Intrapericardial Blalock-Taussig shunt.

The standard Blalock-Taussig (B-T) shunt is preferred over other shunts in the treatment of infants with cyanotic heart disease and reduced pulmonary blood flow. The B-T shunt is not, however, without problems such as phrenic nerve injury and excessive bleeding. It is a time-consuming procedure owing to the degree of lateral mediastinal dissection required (the latter is especially important in critically hypoxic infants). An alternative procedure is described in which an intrapericardial approach is used. This approach requires minimal dissection of the subclavian artery and the anastomosis is performed to the pulmonary artery, medial to the superior vena cava (SVC) and lateral to the aorta. The procedure was performed on 17 infants from 1 day to 2 years of age (average age of 9.4 months, with seven of the 17 infants being less than 6 months of age). Follow-up ranged from 1 to 44 months (average of 17 months). In 94%, the shunt was functioning well. The potential advantages of this approach include: elimination of phrenic nerve injury, easy dissection with reduced operating time, reduced intraoperative hemorrhage, and perhaps a larger anastomosis with improved patency rate.