Name of the Procedure:

Shunt; subclavian to pulmonary artery (Blalock-Taussig type operation)

Summary

The Blalock-Taussig shunt is a surgical procedure that creates a connection between the subclavian artery and the pulmonary artery. This helps increase blood flow to the lungs in patients, typically infants, with congenital heart conditions that reduce pulmonary blood flow.

Purpose

This procedure addresses congenital heart defects that lead to poor oxygenation, such as Tetralogy of Fallot. The primary goal is to improve oxygenation by increasing blood flow to the lungs, thereby enhancing the patient's quality of life and enabling further growth and development.

Indications

• Symptoms of cyanosis (bluish skin due to lack of oxygen)
• Diagnosed congenital heart conditions such as Tetralogy of Fallot, pulmonary atresia, or tricuspid atresia
• Patients who are not immediate candidates for complete surgical correction of their heart defect

Preparation

• Fasting (usually 8 hours prior to the procedure)
• Adjustment or temporary cessation of certain medications
• Preoperative tests such as chest X-rays, echocardiograms, and blood tests
• Consultation with a cardiologist and anesthesiologist

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the chest, usually on the side.
3. The surgeon identifies and isolates the subclavian artery and the pulmonary artery.
4. A synthetic graft or tube is used to create a connection (shunt) between the subclavian artery and the pulmonary artery.
5. The shunt is secured and blood flow is checked to ensure proper function.
6. The incision is closed, and the patient is moved to recovery.

The tools used include surgical instruments, synthetic graft materials, and monitoring equipment to ensure the patient’s safety throughout the procedure.

Duration

The procedure typically takes about 3 to 4 hours.

Setting

The procedure is performed in a hospital operating room with specialized cardiovascular surgical facilities.

Personnel

• Cardiothoracic surgeon
• Pediatric cardiologist
• Anesthesiologist
• Operating room nurses
• Surgical technologists

Risks and Complications

• Infection at the incision site
• Bleeding or clotting issues
• Shunt occlusion (blockage)
• Pulmonary hypertension
• Arrhythmias (irregular heartbeats)
• Potential need for additional surgeries

Benefits

• Improved oxygenation and reduced cyanosis
• Enhanced growth and development for infants
• Stabilization of condition allowing for future corrective surgeries

Recovery

• Initial recovery in the Intensive Care Unit (ICU) for monitoring
• Gradual increase in activity as tolerated
• Pain management with medications
• Follow-up appointments with cardiologists and surgeons
• Parents will receive education on signs to watch for potential complications

Alternatives

• Other palliative procedures such as the Glenn or Fontan procedures
• Complete surgical repair, if feasible
• Medical management, although often not sufficient alone

Each alternative has specific pros and cons that need to be considered by the healthcare team and the patient's family.

Patient Experience

• The patient will be under general anesthesia during the procedure and will not feel anything.
• Post-procedure, the patient may experience pain at the incision site, managed with analgesics.
• Gradual recovery with increased activity as the patient heals.
• Parents or caregivers will need to watch for any signs of complications, such as fever or unusual changes in breathing or skin color.

Pain management and supportive care will be a priority to ensure the patient’s comfort during the recovery period.