Left modified Blalock–Taussig (BT) shunt in a child with cyanotic congenital heart disease

Chirstal reena golda1*, Hemalatha,2 Sri Preethi,3 Jaya Menon.4

1Senior Staff Nurse, Kauvery Hospital, Heart city, Trichy, Tamil Nadu

2Assistant Nursing Superintendent , Kauvery Hospital, Heart city, Trichy, Tamil Nadu

3Nurse Educator, , Kauvery Hospital, Heart city, Trichy, Tamil Nadu

4Nursing Superintendent, , Kauvery Hospital, Heart city, Trichy, Tamil Nadu

*Correspondence

Abstract

The Modified Blalock–Taussig (BT) shunt is a palliative surgical procedure performed in children with cyanotic congenital heart diseases to improve pulmonary blood flow and systemic oxygenation. This case study describes a 7-year-old child who underwent a left modified BT shunt for Tetralogy of Fallot with severe pulmonary stenosis. The report discusses the patient’s history, clinical presentation, diagnosis, medical, surgical, and nursing management, postoperative outcome, and the importance of multidisciplinary care. Early recognition of complications and comprehensive nursing management contribute significantly to successful recovery.

Key words: Modified Blalock–Taussig (BT) shunt; Tetralogy of Fallot (TOF)

Introduction

The Modified Blalock–Taussig (BT) shunt is a palliative cardiac surgical procedure used to increase pulmonary blood flow in children with cyanotic congenital heart diseases such as Tetralogy of Fallot (TOF), pulmonary atresia, and tricuspid atresia. The procedure involves placing a synthetic Gore-Tex graft between the subclavian artery and the pulmonary artery. The left modified BT shunt is commonly performed when anatomical considerations favor the left side. Although it does not correct the underlying defect, it improves oxygen saturation, reduces cyanosis, and allows adequate growth until definitive intracardiac repair.

Patient history

  • Age: 7 years,Sex: Female
  • Known case of Tetralogy of Fallot with severe pulmonary stenosis
  • History of recurrent cyanotic spells
  • Breathlessness on exertion
  • Easy fatigability
  • Poor weight gain
  • Low oxygen saturation since infancy
  • Planned for staged surgical palliation

Presenting complaints

  • Central cyanosis
  • Shortness of breath
  • Fatigue during activity
  • Low oxygen saturation (70–80%)
  • Clubbing of fingers
  • Occasional squatting episodes

Diagnosis

  • Tetralogy of Fallot (TOF), severe annular and supra-valvar pulmonic stenosis, confluent pulmonary arteries
  • Severe right ventricular outflow tract obstruction
  • Reduced pulmonary blood flow
  • Chronic hypoxemia
  • Type 1 DM
  • Echocardiography confirmed TOF with severe pulmonary stenosis.
  • Chest X-ray and ECG supported the diagnosis.

Investigations

EEG

Impression

The anatomy appears feasible for a complete repair which likely requires a trans-annular patch. she will need testing for George syndrome before surgery.

Echo

Impression

  • Typical TOF
  • Good biventricular function

MRI

MRI of brain with and MRV report

Impression

  • Multifocal acute infarcts in right parieto-occipital, left temporal and posterior parietal cortex with minimal mass effect.
  • No evidence of cerebral abscess.

Management

Medical Management

  • Oxygen therapy as required
  • Intravenous long-term antibiotic prophylaxis
  • Pain management (Paracetamol/Opioids)
  • Inotropic support if indicated
  • Anticoagulation or antiplatelet therapy (Aspirin) to maintain shunt patency
  • Continuous monitoring of oxygen saturation and hemodynamic status

Surgical Management

Procedure: Left Modified Blalock–Taussig Shunt

  • General anesthesia administered
  • Left thoracotomy performed
  • Gore-Tex graft placed between the left subclavian artery and left pulmonary artery
  • Hemostasis achieved
  • Intercostal chests drain inserted
  • Surgical wound closed in layers
  • Patient shifted to the Cardiac ICU for postoperative monitoring

Postoperative Care

  • Continuous ECG monitoring
  • Monitor heart rate, blood pressure, respiratory rate, temperature, and SpO₂
  • Assess for shunt murmur
  • Monitor chest drain output
  • Pain assessment and management
  • Observe for bleeding and infection
  • Maintain airway and oxygenation
  • Early mobilization
  • Neurovascular assessment of the left upper limb
  • Strict intake-output monitoring
  • Family education regarding home care and follow-up

Discussion

The Modified BT shunt is an effective palliative procedure that improves pulmonary blood flow in children with cyanotic congenital heart disease. Improvement in oxygen saturation decreases cyanosis and enhances physical activity and growth before completing surgical correction. Postoperative nursing care plays a crucial role in identifying complications such as shunt thrombosis, bleeding, infection, pneumothorax, pleural effusion, and low cardiac output syndrome. Continuous monitoring and timely intervention improve patient outcomes.

Outcome

  • Oxygen saturation improved from approximately 75% preoperatively to 88–92% postoperatively.
  • Cyanosis significantly reduced.
  • Stable hemodynamic condition.
  • Chest drain removed after satisfactory drainage.
  • Surgical wounds healed without infection.
  • Patients discharged with medications and follow-up advice for definitive repair.

Conclusion

The left Modified Blalock–Taussig shunt is an effective palliative surgical procedure for children with cyanotic congenital heart disease. It improves pulmonary blood flow, oxygenation, and quality of life until definitive intracardiac repair can be performed. Comprehensive perioperative nursing care and close postoperative monitoring are essential to achieve favorable outcomes and minimize complications.

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