Open Access

ARTICLE

Efficacy of Descending Aortic Retrograde Flow Area to Forward Flow Area Ratio on Echocardiography in Perioperative Management after Blalock-Thomas-Taussig Shunt

Kentaro Kogawa^1,2,*, Reiji Ito², Daishi Hirano², Kenji Hoshino^1,2

1 Division of Pediatric Cardiology, Saitama Children’s Medical Center, Saitama, 330-8777, Japan
2 Department of Pediatrics, The Jikei University School of Medicine, Tokyo, 105-8471, Japan

* Corresponding Author: Kentaro Kogawa. Email:

(This article belongs to the Special Issue: Novel Methods and Techniques for the Management of Congenital Heart Disease)

Congenital Heart Disease 2025, 20(4), 451-461. https://doi.org/10.32604/chd.2025.068006

Received 19 May 2025; Accepted 29 August 2025; Issue published 18 September 2025

Abstract

Objective: To investigate the usefulness of the descending aortic retrograde flow area to forward flow area (dAO RF) ratio using echocardiography in managing pulmonary blood flow during the perioperative period following Blalock-Thomas-Taussig shunt (BTTS) surgery. Methods: This retrospective study analyzed patient characteristics, surgical procedures, and perioperative courses. The dAO RF ratio was measured upon admission to the pediatric intensive care unit (PICU) and 12, 24, 48, and 72 h post-surgery. Blood pressure, percutaneous oxygen saturation, arterial blood gas values, and lactate levels were measured at the same time as the dAO RF ratio. Results: Seventy-one cases were analyzed. Excessive and low pulmonary blood flow occurred in 17 and two patients, respectively. Four patients required resuscitation within 72 h post-surgery, due to excessive pulmonary blood flow. No deaths occurred within 72 h. The dAO RF ratio was significantly higher in patients with excessive pulmonary blood flow at PICU admission and at its maximum (p = 0.049 and p < 0.01, respectively). The maximum dAO RF ratio was significantly correlated with lactate levels when measured concurrently; however, there was clinical variability in the resuscitation cases. The dAO RF ratio cutoff of 0.61 was highly accurate (area under the receiver operating characteristic curve: 0.91 [95% confidence interval: 0.82–1.00]), sensitive (82.4%), and specific (94.4%) for detecting excessive pulmonary blood flow. Conclusions: Measuring the dAO RF ratio postoperatively can prevent deterioration in patients with BTTS by accurately detecting excessive pulmonary blood flow, offering a minimally invasive and accurate assessment of perioperative pathophysiology.

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