[Shunt malfunction due to a Blalock-Taussig anastomosis of the pulmonary vein].

In two of 81 patients in whom a Blalock-Taussig shunt was created due to pulmonary atresia, the anastomosis was inadvertently placed on the pulmonary vein. The first case was a newborn with mirror-image dextrocardia, pulmonary valve atresia and a high ventricular septal defect. Subsequent to a Rashkind maneuver and treatment with prostaglandins, at the age of eleven days the shunt procedure was performed. Right sided pulmonary edema developed twelve hours after surgery and the infant died on the second postoperative day. Anastomosis of the shunt to the right pulmonary vein was revealed at autopsy. The second case was a six year-old boy admitted for corrective surgery with pulmonary valve atresia, main pulmonary artery atresia, large ventricular septal defect and patent ductus arteriosus. Because of additional systemic-pulmonary collaterals, the larger collaterals were ligated and the Blalock-Taussig shunt was carried out using a Goretex prosthesis. Nine months postoperatively, at follow-up cardiac catheterization, the ill-directed shunt was diagnosed and subsequently revised. The onset of ipsilateral pulmonary edema and increasing signs of congestive heart failure after surgical creation of a Blalock-Taussig shunt as well as the persistence of lowered oxygen partial pressure, cyanosis and poor general health, should alert the attending physician to rule out the rare complication of anastomosis to the pulmonary vein.