日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

The Blalock–Taussig shunt (BTS) operation has been a cornerstone procedure as the first palliative operation for congenital heart disease with severely reduced pulmonary blood flow (PBF). Although the ideal PBF provided by BTS is crucial for an uneventful postoperative course, particularly in neonates and infants with single ventricular physiology, there are no standardized criteria for selection of the shunt graft size and anastomosis site. Excess PBF results in acute distress of the systemic circulation, and insufficient PBF requires another BTS surgery. Adjustment of PBF is a definitive solution for these problems that occur with BTS use. Therefore, we developed a simple device to percutaneously control the shunt graft flow with a constrictor balloon connected to a subcutaneous port. The device provided good flow control by inflating and deflating the balloon ex vivo and in vivo for up to 3 months (in a canine model of replacement of the right carotid artery with a small graft wrapped with the device). This simple device could enable the regulation of the PBF through a small vascular graft and help prevent severe morbidity and mortality even in the clinical setting of BTS.