BT Shunt Refresher

14 Sep

A Blalock-Taussig Shuntis a palliative procedure for cyanotic heart disease and single ventricle heart disease

 

Increases pulmonary blood flow by shunting some of the systemic circulation to the pulmonary arteries

 

Provides a continuous flow of blood to the lungs (should hear a continuous shunt murmur)

 

Modified BT shunt uses a Gore-Tex tube. Classic BT shunt sacrifices the right subclavian artery to form a connection from the aorta to the pulmonary artery

 

Complications:

Clot formationwithin the shunt, often caused by dehydration

Volume overload causing pulmonary edema

Low diastolic BP at baseline can cause poor coronary perfusion with potential for coronary steal syndrome

 

Pts take aspirin daily to prevent clot formation, but data is conflicting as to its efficacy

 

Ask parents what baseline sats are (often in the 70s-80s)

 

Get a chest xray quickly to aid in clinical assessment of volume status

 

Call Pediatric Cardiology for echocardiogram if any concern for clotted shunt

 

Submitted by M. Smith.

 

References: Blalock A, Taussig HB. The Surgical Treatment of Malformations of the Heart In Which There Is Pulmonary Stenosis or Pulmonary Atresia. JAMA 1945;128:189-202.; Ramaswamy P. Systemic to Pulmonary Artery Shunting for Palliation. Emedicine. http://www.emedicine.medscape.com/article/905950-overview#a26. 2012.

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