Anders, M. Blalock-Taussig Shunt, Don't Forget the Bubbles, 2013. Available at:
Definition: Modified Blalock-Taussig shunt: Gortex graft from subclavian or innominate artery to the ipsilateral PA to augment PBF. Blalock-Taussig shunt: direct anastomosis between the transected subclavian artery (or the innominate artery) and the pulmonary artery.
To provide adequate (but not excessive) pulmonary blood flow, hence minimising the risk of congestive cardiac failure and pulmonary hypertension: TOF, TA, PA with IVS, Ebstein’s anomaly, HLHS.
Aiming for a balanced circulation (SpO2 75-85%), aiming for a Qp:Qs = 1:1.
- Commence heparin 10U/kg/hr once no major bleeding
- Start aspirin (5 mg/kg) on first postoperative day. Once feeds are tolerated, cease heparin if no CVL in situ
- Commence morphine sedation, paralyse with cisatracurium for 12 hours until the pulmonary and systemic blood flow have balanced
- Respiratory: SpO2 75-85%; may need some time to settle pulmonary blood flow and achieve stable saturations
- Inotropes: usually not required
- Haemodynamics: SBP >60 mmHg, MAP >40 mmHg (increasing over time), LAP 8-12 mmHg, CVP 8-12 mmHg
- Fluid restriction: 3ml/kg/hr, avoid hypovolaemia, trophic feeds
- Haemostasis: Hb 130-150 g/l
- Prostaglandin infusion should be weaned slowly, especially if infant was on it for more than 48 hours
- Low diastolic BP usually indicates good shunt flow (diastolic run off), but also lower coronary artery perfusion pressure and risk of splanchnic hypoperfusion
- If low SpO2, exclude shunt occlusion (change in murmur ?): ECHO, heparin 50 U/kg, inform surgeons; hypovolaemia (give volume bolus); hypotension (volume bolus and/or inotropes); inadequate CO (inotropes)
- If high SpO2 with pulmonary overcirculation leading to pulmonary oedema (unilateral) may indicate a too large shunt or PDA, which was not ligated. If still intubated: decrease FiO2 to 0.21; allow mild hypercapnoea; correct hypovolaemia; increase Hb; PDA ligation if necessary; try to extubate if feasible; non-invasive ventilation to support CO
References: Critical Heart Disease in Infants and Children; 2nd ed, Nichols et al: Tricuspid Atresia  J Card Surg 2009;24: 101-108: Yuan et al: The Blalock-Taussig Shunt  Ann Thorac Surg 2011;92:642-52: Petrucci et al: Risk Factors for Mortality and Morbidity After the Neonatal Blalock-Taussig Shunt Procedure  Partners of the Heart: Vivien Thomas and His Work with Alfred Blalock, by Vivien T. Thomas (originally published as Pioneering Research in Surgical Shock and Cardiovascular Surgery: Vivien Thomas and His Work with Alfred Blalock), University of Pennsylvania Press, 1985
Definition: anastomosis between the ascending aorta and the main pulmonary artery made of PTFE. Ann Thorac Surg. Nov 1991;52(5):1132-7: Watterson et al: Very small pulmonary arteries: central end-to-side shunt.
Definition: right ventricle-to-pulmonary artery shunt in an attempt to overcome the obstacles noted with a systemic-to-pulmonary artery shunt (diastolic runoff and low coronary artery perfusion pressure); disadvantages: Sano Shunt becomes obstructive over time. J Thorac Cardiovasc Surg. Aug 2003;126(2):504-9; discussion 509-10: Sano et al: Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome  J Card Surg. 2009 Mar-Apr;24(2):101-8: Yuan et al: The Blalock-Taussig shunt