Hi Mossab,
I assume that for Waterston shunt you mean the creation of an aorto pulmonary shunt by connecting the ascending aorta to the right pulmonary artery. Initially done by direct anastomosis it has been modified by using the interposition of a PTFE tube graft between the ascending aorta and the right pulmonary artery to create the shunt. If for modified Waterston shunt (aorto pulmonnary shunt with the interposition of PTFE graft) you mean this last description the is usually done through a midline sternotomy,
I do not have experience with right or left thoracotomy. Although I imaging that can be performed through a right thoractomy. Regarding you question of a left thoracotomy approach i believe that Waterston shunt are not doable. What you can do from a left thoractomy (maybe) is a Potts shunt that consisted in anastomosis of the left pulmonary artery with the descending aorta.
Nowadays I believe that Potts shunts are almost abandoned and Waterston are used only for limited group of patients like Tetralogy of Fallot with pulmonary atresia. Current approaches tend to do primary repair in first instance (when possible) but if a shunt is required modified Blalock Taussig is the more widely adopted shunt.
I'm sure that Waterston shunts could be still a valid option for older patients with untreated congenital heart disease and pulmonary hypertension or untreatable pulmonary artery hypoplasia where the shunt is used to increment oxigenation as destination therapy but there is not extensive literature supporting that apart single centers experience.
I hope this is what yo were looking for.
through right thoracotomy
is no longer performed because better alternatives
thank you very much for your answers Dr. Mauro Lo Rito and Dr. Marc Gewilling.
as you both support the central approach of the modified Waterston shunt, I am totally with you. I was thinking about right thoracotomy approach in cases you face anatomical challenges ( bovine arch, aberrant subclavian artery,..etc) to perform the right BT shunt while you all ready opened the patient right chest.
thank you again
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