Abstract
Introduction. Pulmonary hypertension is a severe and often rapidly progressive disease with fatal outcome. Pulmonary-to-aortic
Potts shunt allows to improve the functional status of patients with pulmonary hypertension despite of moderate hypoxemia of the
lower half of the body.
Objective. To analyze own and published world experience of the Potts shunt in patients with pulmonary hypertension.
Material and methods. From April 2013 to December 2014 Potts shunt was performed in 7 children with various forms suprasystemic
pulmonary hypertension. The obtained data were compared with the results of 48 cases of Pott shunt, published in the available
world literature.
Results. Two patients with extremely high pulmonary vascular resistance died in the early postoperative period of uncontrolled
arterial hypoxemia. All 5 children survivors after Potts shunt with a maximum follow up from 1 to 2.7 years, had a significant
improvement in the clinical status: functional class of pulmonary hypertension significantly decreased, syncope disappeared, children
developed normally and gained weight. The gradient of oxygen arterial blood saturation between the upper and lower extremities
ranged from 8 to 15%.
Conclusion. As large as possible Potts shunt is clinically effective in patients with mean pulmonary artery pressure and pulmonary
vascular resistance, moderately exceeding the system,. In more severe degree of pulmonary hypertension controlled veno-arterial
shunt of blood can probably be achieved by creating restrictive Potts shunt.
References
- Potts W.J., Smith S., Gibson S. Anastomosis of the aorta to a
pulmonary artery; сertain types in congenital heart disease.
J. Am. Med. Assoc. 1946; 132: 627–31.
- Blanc J., Vouhe′P., Bonnet D. Potts shunt in patients with pulmonary
hypertension. N. Engl. J. Med. 2004; 350: 623.
- D'Alonzo G.E., Barst R.J., Ayres S.M., Bergofsky E.H.,
Brundage B.H., Detre K.M. et al. Survival in patients with primary
pulmonary hypertension. Results from a national
prospective registry. Ann. Intern. Med. 1991; 115: 343–9.
- Ivy D.D., Abman S.H., Barst R.J., Berger R.M., Bonnet D.,
Fleming T.R. et al. Pediatric pulmonary hypertension. J. Am.
Coll. Cardiol. 2013; 62: D117–26.
- Baruteau A.E., Serraf A., Levy M., Petit J., Bonnet D., Jais X.
et al. Potts shunt in children with idiopathic pulmonary arterial
hypertension: long-term results. Ann. Thorac. Surg. 2012; 94:
817–24.
- Baruteau A.E., Belli E., Boudjemline Y., Laux D., Le′vy M.,
Simonneau G. et al. Palliative Potts shunt for the treatment of
children with drug-refractorypulmonary arterial hypertension:
updated data from the first 24 patients. Eur. J. Cardiothorac.
Surg. 2015; 47: e105–10.
- Grady R.M., Eghtesady P. Potts shunt and pediatric pulmonary
hypertension: what we have learned. Ann. Thorac. Surg.
2016; 101 (4): 1539–43.
- Bhamra-Ariza P., Keogh A.M., Muller D.W. Percutaneous interventional
therapies for the treatment of patients with severe
pulmonary hypertension. J. Am. Coll. Cardiol. 2014; 63:
611–8.
- Eggers A., Latham G.J., Geiduschek J., Yung D., Chen J.M.,
Joffe D.C. Anesthesia for potts shunt in a child with severe
refractory idiopathic pulmonary arterial hypertension. A&A
Case Reports. 2016; 6 (3): 56–60.
- Latus H., Apitz C., Moysich A., Kerst G., Jux C., Bauer J. et al.
Creation of a functional Potts shunt by stenting the persistent
arterial duct in newborns and infants with suprasystemic pulmonary
hypertension of various etiologies. J. Heart Lung
Transplant. 2014; 33: 542–6.
- Esch J.J., Shah P.B., Cockrill B.A., Farber H.W., Landzberg
M.J., Mehra M.R. et al. Transcatheter Potts shunt creation
in patients with severe pulmonary arterial hypertension: initial
clinical experience. J. Heart Lung Transplant. 2013; 32:
381–7.
