Aorto-Pulmonary Shunt in Congenital Cyanotic Heart Disease:Waterston Shunts in Infants under Two Years of Age

Abstract

Aorto-pulmonary (Waterston) shunts have been created in 12 patients under 2 years of age with congenital cyanotic heart disease. Six patients had tetralogy of Fallot, 3 tricuspid atresia and 3 pulmonary atresia. The postopeartive observation time is from 3 to 18 months, average 10 months. Four hospital deaths are described in detail, and stress the point that the complicated congenital cyanotic cardiac defects, with associated cardiac and other anomalies, have a grave prognosis.

Pulmonary atelectasis as a postoperative complication was very common, and caused 3 of the deaths. Cardiac failure, hypervascularity of the ipsilateral lung to the shunt and shunt thrombosis were infrequent complications.

It is of great importance to choose the right size of shunt, place it correctly and relate it to the size of the patient and the nature of the cardiac lesion. Patients with tricuspid or pulmonary atresia should have smaller shunts than those with tetralogy of Fallot. The effect of the shunt on the polycythaemia and hypoxia is discussed and appears as changes in the haematocrit and O₂-saturation, both of which were normalised postoperatively. The aorto-pulmonary gradient across a functional shunt, and the shunt flow in the pulmonary artery distal to the anastomosis have been measured and illustrate the effect of the shunt on the pulmonary circulation. These haemodynamic data and the shunt index will also aid in selecting the right size of the Waterston anastomosis.