This document provides an overview of palliative cardiac surgery procedures, including definitions, goals, and specific procedures. It discusses Blalock-Taussig shunts (BT shunts), bi-directional Glenn shunts (BDG shunts), Fontan procedures, and pulmonary artery banding (PA banding). For each procedure, it describes the purpose, surgical techniques, indications, and potential complications. The document is intended to educate about palliative options for congenital heart defects that provide symptomatic relief but do not correct the underlying conditions.

1. Palliative Cardiac surgery
Presenter:– Hardik .V. Petkar
Moderator:– Dr.Shantanu Gomase sir
Branch:-Bsc.CVTS 3rd yr

2. Definition of palliative surgery
 Palliative surgery is surgical intervention targeted to
make a patient’s symptoms less severe , thus make
the patient’s quality of life better despite negligible
impact on the patient’s survival. Palliative surgery
focuses on supplying the greatest benefit to the
patient using the least invasive intervention.

3. Goals of Palliative Procedures
To provide symptomatic relief making:-
 The cardiac malformations more tolerable,
 Providing an improvement in the patient’s condition
and
 Permitting growth until the child has complete
correction.

4. Palliative procedures
 surgical procedures:-
1. Blalock-Taussig Shunt (BT shunt)…..
2. Bi-directional Glenn Shunt (BDG Shunt)….
3. Fontan procedure…..
4. Pulmonary Artery Banding (PA Banding)…..

5. 1. BT shunt
(Blalock-
taussig shunt)

6. What is the BT shunt surgery
 The Blalock-taussig shunt (BT Shunt) is a surgical
procedure used to increase blood flow to the
lungs in some forms of congenital heart disease.
These conditions, in which a child is born with
an abnormal heart include pulmonary atresia
and Tetralogy of Fallot and are common causes
of blue baby syndrome.
 The procedure involves connecting a branch of
the subclavian artery or carotid artery to the
pulmonary artery. In modern practice, this
procedure is temporarily used to direct blood
flow to the lungs and releive cyanosis while the
infant is waiting for corrective or definitive
surgery.

7. Types of BT shunt
A. Classical procedure
B. Modified procedure

8. Indications
 Pulmonary atresia.
 Tetralogy of Fallot with small PA size.
 Single ventricle with pulmonary atresia / severe PS.

9. Complications
 Shunt block.
 Shunt stenosis.
 Shunt overflow.
 Loss of upper limb arterial pulsation.
 PA distortion.
 Renal failure.
 Infection.

10. 2. BDG Shunt
( Bi-directional
Glenn Shunt)

11. What is Bi-directional Glenn Shunt
 The Bi-directional glenn (BDG) shunt, or
birectional cavopulmonary anastomosis,
is a surgical technique used in pediatric
cardiac surgery procedure used to
temporarily improve blood oxygenation
for patients with a congenital cardiac
defects resulting in a single functional
ventricle. Creation of a bidirectional
shunt reduces the amount of blood
volume that the heart needs to pump at
the time of surgical repair with the
fonton procedure.

12. Indications of BDG shunt
 Severe ebstein anamoly.
 Tricuspid atresia.
 Hypoplastic left heart.
 Second stage for univentricular repair.

13. Surgery techniques
 The Bi-directional glenn procedure is usually performed on
cardiopulmonary bypass. The superior venacava is ligated
from the right atrium and anastomosed (end to side) to the
right pulmonary artery. The right pulmonary artery is not
separated from the pulmonary artery trunk therefore the the
branch pulmonary arterIes are continuous.
 Superior venacava flow is bi-directional providing venous
blood flow from the head , neck and upper extremities to the
right and left lung. When a left and right superior venacava
are present a bilateral Bi-directional glenn procedure is
performed.

14. Complications of BDG shunt
 SVC syndrome.
 Pulmonary overflow.
 Pleural effusion, chylothorax.
 Pericardial effusion.
 Cavopulmonary stenosis.
 Aortapulmonary collaterals developments.
 Infections.

