Revival Of The Reverse Potts Shunt; An Alternative To Maximum Medical Therapy In Supra-systemic Pulmonary Hypertension.
Ali Ibrahimiye, James Hammel, Scott Fletcher.
Childrens hospital and Medical Center Omaha, Omaha, NE, USA.
Objective(s): Patient is a 6 month old infant who underwent balloon septostomy on day of life 1 followed by arterial switch operation for d-TGA/IVS on day 3 of life. On post operative day 2 after an echocardiogram revealed a TR velocity >3.5 m/sec and moderate pulmonary insufficiency, she was started on iNO. She was transitioned to a PDE5 inhibitor and discharged home on sildenafil on post operative day 8. Over the course of six months her therapy needed to be escalated to include sildenafil, bosentan and treprostenil for supra-systemic pulmonary hypertension with no evidence of pulmonary vein stenosis by echocardiographic or catheterization assessment.
Methods: We performed a reverse Potts shunt. Due to Le Compte maneuver the anastomosis was made between mid left pulmonary artery and descending aorta using 6mm heparin bonded goretex graft via left thoracotomy.
Results: With a right to left shunt , patient had a 10-15 point differential between upper and lower extremity saturations. She was discharged home on post op day 6 on bosentan and sildenafil. Four weeks later bosentan was discontinued. She is currently on sildenafil and doing well.
Conclusions: Reverse Potts Shunt, which is not a common procedure performed by cardiac surgeons any more, can be a viable alternative for maximum medical therapy in patients with suprasystemic pulmonary hypertension and prevent potentially fatal pulmonary hypertensive crisis. This video shows the technique of creating a Potts shunt in a patient who has had a LeCompte maneuver as part of arterial switch operation.
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