Balancing pulmonary blood flow: Theory, in vitro measurements, and clinical correlation of systemic-to-pulmonary shunt banding Cori R. Atlin, MD, Christoph.

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Balancing pulmonary blood flow: Theory, in vitro measurements, and clinical correlation of systemic-to-pulmonary shunt banding Cori R. Atlin, MD, Christoph Haller, MD, Osami Honjo, MD, PhD, Anusha Jegatheeswaran, MD, PhD, Glen S. Van Arsdell, MD The Journal of Thoracic and Cardiovascular Surgery Volume 152, Issue 5, Pages 1343-1352.e2 (November 2016) DOI: 10.1016/j.jtcvs.2016.07.081 Copyright © 2016 Terms and Conditions

Figure 1 Physiological impact of length of the band for common thin-walled shunt sizes. (A) 3 mm. (B) 3.5 mm. (C) 5 mm. The solid line represents the length of the banding in relation to the desired diameter. The dotted line represents the length of the banding in relation to the prebanding Qp:Qs. This figure can be used to easily assess the length of the band needed for reduction to a certain shunt diameter (x-value of the solid line at respective diameter), as well as to get an estimate of the physiological impact of the banding (y-value of the dotted line at respective band length). Qp, Pulmonary blood flow; Qs, systemic blood flow. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1343-1352.e2DOI: (10.1016/j.jtcvs.2016.07.081) Copyright © 2016 Terms and Conditions

Figure 2 Morphometric shunt cross-sections. (A) 3.5-mm thin-walled Blalock-Taussig (BT) shunt banded to 3 mm. (B) 3.5-mm thin-walled BT shunt. (C) 3.5-mm regular-walled BT shunt banded to 3 mm. (D) 3.5-mm regular-walled BT shunt. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1343-1352.e2DOI: (10.1016/j.jtcvs.2016.07.081) Copyright © 2016 Terms and Conditions

Figure 3 Changes in hemodynamic and blood gas values. SaO2, Arterial oxygen saturation; Qp, pulmonary blood flow; Qs, systemic blood flow; n.s., not significant; sBP, systolic blood pressure; dBP, diastolic blood pressure; paO2, partial pressure of oxygen; paCO2, partial pressure of carbon dioxide; SmVO2, mixed venous saturation. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1343-1352.e2DOI: (10.1016/j.jtcvs.2016.07.081) Copyright © 2016 Terms and Conditions

Figure E1 Banding accuracy. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1343-1352.e2DOI: (10.1016/j.jtcvs.2016.07.081) Copyright © 2016 Terms and Conditions

Figure E2 Excised banded 3.5-mm Blalock-Taussig shunt at the time of stage II palliation. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1343-1352.e2DOI: (10.1016/j.jtcvs.2016.07.081) Copyright © 2016 Terms and Conditions

Figure E3 Angiograms of banded Blalock-Taussig shunts. Arrows indicate area of shunt banding. (A) Anteroposterior view. (B) Lateral view. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1343-1352.e2DOI: (10.1016/j.jtcvs.2016.07.081) Copyright © 2016 Terms and Conditions

Banded and regular shunts in vitro. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1343-1352.e2DOI: (10.1016/j.jtcvs.2016.07.081) Copyright © 2016 Terms and Conditions

Video 1 Angiography delineating a banded Blalock-Taussig shunt. Video available at: http://www.jtcvsonline.org/article/S0022-5223(16)31069-8/addons. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1343-1352.e2DOI: (10.1016/j.jtcvs.2016.07.081) Copyright © 2016 Terms and Conditions