15. 3. Fontan
Procedure

16. What is fontan procedure
 The fontan procedure, is a palliative surgical
procedure used in children with complex
congenital heart defects.
 It involves diverting the venous blood from
the right atrium to the pulmonary arteries
without passing through the morphologic
pulmonary ventricle. It was initially described
in 1971 by Dr.fontan and separately as a
surgical treatment for tricuspid atresia.

17. Indications
 The fontan procedure has more recently been used in
pediatric situations where an infant only has a single
effective ventricle, either due to heart valve defects (e.g.
tricuspid or pulmonary atresia) or an abnormality of the
pumping ability of the heart (e.g. hypoplastic left heart
syndrome, hypoplastic right heart syndrome), or has
complex congenital heart disease where a bi-ventricular
repair is impossible or in advisible.

18. Indications
 Children with hypoplastic left heart syndrome have a
single effective ventricle supplying blood to the
lungs and the body ( either from birth or after an
initial surgery e.g. Norwood procedure). They are
delicately balanced between inadequate blood
supply to the lungs (causing cyanosis) and
oversupply to the lungs (causing heart failure).

19. Contraindications
 After fontan , blood must flow through the lungs without
being pumped by the heart. Therefore children with high
pulmonary vascular resistance may not tolerate of fontan
procedure. Often cardiac catheterization is performed to
check the resistance before proceeding with the surgery.
 This is also the reason of fontan procedure cannot be done
immediately after birth, the pulmonary vascular resistance is
high in utero and takes months to drop.

20. Complications of fontan
 Children can have trouble with atrial flutter and atrial
fibrillation because of scarring in the atrium, especially if the
connection of IVC pulmonary arteries involved and intra
cardiac buffle (instead of an extracardiac conduit). This
sometimes requires treatment such as radiofrequency
ablation. There are other long term risks, including protein
losing enteropathy and chronic renal insufficiency , although
understanding of these risks is still incomplete. Some
patients require long term blood thinners.

21. 4. PA Banding
(Pulmonary
Artery
Banding)

22. What is pulmonary artery banding
 Pulmonary Artery Banding is a surgical
technique to reduce excessive
pulmonary blood flow in infants
suffering from congenital heart defects.
PA Banding is a palliative operation as it
does not correct the problems, but
attempts to improve abnormal heart
function, relieve symptoms and reduce
high Pressure in the lungs.

23. Indications
 In congenital heart defects such as ventricular septal
defects (VSD) and Atrioventricular septal defects,
there may be one or multiple holes in the walls
separating adjacent chambers.
 This causes left-to-right shunting of blood as
oxygenated blood can flow back to the right side of
the heart , resulting in a mixture of oxygenated and
deoxygenated blood.
 Increased amounts of blood on the right side of the
heart Cause an excess of blood flow into the lungs
(pulmonary circulation) and increased pulmonary
resistance due to the build-up of pressure.

24. Surgical technique
 The goal of PA Banding is to reduce pulmonary artery
pressure and excess pulmonary blood flow.
 PA Banding involves the insertion of a band around the
pulmonary artery to reduce blood flow into the lungs.
 A variety of banding Materials are used ; one commonly
used material is polytetrafluoroethylene.

25. Surgical technique
 The band is wrapped around the main pulmonary
artery and fixed into place. Once inserted,the band is
tightened, narrowing the diameter of the pulmonary
artery to reduce blood flow to the lungs and reduce
pulmonary artery pressure.

26. Complications
 Stenosis or distortion of one or both branch pulmonary arteries.
 Distortion of pulmonary valve.
 Thrombosis.
 Hemolysis.
 PA pseudoaneurysm.
 Alterations in the function of the pulmonary valve.
 Ineffective band placement leading to irreversible changes to pulmonary
vasculature cause pulmonary hypertension.
 Local infection.

27. Palliative surgery
 Interventional procedures
1. Atrial steptostomy…..
2. PDA stenting……

28. Thank you