Revived role of reverse Potts shunt in management of paediatric severe pulmonary hypertension.

Pulmonary artery hypertension in children is a progressive, fatal disease secondary to a variety of causes leading to right ventricular dysfunction. Traditional treatments include lung transplantation (LTx) and targeted therapy. However, due to the shortage of donor sources, heavy medical economic burden, immune rejection, and other problems, many patients are discouraged. In the past 20 years, the Potts palliative shunt, which was initially used for the treatment of cyanotic heart disease, has been gradually revived. Studies have shown that reverse Potts shunt can improve postoperative cardiac function, delay lung transplantation, and improve long-term quality of life in children with severe pulmonary arterial hypertension, which is a feasible and effective alternative to LTx. The surgical procedure is relatively less complex, so it is worth promoting in resource-poor countries, and limited medical expertise. In the future, with refinements of the reverse Potts shunt (unidirectional-valved shunt and transcatheter Potts shunt) and formulation of guidelines (shunt sizes, involvement of multidisciplinary team), there is expected to be further expansion of indications. This article reviews the physiological mechanisms, past and present status of reverse Potts shunt indications and contraindications, surgical procedures, benefits, future application prospects, and key unsolved problems of reverse Potts shunt in the treatment of severe pulmonary arterial hypertension in children.