Revisiting the central aortopulmonary shunt procedure

Abstract

Background: In this study, we present our experience with the central aortopulmonary shunt technique with interposing a polytetrafluoroethylene graft between main pulmonary artery (end-to-end) and the ascending aorta (side-to-side) in a variety of cyanotic congenital heart defects.

Methods: Between January 2019 and June 2022, a total of 10 patients (6 males, 4 females; mean age: 4.3±2.8 months; range, 5 days to 10 months) with hypoplastic central pulmonary arteries who underwent central aortopulmonary shunt procedure were retrospectively analyzed. Demographic characteristics, preoperative, operative, and postoperative data of the patients were recorded. The Nakata indices of the patients were also noted before the procedure, as well as before the second stage of palliation or definitive repair.

Results: Four (40%) patients were operated as the first-step palliation for univentricular circulation. Six (60%) patients had well-developed ventricles and were palliated to be treated with total correction. The median follow-up after the procedure was 12 (range, 8 to 16) months. The mean systemic arterial saturation level at room air was 89.3±2.9% during follow-up. No mortality was observed in any patient.

Conclusion: A central aortopulmonary shunt procedure provides a reliable antegrade blood flow with a relatively non-challenging surgical technique that offers sufficient growth for the hypoplastic and confluent central pulmonary arteries with a very low risk of shunt thrombosis and overflow.

Keywords: Cardiac; congenital heart disease; pulmonary artery; pulmonary vein; shunt.

Figure 1. Operative technique. (a) The main pulmonary artery is transected at its origin distal to the right ventricle and a PTFE graft is anastomosed with an end-to-end fashion (arrow). (b) Afterwards, a side clamp is placed at the ascending aorta and the proximal end of the graft is anastomosed in a side-to-side fashion (arrow), leaving a stump of main pulmonary artery at its origin (asterisk). (c) The proximal stump of the graft proximal to the side-to-side anastomosis is sutured and clipped (arrow). RPA: Right pulmonary artery; LPA: Left pulmonary artery; MPA: Main pulmonary artery; PTFE: Polytetrafluoroethylene.

Figure 2. Chest X-ray of an overflow following central aortopulmonary shunt procedure. (a) The parenchyma of the right lung demonstrates the findings of congestion (asterisk). (b) The findings disappear at the same field following medical management (asterisk).

Figure 3. An angiography demonstrating the patent PTFE graft that provides unobstructed blood flow to the branch pulmonary arteries after central aortopulmonary shunt procedure. PTFE: Polytetrafluoroethylene; RPA: Right pulmonary artery; MPA: main pulmonary artery; LPA: Left pulmonary artery.