I understand how difficult it can be for a parent to be told by a doctor that your newborn baby has a congenital heart defect. At a time like this, when you hear about a 'BTT shunt', you probably have a lot of questions about what it is, why it's done, will it hurt the baby, and are there any risks. Don't worry. Today, we'll talk about it all clearly and simply.
Simply put, what is this BTT Shunt?
A BTT shunt, or Blalock-Taussig-Thomas shunt, is a special surgery performed to help babies who are not getting enough oxygen to their bodies. This condition is caused by a congenital heart condition .
Think about it, our bodies get oxygen from the air we breathe into our lungs. This oxygen needs to be added to the blood and carried throughout the body. However, in some babies with heart disease, the main blood vessel that carries blood from the heart to the lungs , the pulmonary artery , doesn't get enough blood. Then the body doesn't get enough oxygen.
So, what a BTT shunt does is create a new path by inserting a small artificial tube (shunt or graft) from the main blood vessel that carries blood from the heart to the body to the lungs. It's like a small bypass road that bypasses a busy road. This increases the amount of blood going to the lungs, and the body gets better oxygen.
The important thing is that this is usually a temporary solution. Once the baby is a little older and stronger, a major surgery is performed to completely correct the original heart problem. During that surgery, the BTT shunt is removed. However, very rarely, some babies may need to have this shunt as a long-term solution.
What types of heart diseases require BTT Shunt surgery?
This surgery is useful for several congenital heart diseases that reduce blood flow to the lungs.
| Congenital heart conditions |
|---|
| Hypoplastic left heart syndrome |
| Tetralogy of Fallot (TOF) |
| Truncus arteriosus |
| Ebstein's anomaly |
| Pulmonary atresia |
| Tricuspid atresia |
| Some forms of transposition of the great arteries |
What happens before the surgery?
Before the surgery, your baby's medical team will gather all the necessary information. They will examine your baby carefully and take a look at his or her health history from your pregnancy. They may also perform some non-invasive tests.
| Types of tests that can be performed |
|---|
| A heart scan (Transthoracic echocardiogram) |
| Blood tests |
| Chest X-ray |
| ECG test (Electrocardiogram) |
| Sometimes an angiogram or CT angiogram (Coronary angiogram or CT angiogram) |
You will also receive instructions on how to bathe your baby before surgery and when to stop eating and breastfeeding.
What happens during the surgery?
This operation takes several hours and is very delicate. The surgeon mainly does the following:
- The heart is accessed through an incision in the middle of the baby's chest (sternum) .
- To get closer to the heart, the thymus gland located nearby is completely removed.
- As mentioned earlier, a synthetic graft is connected between a main artery that supplies blood to the body (the subclavian artery) and a blood vessel that supplies blood to the lungs (the pulmonary artery).
- This connection is carefully checked to see if it is working properly, if there are any blood clots, or if there is any blood leakage.
- If everything is OK, the baby's chest will close again.
What happens after the surgery?
After the surgery, your baby will be admitted to the intensive care unit (ICU) .
Don't be alarmed by this. You may feel a little uncomfortable when you see your baby after the surgery. The baby will have a lot of tubes and wires attached to it. But remember, all of that equipment is there to help the baby heal quickly. So stay strong.
The baby is given a blood thinner, such as heparin, to prevent blood clots. They also start aspirin . The baby will have to take this aspirin for the rest of his life. Very rarely, some babies may need the help of a temporary life support machine, such as ECMO .
What are the benefits and risks of this surgery?
The main advantage:
The biggest benefit of this surgery is that it increases the amount of oxygen that reaches the baby's body cells. This reduces the blue coloration (cyanosis) seen in some babies' skin, lips, and fingernails due to lack of oxygen. This is a great bridge for the baby to stay healthy and strong until the next major surgery.
Risks and complications:
As with any surgery, there are some risks. Your doctor will explain these to you in detail. Some of the possible complications include:
- More blood flows through the shunt to the lungs than is necessary (pulmonary overcirculation).
- Blood clots.
- Damage to a nerve near the surgical site (especially the nerve that affects the depth of the baby's voice).
- Heartbeat abnormalities (Arrhythmia).
- Cardiac arrest.
These risks are very low, and the medical team is doing its best to prevent things like this.
How long does it take to recover and when should I see a doctor?
The baby will usually stay in the hospital for about two weeks. The first week or so will be spent in the intensive care unit (ICU). Even after you go home, you will need to take your baby for regular checkups. The first visit will usually be within a week or two of going home.
After returning home, if you notice the following symptoms, you should call your doctor immediately.
| Warning signs to look out for |
|---|
| Swelling at the surgery site or elsewhere in the body |
| Redness around the surgical wound |
| If the skin and lips appear blue again |
| If the baby appears to be overly tired or lethargic |
| If you have a fever |
| If fluid is leaking from the surgical wound |
As a parent, we know you want to give your baby the best you can. The best thing you can do at this time is to ask the medical team all the questions you have. Talk clearly about your baby's condition, the surgery, and the future. Choosing a hospital and doctors who have extensive experience in such surgeries will also bring you great peace of mind.
Take-Home Message
- BTT Shunt is a surgery performed on babies with congenital heart disease to increase the amount of blood flowing to the lungs and provide oxygen to the body.
- This is often a temporary solution. Once the baby grows, another surgery will be needed to correct the underlying heart condition.
- After the surgery, the baby will need intensive care treatment and may need to take medications such as aspirin for the rest of his life.
- As with any surgery, there are risks. Talk openly with your doctor about them.
- After you go home, pay close attention to your baby's behavior, skin color, fever, etc. If you notice any changes, seek medical advice immediately.
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