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Impact Analysis of Systemic-Pulmonary Arterial Shunt Creation on Patients With Tetralogy of Fallot
摘要
PURPOSE. The systemic-pulmonary arterial shunt is a standard palliative procedure for Tetralogy of Fallot (TOF). We used computed tomography (CT) to determine post-surgical outcomes of this procedure. MATERIALS AND METHOD. In this retrospective study, we used CT scans of patients with TOF who received a systemic-pulmonary arterial shunt before total correction (the closure of the ventricular septal defect and the reconstruction of the right ventricular outflow tract) during 2000 and 2020 in one tertiary referring hospital. A total of 38 patients and 76 exams (mean age of shunt installment: 33 days; average follow-up time: 212 days; range: 9-638 days) were included in this study. We analyzed the following parameters: initial pulmonary artery condition, operation age, the shunt size, the proximal origin site, the distal insertion of the shunt, and the period of the shunt. We also separated patients with shunt patency to assess the most crucial factors that caused an increase in the McGoon ratio. RESULTS. The mean McGoon ratio before shunt placement was 1.2. We found that the proximal and distal anastomotic sites and the shunt stenosis conditions were associated with an increased McGoon ratio. Twelve patients with patent shunts were selected for further analysis to exclude any effects of shunt stenosis. We identified that the shunt size, distal anastomotic site, and pulmonary trunk’s initial size had increased the McGoon ratio. We determined that the most important factor leading to a statistical increase in the McGoon ratio was the location of shunt insertion, e.g., a shunt placed using a central insertion leading to a significant increase in the McGoon ratio (p ＜ 0.05). CONCLUSION. We concluded that the central shunt was more effective than the peripheral shunt (modified Blalock-Taussig shunt) in promoting an increase in the McGoon ratio. This means that a patient with adequate pulmonary flow can receive a total correction operation earlier.
延伸閱讀
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