“Reverse Blalock-Taussig shunt”: Application in single ventricle hybrid palliation

Published:December 10, 2012DOI:


      Retrograde aortic arch malperfusion after ductal stenting can be life-threatening after univentricular hybrid palliation. Arch perfusion can be maintained with a main pulmonary artery to innominate artery shunt placed during the stage I procedure: a “reverse Blalock-Taussig shunt.”


      A retrospective review of 37 infants who underwent hybrid palliation from January 2004 to March 2010 was performed. The infants were divided into 2 groups, those with (group I, n = 16) and those without (group II, n = 21) a reverse Blalock-Taussig shunt.


      At the initial palliation, no differences were found in the demographics, systolic or diastolic pressures, or ventricular or atrioventricular valve function between the 2 groups. Group I had more infants with aortic atresia (P < .01) and smaller ascending aortas (P < .01). Before stage II, the retrograde aortic Doppler flow velocity increased in group I (P < .01) and was unchanged in group II. The reintervention rates before stage II were similar between the 2 groups. Before stage II, the ventricular end-diastolic pressure, left and right pulmonary artery pressures and diameters, and mixed venous and arterial saturations were similar between the 2 groups. The complication rates between the 2 groups were not significantly different, although a nonsignificant trend toward more neurologic complications was noted in group I. The Kaplan-Meier survival estimate at 1 year was similar between the 2 groups (63% for group I vs 71% for group II).


      The presence of a reverse Blalock-Taussig shunt was not associated with more adverse events than those without. Gradual retrograde arch obstruction occurs commonly in palliated infants with aortic atresia. A reverse Blalock-Taussig shunt might play an important role to address the potential of retrograde obstruction, augmenting arch blood flow.

      Abbreviations and Acronyms:

      AVVR (atrioventricular valve regurgitation), BT (Blalock-Taussig), ECMO (extracorporeal membrane oxygenation), PA (pulmonary artery), PVR (pulmonary valve regurgitation), revBT (reverse BT)

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        • Akintuerk H.
        • Michel-Behnke I.
        • Valeske K.
        • Mueller M.
        • Thul J.
        • Bauer J.
        • et al.
        Stenting of the arterial duct and banding of pulmonary arteries: basis for combined Norwood stage I and II repair in hypoplastic left heart.
        Circulation. 2002; 105: 1099-1103
        • Galantowicz M.
        • Cheatham J.P.
        Lessons learned from the development of a new hybrid strategy for the management of hypoplastic left heart syndrome.
        Pediatr Cardiol. 2005; 26: 190-199
        • Caldarone C.A.
        • Benson L.
        • Holtby H.
        • Li J.
        • Redington A.N.
        • Van Arsdell G.S.
        Initial experience with hybrid palliation for neonates with single-ventricle physiology.
        Ann Thorac Surg. 2007; 84: 1294-1300
        • Caldarone C.A.
        • Benson L.N.
        • Holtby H.
        • Van Arsdell G.S.
        Main pulmonary artery to innominate artery shunt during hybrid palliation of hypoplastic left heart syndrome.
        J Thorac Cardiovasc Surg. 2005; 130: e1-e2
        • Helmcke F.
        • Nanda N.C.
        • Hsiung M.C.
        • Soto B.
        • Adey C.K.
        • Goyal R.G.
        • et al.
        Color Doppler assessment of mitral regurgitation with orthogonal planes.
        Circulation. 1987; 75: 175-183
        • Rao P.S.
        • Galal O.
        • Patnana M.
        • Buck S.H.
        • Wilson A.D.
        Results of three to 10 year follow up of balloon dilatation of the pulmonary valve.
        Heart. 1998; 80: 591-595
        • Nakata S.
        • Imai Y.
        • Takanashi Y.
        • Kurosawa H.
        • Tezuka K.
        • Nakazawa M.
        • et al.
        A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart disease with decreased pulmonary blood flow.
        J Thorac Cardiovasc Surg. 1984; 88: 610-619
        • Stoica S.C.
        • Philips A.B.
        • Egan M.
        • Rodeman R.
        • Chisolm J.
        • Hill S.
        • et al.
        The retrograde aortic arch in the hybrid approach to hypoplastic left heart syndrome.
        Ann Thorac Surg. 2009; 88: 1939-1947
        • McGuirk S.P.
        • Stickley J.
        • Griselli M.
        • Stumper O.F.
        • Laker S.J.
        • Barron D.J.
        • et al.
        Risk assessment and early outcome following the Norwood procedure for hypoplastic left heart syndrome.
        Eur J Cardiothorac Surg. 2006; 29: 675-681
        • Sinzobahamvya N.
        • Photiadis J.
        • Kumpikaite D.
        • Fink C.
        • Blaschczok H.C.
        • Brecher A.M.
        • et al.
        Comprehensive Aristotle score: implications for Norwood procedure.
        Ann Thorac Surg. 2006; 81: 1794-1800
        • Sakurai T.
        • Kado H.
        • Nakano T.
        • Hinokiyama K.
        • Shiose A.
        • Kajimoto M.
        • et al.
        Early results of bilateral pulmonary artery banding for hypoplastic left heart syndrome.
        Eur J Cardiothorac Surg. 2009; 36: 973-979
        • Honjo O.
        • Benson L.N.
        • Mewhort H.E.
        • Predescu D.
        • Holtby H.
        • Van Arsdell G.S.
        • et al.
        Clinical outcomes, program evolution, and pulmonary artery growth in single ventricle palliation using hybrid and Norwood palliative strategies.
        Ann Thorac Surg. 2009; 87: 1885-1893
        • Honjo O.
        • Caldarone C.A.
        Hybrid palliation for neonates with hypoplastic left heart syndrome: current strategies and outcomes.
        Korean Circ J. 2010; 40: 103-111
        • Hornik C.P.
        • Jacobs J.P.
        • He X.
        • Hodges A.
        • Jaquiss R.D.B.
        • Jacobs M.L.
        • et al.
        Prevalence and mortality risk associated with post-operative complications following the Norwood operation: analysis of a national clinical database.
        J Am Coll Cardiol. 2011; 57: E449
        • Menache C.C.
        • du Plessis A.J.
        • Wessel D.L.
        • Jonas R.A.
        • Newburger J.W.
        Current incidence of acute neurologic complications after open-heart operations in children.
        Ann Thorac Surg. 2002; 73: 1752-1758