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The Annals of Thoracic Surgery, Vol 44, 495-498, Copyright © 1987 by The Society of Thoracic Surgeons

ARTICLES

Indication for systemic-pulmonary artery shunts guided by two- dimensional and Doppler echocardiography: criteria for patient selection

B Marino, A Corno, L Pasquini, P Guccione, MG Carta, L Ballerini, G de Simone and C Marcelletti
Department of Pediatric Cardiology and Cardiac Surgery, Hospital Pediatrico Bambino Gesu, Rome, Italy.

From June, 1983, to February, 1987, 91 patients with pulmonary outflow tract obstruction underwent a systemic-to-pulmonary artery shunt without an invasive study. The surgical indication was based on two- dimensional (2-D) and Doppler echocardiography only. In 82 patients (90.1%), 2-D and Doppler echocardiography allowed correct assessment of the intracardiac anatomy and of the morphology of the pulmonary arteries, pulmonary veins, and aortic arch. The aortic arch anatomy was misdiagnosed in 6 patients (6.6%) who underwent a modified instead of a classic Blalock-Taussig shunt. In 3 patients (3.3%), the indication for the systemic-pulmonary artery shunt was inappropriate; in 1, operative death resulted from the incomplete diagnosis. After the preselection of patients based on knowledge of the anatomical patterns, a systemic- pulmonary artery shunt may be performed without cardiac catheterization if these rules for definitive patient selection are followed: (1) accurate clinical assessment to identify the patients with restricted pulmonary blood flow; (2) precise intracardiac diagnosis by 2-D and Doppler echocardiography; and (3) definitive 2-D echocardiographic visualization of the pulmonary venous connection and the confluence of the pulmonary arteries.

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