الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
SUMMARY
P
ulmonary atresia with Ventricular septal defect is one of the most difficult pathology to manage, and the surgical procedures related are associated with high mortality and morbidity. Due to wide heterogeneity and variation. No single approach could fit all patients.
Palliative procedure to provide a more stable source of pulmonary blood flow is often required prior to undergoing a more definitive palliation or repair. A surgical shunt, most commonly the modified Blalock-Taussig shunt (MBTS) is the first initial palliative surgical procedure despite this it has been associated with high morbidity and mortality.
Morbidity and mortality after MBTS in general is associated with several factors, including the baseline cardiac anatomy , age , chromosomal abnormalities, weight and sex.
Anatomical factors like pulmonary artery diameter, presence of MAPCAs could also play a role on the outcomes. The approach, PDA ligation, choice of the feeding artery and choice of the size of the shunt all are surgical factors that is dependent on surgeon choice which could differ from patient to patient.
Most of studies about risk factors for mortality about MBT shunt are including different pathologies combined on one study. Pulmonary atresia is one of the most common pathology that require MBT shunt.
There are very few studies that have been reported from the developing regions. Developing countries suffer from a greater burden of infectious diseases which could not only contribute to a higher burden of congenital cardiac malformations, but also affect survival rates after such complex surgeries by increasing post-operative morbidity and mortality through sepsis and thrombotic shunt failures.
In our study, we reviewed the literature and covered the different risk factor that can affect the outcome of MBT shunt operation in patients with PA – VSD
Our aim in this study was to specify risk factors for mortality in Patients with pulmonary atresia undergoing MBT shunt operation which include: demographic data and preoperative clinical data, anatomical data, intraoperative technique, post operative course and complications.
For this purpose, 33 patients with PA-VSD between August 2019 and April 2022 were included and their data were collected and analysed.
The patients included are patients with PA-VSD with age range from newborn up to 3 years old. Patients with Intact interventricular septum and Patients undergoing MBT shunt surgery as part of Norwood operation and any other types of shunts rather than MBT shunt were excluded.
We found a mortality of 18 % in our study. We statistically proved relation of weight, preoperative mechanical ventilation and admission of shock or acidosis with mortality.
On the surgical part, PDA ligation and choice of feeding artery were positively correlated with mortality. Sepsis was the most common complication and was statistically significant risk factor.
We reflected our study upon other studies and found that this mortality percentage was not low. We also reviewed the literature for the other options for this group of patients and found that PDA stenting or early total repair are achieving good results in the recent studies.