الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Congenital heart disease remains the leading cause of death in children with congenital malformations. Birth prevalence of congenital heart disease in the general population is approximately 8/1,000 live births.
Although definitive repair of congenital heart disease in the neonatal period is the desired preference, the application of a systemic to pulmonary artery shunt continues to play an important role in the palliation of a variety of lesions the modification of the Blalock-Taussig shunt in which a PTFE (polytetrafluoroethylene) tube graft is inserted between the subclavian and pulmonary arteries, has become the preferred systemic to pulmonary artery connection to augment pulmonary blood flow.
The preferred surgical approach to this shunt when it was first described by De Leval was through a left thoracotomy, others prefer median sternotomy incision for performing a systemic pulmonary arterial shunt.
The aim of this study is to evaluate sternotomy approach for patients undergoing modified Blalock-Taussig shunt as a palliative procedure for complex cyanotic congenital heart diseases through determining the effect of the sternotomy approach on morbidity and mortality and identifying the outcome and most common complications. in this study, we reviewed tاe literature and covered the surgical aspect of the blalock taussig shunt including surgical techniques complications and outcome.
In this study, we have 15 patients with cyanotic congenital heart diseases who underwent modified blalock taussig shunt in the period between September 2010 till may 2012.
All patients were subjected to the following:
1. Compelete preoperative study, including age ,weight ,morphology of the heart with assessment of pulmonary artery size using both echocardiograpy and cardiac catheterization.
2. Complete post-operative evaluation of the results and complications.
from the data outcome in this study we concluded that The modified Blalock Taussig shunt is a relatively safe procedure and it is considered suitable as a palliation for cyanotic congenital heart disease with reduced pulmonary blood flow and the sternotomy approach to MBTS in neonates and infants has many advantages . This approach is technically easier to perform, is cosmetically preferable, and perhaps is hemodynamically superior. The in-hospital mortality rate is acceptable, and this route is associated with less shunt failure .Correction of any pulmonary distortion is easily incorporated at subsequent procedures. Our experience with reoperative cardiac surgery suggests that the advantages of the sternotomy approach are not outweighed by the disadvantages of a subsequent resternotomy.
It is crucial to take every effort for the corrective surgery to be done as soon as the patient condition is suitable to avoid the late shunt complications and the malnutrition associated with cyanotic congenital heart disease.