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The Blalock–Thomas–Taussig shunt (BTT shunt), [1] previously known as the Blalock–Taussig Shunt (BT shunt), [2] is a surgical procedure used to increase blood flow to the lungs in some forms of congenital heart disease [3] such as pulmonary atresia and tetralogy of Fallot, which are common causes of blue baby syndrome. [3]
The circulation of a patient after BDG shunt placement requires adequate systemic venous return to support pulmonary blood flow. However, pulmonary blood flow, and thus oxygenation, is inhibited by high pressures or valvular obstructions. [1] Pulmonary hypertension (moderate to severe) is a relative contraindication to the bidirectional Glenn. [5]
The most common shunts are the Modified Blalock Taussig shunt (MBTS) or right ventricle- to pulmonary artery shunt (RVPA or Sano shunt). Most patients who undergo a Norwood procedure will proceed to further stages of single ventricle palliation. A second surgery, also known as the Glenn procedure, occurs at 4–6 months
The surgery allows blood to be delivered to the lungs via central venous pressure rather than via the right ventricle. [3] Patients typically present as neonates with cyanosis or congestive heart failure. [4] Fontan completion is usually carried out when the patient is 2–5 years of age, but is also performed before 2 years of age. [5] [6]
A pulmonary shunt is the passage of deoxygenated blood from the right side of the heart to the left without participation in gas exchange in the pulmonary capillaries. It is a pathological condition that results when the alveoli of parts of the lungs are perfused with blood as normal, but ventilation (the supply of air) fails to supply the perfused region.
Prior to the development of the Senning procedure in the 1950s, blue baby syndrome from transposition was usually fatal. The defect causes blood from the lungs to flow back to the lungs and blood from the body to flow back to the body. As a result, the babies are blue at birth because of insufficient blood oxygen. [2]
Cardiac shunts may be described as right-to-left, left-to-right or bidirectional, or as systemic-to-pulmonary or pulmonary-to-systemic.; Cerebral shunt: In cases of hydrocephalus and other conditions that cause chronic increased intracranial pressure, a one-way valve is used to drain excess cerebrospinal fluid from the brain and carry it to other parts of the body.
Lung transplantation is an intricate treatment that can provide efficient results, however, there are risks that come with this procedure which include: bleeding, infection, blockage of the blood vessels to the new lungs, blockage of the airways, severe pulmonary oedema as well as potential blood clot formation. [45]