Risk Factor Analysis for SaO2 Instability after Systemic-pulmonary Shunt

Yun, Tae Jin; Jung, Sung Ho; Yun, Sok Won; Park, Jung Jun; Seo, Dong Man; Kim, Young Hwue; Ko, Jae Kon; Park, In Sook

Abstract

BACKGROUND: Arterial oxygen saturation (SaO2) instability frequently takes place after systemic-pulmonary shunt without shunt occlusion. We analyzed actual incidence and risk factors for SaO2 instability after shunt operations, and possible mechanisms were speculated on. MATERIAL AND METHOD: Ninety three patients, who underwent modified Blalock-Taussig shunt from January 1996 to December 2000, were enrolled in this study. Adequacy of shunt was verified in all patients, either by ensuing one ventricle or biventricular repair later on or by appropriate pulmonary artery growth on postoperative angiogram. Age, body weight, hemoglobin level at operation were 3 day to 36 years (median: 1.8 months), 2.5 kg to 51 kg (median: 4.1 kg) and 10.7~24.3 gm/dL (median: 15.2 gm/dL) respectively. Preoperative diagnoses were functional single ventricle with pulmonary stenosis or atresia in 39, tetralogy of Fallot in 38 and pulmonary atresia with intact ventricular septum in 16. Pulmonary blood flow (PBF) was maintained pre-operatively by patent ductus or previous shunt in 64 and by forward flow through stenotic right ventricular outflow tract (RVOT) in 29. SaO2 instability was defined as SaO2 less than 50 % for more than 1 hour with neither anatomic obstruction of shunt nor respiratory problem. RESULT: 10 patients (10.7%) showed SaO2 instability after shunt operation. After shunt occlusion was ruled out by echocardiogram, they received measures to lower pulmonary vascular resistance (PVR), which worked within a few hours in all patients. Risk factors for SaO2 instability included older age at operation (p=0.039), lower preoperative SaO2 (p=0.0001) and emergency operation (p=0.001). PBF through stenotic RVOT showed marginal statistical significance (p=0.065).
CONCLUSION
SaO2 instability occurs frequently after shunt operation, especially in patients with severe hypoxia pre-operatively or unstable clinical condition necessitating emergency operation. Temporary elevation of pulmonary vascular resistance is a possible mechanism in this specific clinical setting.