Comparisons of Arterial and Venous Palliative Shunts in Adult Patients With Cyanotic Congenital Heart Diseases

Generally, 2 types of surgical operations are available for the treatment of cyanotic heart diseases: corrective and palliative. The goal of palliative surgery is to increase the pulmonary blood flow via systemic-to-pulmonary arterial shunting.  

In this case-series study, we evaluated patients older than 15 years old with documented cyanotic heart diseases who underwent palliative shunting in Rajaie Cardiovascular Medical and Research Center between 2001 and 2015.  

Forty-seven patients at a mean age of 24.74 ± 5.67 years were enrolled in this study. Twenty-two (46.8%) patients were male. Nearly half of the study population (23 patients) had central shunting, 23 patients Glenn shunting, and 1 patient Blalock–Taussig shunting. Following surgery, there was a significant rise in the mean partial pressure of O2 and O2 saturation, a significant drop in the hemoglobin concentration, and a significant increase in the platelet count. Five (10.6%) patients expired during the study period. The mortality rate of Blalock–Taussig shunting and Glenn shunting was 12.5% and 8.69%, respectively.  

In this case-series study, all the patients showed dramatic improvements in the New York Heart Association functional class, O2 saturation, the partial pressure of O2, the partial pressure of carbon dioxide, hemoglobin levels, and ferritin levels in the first postoperative year; however, these improvements were greater in arterial shunts. The following 10 years saw a decline in these improvements; nonetheless, the clinical status and lab data were good by comparison with the baseline. In adults with congenital cyanotic heart diseases, palliative shunting is a good option and should be considered in patients who are inoperable due to structural problems or high risk of anesthesia or surgery. (Iranian Heart Journal 2020; 21(4): 60-66)