Narrative review discusses systemic-to-pulmonary shunts for complex congenital heart defects in pediatric populations

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Frontiers in Medicine Published April 21, 2026 Medically reviewed May 25, 2026 DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Consider systemic-to-pulmonary shunts as a fundamental palliative option for complex congenital heart defects in pediatric patients.

This narrative review evaluates the role of systemic-to-pulmonary shunts, specifically the Blalock-Taussig-Thomas shunt and variants, in the palliative management of complex congenital heart defects. The scope covers prenatal, neonatal, and school-age patients, excluding studies involving adolescents. The authors synthesize evidence indicating that these shunts remain a valuable and widely used palliative technique for univentricular physiology.

The review highlights that differences in complication rates among shunt variants are influenced by patient selection and institutional experience. While emerging alternatives such as ductal stenting may reduce the frequency of surgical shunt placement in selected patients, the authors caution that these alternatives do not currently replace the systemic-to-pulmonary shunt as a comprehensive or universally applicable strategy.

The authors acknowledge that studies involving adolescents were excluded from the analysis. No specific adverse events, absolute numbers, or statistical measures were reported in this narrative synthesis. Consequently, the review supports the practice relevance that systemic-to-pulmonary shunts remain a fundamental surgical option, while noting the limitations of current comparative data.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedApr 2026

View Original Abstract ↓

BackgroundSystemic-to-pulmonary shunts remain a fundamental surgical option in the palliative management of complex congenital heart defects, particularly in patients with univentricular physiology. Although technically demanding, the procedure has evolved through multiple modifications aimed at simplifying its execution and reducing complications, while maintaining its essential clinical role.ObjectiveTo provide a narrative review of the Blalock-Taussig-Thomas shunt, examining its physiological basis, surgical technique, associated risks and complications, postoperative management, and historical evolution, with the goal of evaluating its continued relevance in the palliative treatment of complex congenital heart defects.MethodsA literature search was conducted in Elsevier, PubMed, and Scopus using the keyword “systemic-to-pulmonary shunt.” Studies addressing historical development, technical evolution, clinical indications, and postoperative outcomes were included. The review focused on pediatric populations, specifically prenatal, neonatal, and school-age patients. Studies involving adolescents were excluded to maintain consistency with early developmental stages and the typical clinical context in which these shunts are used.Results & conclusionThe systemic-to-pulmonary shunt remains a valuable and widely used palliative technique for patients with complex congenital heart defects and univentricular physiology. While the original Blalock-Taussig-Thomas technique has historically shown favorable outcomes, differences in complication rates among its variants are influenced by patient selection and institutional experience. Emerging alternatives, such as ductal stenting, may reduce the frequency of surgical shunt placement in selected patients; however, they do not currently replace the systemic-to-pulmonary shunt as a comprehensive or universally applicable strategy.