Neonatal Blalock-Taussig shunt: technical aspects and postoperative management.

A systemic-pulmonary artery shunt in neonates with decreased pulmonary blood flow is technically demanding. We describe our surgical technique, postoperative management, and results in 19 neonates who underwent a modified Blalock-Taussig shunt between April 2003 and March 2006. Prostaglandin infusion was required in 8 patients who were critically cyanosed, and 5 were on inotropic support preoperatively. A 3.5 or 4.0-mm polytetrafluoroethylene graft was anastomosed with 8/0 polypropylene suture. Postoperatively, systemic pressure was kept slightly higher than normal, and heparin was started early. One patient required revision of the shunt, and one was reexplored for bleeding. There were 2 hospital deaths (mortality, 11%) in patients with preoperative hemodynamic instability. The mean follow-up period was 12 months, with no late postoperative shunt blockage or death. Meticulous surgical technique and judicious use of heparin and inotropic agents improved the outcome and reduced the incidence of shunt blockage and reexploration for bleeding.