Copyright © 1975 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1975.01360170123018
Publisher site
See Article on Publisher Site

Abstract

Abstract • Aortopulmonary (Potts-Smith), subclavian-pulmonary (Blalock-Taussig), and cavopulmonary (Glenn) shunts are the commonly performed operations for palliation of tricuspid atresia. A total of 104 patients with tricuspid atresia have undergone these procedures, either alone or in combination over a 28-year-period at the Hospital for Sick Children, Toronto. Operative risk is high in the first six months of life (44%), reasonable after six months of age (7.4%), and low for reoperation (3.5%). Long-term palliation of the 75 survivors (mean follow-up, 8.5 years) is compared for the three operative groups and charted on an actuarial table. Potts shunt offers superior long-term palliation. Therefore, as an overall plan of management, a Potts shunt with restriction of its anastomotic growth is the initial procedure of choice. When the patient outgrows the Potts shunt, a Glenn anastomosis is constructed. Ideally, the combination of these two shunts will produce a balanced circulation offering excellent long-term palliation. (Arch Surg 110:1383-1386, 1975) References 1. Keith JD, Vlad P, Rowe RD: Heart Disease in Infancy and Childhood , ed 2. New York, Macmillan Co, 1967, p 644. 2. Tandon R, Edwards JE: Tricuspid atresia: A reevaluation and classification . J Thorac Cardiovasc Surg 67:530-541, 1967. 3. Fontan F, Baudet E: Surgical repair of tricuspid atresia . Thorax 26:240-248, 1971.Crossref 4. Kreutzer G, Galindez E, Bono H, et al: An operation for the correction of tricuspid atresia . J Thorac Cardiovasc Surg 66:613-621, 1973. 5. Glenn WWL, Brown M, Whittemore R: Circulatory bypass of the right side of the heart: Cava-pulmonary artery shunt—indications and results , in Cassels DE: The Heart and Circulation in the Newborn and Infant . New York, Grune & Stratton Inc, 1966, pp 345-357. 6. Trusler GA, MacGregor D, Mustard WT: Cavopulmonary anastomosis for cyanotic congenital heart disease . J Thorac Cardiovasc Surg 62:803-809, 1971. 7. Laks H, Castaneda AR: Subclavian arterioplasty for the ipsilateral Blalock-Taussig shunt . Ann Thorac Surg 19:319-321, 1975.Crossref 8. Rashkind W, Waldhausen J, Miller W, et al: Palliative treatment in tricuspid atresia . J Thorac Cardiovasc Surg 57:812-818, 1969. 9. Trusler GA, Kanzaki Y: Controlling the growth of aortopulmonary anastomoses in piglets . Arch Surg 106:72-74, 1973.Crossref 10. Bargeron LM Jr, Karp RB, Barcia A, et al: Late deterioration of patients after superior vena cava to right pulmonary artery anastomosis . Am J Cardiol 30:211-216, 1972.Crossref 11. Boruchow IB, Swenson EW, Elliott LP, et al: Study of the mechanisms of shunt failure after superior vena cava-right pulmonary artery anastomosis . J Thorac Cardiovasc Surg 60:531-539, 1970. 12. Trusler GA, Williams WG: Long-Term Results of the Glenn Procedure for Tricuspid Atresia. New York, Futura Publications, to be published.

Journal

Archives of SurgeryAmerican Medical Association

Published: Nov 1, 1975

References