Surgical Shunt Dysfunction

Due to palliative shunt procedures performed in the neonatal period prior to definitive operative repair of complex congenital heart disease, shunts can malfunction. Typically, infants in such a situation are in acute distress with increasing cyanosis. Although not as dramatic as with ductus-dependent lesions, symptoms develop when the shunt flow narrows to less than 50 percent of usual. Ordinarily, a continuous murmur is heard over the side of the shunt. Diminution or disappearance of the murmur suggests occlusion of the shunt. Typically, emergency physicians can do nothing for these infants. Palliative therapy with 100 percent oxygen is utilized, and transfer to a tertiary center is expedited. The use of thrombolytic therapy has been tried, but should be used by only pediatric cardiologists by direct shunt instillation or systemically. In all cases, possible replacement of the shunt or definitive surgical repair might be the only option.

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