Many decades ago Potts shunt (Central Aortic -PA shunt)was used to increase pulmonary blood flow for severe RVOT obstruction mostly for TOF and tricuspid atresia .With the advent of ICR and Fontan role for central aorti shunts waned.
Now, read this
Chronic ,refractory pulmonary hypertension of any cause has dismal outcome.In patients with severe PAH many patients reach supra-systemic pressures . RV a volume handling chamber faces a uphill task of overcoming huge RV after load. As cardiac physicians , we struggle to perfuse the lungs in such situations.
The only option seems to be lung transplantation !
How to perfuse the lungs if the RV is failing ?
Is there any other alternative ?
Why not,use LV contractility to perfuse lungs .
Great Idea isn’t ? After all , how can we allow left ventricle known for it’s robust bumping function sit idle and relax when it’s counterpart is struggling with heavy load ?
How to use LV for increasing pulmonary blood flow ?
Create a central Aortic -Pulmonary shunt.
That’s resurgence of Potts shunt.
Dr Julie Blanc from France suggested this approach in in NEJM as a letter (Potts Shunt in Patients with Pulmonary Hypertension N Engl J Med 2004; 350:623) . It was a great Idea.
Since then lots of patients have a benefited from this vintage surgery.
Final message
A surgery blamed for early onset of pulmonary vascular damage due to potential Eisenmenger reaction is back .Indication for refractory Eisenmenger syndrome to perfuse lungs at very high pressure Nothing is obsolete in medical science .Nothing is ironical as well !
Another Innovation : Now Transcatheter Potts Surgery
Dr.S.Venkatesan MD 