Outcome of systemic to pulmonary shunts in infants with cyanotic congenital heart disease and decreased pulmonary blood flow in Srinagarind Hospital (2012-2016)

Abstract

Background: Neonates with critical congenital heart disease (CCHD) can present during their birth hospitalization with approximately 25% present with life-threatening conditions. Systemic to pulmonary shunt is designed to increase pulmonary blood flow in a cyanotic child with inadequate pulmonary blood flow and occurrence of obstructive shunt is a serious complication which can lead to death.

Objectives: To evaluate the outcome of systemic to pulmonary shunt operation and the factors which were associated with systemic to pulmonary shunt thrombosis in 5-year period after the guidelines for administering aspirin after shunting were used in Srinagarind Hospital (SNH).

Methods: This was a retrospective  study. The medical records were searched by using ICD 10 codes from Srinagarind Hospital database in pediatric cardiology clinic and pediatric echocardiography clinic and all of them were targeted for review.

Results: Thirty-six cases of cyanotic congenital heart diseases with decreased pulmonary blood flow were enrolled. Diagnosis were Tetralogy of Fallot (n = 18), pulmonary atresia (n = 11), tricuspid atresia (n = 4), critical pulmonary stenosis (n = 3). There was a case (2.7%) with early shunt obstruction within the first 24 hours after operation. There were 5 (13.9%) postoperative deaths from infection (n = 4) and bleeding (n = 1). Twenty-two cases were followed up until the end of the study period, seven cases had late shunt obstruction (25.9 %). The shunt obstruction group had the median size of the main pulmonary artery (3.1 mm.) smaller than the shunt use in non-obstruction group (5.0 mm.) with statistically significant (p value 0.021). The medians right pulmonary artery (2.7 mm), the left pulmonary artery (2.8 mm.) , the body weight (3.1 kg) and the shunt size (3.5 mm.) were smaller in the shunt obstruction group than those in the shunt non-obstruction group (RPA=3.5 mm., LPA=3.5 mm., BW= 3.4 kg., shunt size=4.1 mm.) with clinically significant but not statistically significant (RPA: p value 0.054; LPA: p value 0.139; BW: p value 0.145; shunt size: p value 0. 217).

Conclusion: Early systemic to pulmonary shunt obstruction in CCHD and decreased pulmonary blood flow was low. The size of  blood vessel was the important factor of a good outcome of the operation. The mortality rate was related with other medical condition.