TY  - EJOU
AU  - Kogawa, Kentaro 
AU  - Ito, Reiji 
AU  - Hirano, Daishi 
AU  - Hoshino, Kenji 

TI  - Efficacy of Descending Aortic Retrograde Flow Area to Forward Flow Area Ratio on Echocardiography in Perioperative Management after Blalock-Thomas-Taussig Shunt
T2  - Structural and Congenital Heart Disease

PY  - 2025
VL  - 20
IS  - 4
SN  - 3071-1738

AB  - <b>Objective:</b> 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. <b>Methods:</b> 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. <b>Results:</b> 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 (<i>p</i> = 0.049 and <i>p</i> < 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. <b>Conclusions:</b> 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.
KW  - Blalock-Thomas-Taussig shunt; aorta; thoracic; echocardiography; pulmonary circulation; perioperative period

DO  - 10.32604/chd.2025.068006