- Labombarda F., Maragnes P., Dupont-Chauvet P., Serraf A.
Potts Anastomosis for children with idiopathic pulmonary
hypertension. Pediatr. Cardiol. 2009; 30: 1143–5.
- Boudjemline Y., Patel M., Malekzadeh-Milani S., Szezepanski
I., Levy M., Bonnet D. Patent ductus arteriosus stenting
(transcatheter Potts shunt) for palliation of suprasystemic pulmonary
arterial hypertension: a case series. Circ. Cardiovasc.
Interv. 2013; 6: e18–20.
- Keogh A.M., Nicholls M., Shaw M., Dhital K., Weintraub R.,
Winlaw D.S. Modified Potts shunt in an adult with pulmonary
arterial hypertension and recurrent syncope – Three-year follow-
up. International J. Cardiol. 2015; 182: 36–7.
- Горбачевский С.В., Бродский А.Г., Айбазов Р.А., Кольцов Ю.А. Случай наложения легочно-системного анастомоза Поттса у ребенка с идиопатической легочной артери-
альной гипертензией. Грудная и сердечно-сосудистая хирургия. 2013; 4: 38–40 / Gorbachevskiy S.V., Brodskiy A.G.,
Aybazov R.A., Kol'tsov Yu.A. The case of the pulmonary-systemic
Potts anastomosis in a child with idiopathic pulmonary
arterial hypertension. Grudnaya i serdechno-sosudistaya
khirurgiya. 2013; 4: 38–40 (in Russ.).
- Z uk M., Mazurkiewicz-Anton′K., Mirecka-Rola A., Kawalec W.
Potts shunt in child with suprasystemic pulmonary arterial
hypertension. Kardiologia Polska. 2015; 73 (3): 221.
- Fiszer R., Karwot B., Chodo′r B., Szkutnik M., Kobylarz K.,
Skalski J. et al. Potts' shunt in a child with idiopathic pulmonary
arterial hypertension – one-and-a-half year observation.
Kardiochirurgia i Torakochirurgia Polska. 2015; 12 (2):
170–2.
- Kim S.H., Jang W.S., Lim H.G., Kim Y.J. Potts shunt in
patients with primary pulmonary hypertension. Korean J.
Thorac. Cardiovasc. Surg. 2015; 48: 52–4.
- Petersen C., Helvind M., Jensen T., Andersen H.O. Potts shunt
in a child with end-stage pulmonary hypertension after late
repair of ventricular septal defect. World J. Pediatr. Congenit.
Heart Surg. 2013; 4 (3): 286–9.
- Latus H., Apitz C., Schmidt D., Jux C., Mueller M., Bauer J.
et al. Potts shunt and atrial septostomy in pulmonary hypertension
caused by left ventricular disease. Ann. Thorac. Surg.
2013; 96: 317–9.
- Song M.K., Bae E.J., Jeong S.I., Kang I.S., Kim N.K.,
Choi J.Y. et al. Clinical characteristics and prognostic factors
of primary pulmonary vein stenosis or atresia in children. Ann.
Thorac. Surg. 2013; 95: 229–35.
- Schranz D., Kerst G., Menges T., Akintu¨rk H., van
Alversleben I., Ostermayer S. et al. Transcatheter creation of a
reverse Potts shunt in a patient with severe pulmonary arterial
hypertension associated with Moyamoya syndrome.
EuroIntervention. 2015; 11 (1): 121.
- Guo K., Langleben D., Afilalo J., Shimony A., Leask R.,
Marelli A. et al. Anatomical considerations for the development
of a new transcatheter aortopulmonary shunt device in
patients with severe pulmonary arterial hypertension. Pulm.
Circul. 2013; 3: 639–46.
- Sayadpour Zanjani K. Radiofrequency perforation may
increase the safety of transcatheter Potts shunt creation.
J. Heart Lung Transplant. 2013; 32: 938.
- Levi D.S., Danon S., Gordon B., Virdone N., Vinuela F., Jr,
Shah S. et al. Creation of transcatheter aortopulmonary and
cavopulmonary shunts using magnetic catheters: feasibility
study in swine. Pediatr. Cardiol. 2009; 30: 397–403.
