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The authors discuss how advances in neonatal anesthesia, cardiopulmonary bypass, and perioperative care enable earlier complete repair, yet early correction is not suitable for all infants due to risks such as small pulmonary arteries, prematurity, low birth weight, and very low oxygen saturation. The mBT shunt remains a common palliative option until early repair is broadly feasible.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/response-to-letter-to-the-editor-is-the-modified-blalock-taussig-shunt-becoming-obsolete/445508/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/response-to-letter-to-the-editor-is-the-modified-blalock-taussig-shunt-becoming-obsolete/445508.png","ImageObject",300,407,{"name":92,"@type":93},"Finn","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-04","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the document’s main purpose?","Question",{"text":112,"@type":113},"It responds to comments on a systematic review and meta-analysis about whether the modified Blalock-Taussig (mBT) shunt is becoming obsolete.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why may early complete repair not be appropriate for all infants?",{"text":117,"@type":113},"Infants with small pulmonary arteries and those who are premature, have low birth weight, or oxygen saturation below 70% face higher risk, including inadequate pulmonary blood flow or persistent cyanosis.",{"name":119,"@type":110,"acceptedAnswer":120},"Under what conditions is the mBT shunt expected to remain important?",{"text":121,"@type":113},"It remains critical for symptomatic neonates with tetralogy of Fallot until early repair becomes universally feasible and appropriate infrastructure and specialized teams are available.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},445508,1790814737,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24},34359740700684,"https://ap-avatar.wpscdn.com/avatar/1f400023980c374ae676?_k=1777273430885731487","Turkish Journal of Thoracic and Cardiovascular Surgery 2025;33(4):588-589  \nLetter to the Edıtor / Editöre Mektup  \nResponse to Letter to the Editor: Is the modified Blalock-Taussig  \nshunt becoming obsolete?  \nEditöre Mektup Yanıtı: Makaleye yorum: Modifiye Blalock-Taussig şantı gözden mi düşüyor? Adli Daffa Ikhwani􀀬, Amar Rayhan􀀬, Suprayitno Wardoyo􀀬  \nDivision of Cardiothoracic and Vascular Surgery, Department of Surgery, Faculty of Medicine,  \nUniversitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia  \nWe sincerely appreciate the thoughtful comments[1] regarding our recent systematic review and meta-analysis on the modified Blalock-TaussigThomas (mBT) shunt. [2]  \nAdvance s in neonatal anesthesia, cardiopulmonary bypass (CPB), and perioperative care have, indeed, enabled early complete repair in many cases . Furthermore, interventional procedures such as right ventricular outflow tract (RVOT) stenting have demonstrated certain advantages including lower admission rates to the pediatric intensive care unit (ICU), shorter total hospital length of stay, and earlier timing to definitive surgical repair. [3]  \nNevertheless, not all patients are suitable candidates for early total correction . Infants with small right and left pulmonary arteries are at risk of right ventricular failure due to elevated right ventricular pressures if a complete repair is attempted too early, thereby leading to inadequate pulmonary blood flow or persistent cyanosis . In addition, premature infants, those with low birth weight, and those with oxygen saturations \u003C70% still remain at significantly higher risk while undergoing early complete repair. For such patients, the mBT shunt continues to be recognized as the most common surgical palliative procedure for symptomatic neonates with tetralogy of Fallot. [4]  \nSuccessful early repair also requires the availability of specialized infrastructure, including a dedicated pediatric cardiac ICU, extracorporeal  \nmembrane oxygenation support, and an experienced perfusion team . In Indonesia, however, not all tertiary centers are able to perform RVOT stenting or early total correction . By contrast, the mBTshunt usually does not require CPB in routine cases, although it is advisable to have CPB on standby in complex scenarios . [5]  \nWe agree that the trend toward early correction is reshaping surgical strategies, and the role of themBT shunt is becoming increasingly selective. Not all patients require an mBT shunt prior to total correction if the pulmonary arteries are adequately developed. However, until early repair becomes universally feasible, the mBT shunt will remain a critical component in the armamentarium of congenital cardiac surgery. In our review, we attempt to highlight complications associated with this procedure, thereby helping clinicians to anticipate and manage them more effectively.  \nThank you for contributing to this important discussion .  \nData Sharing Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.  \nAuthor Contributions: Refines, extends, and challenges existing theories: A.D.I.; Provides new data from experiments or clinical studies: A.R.; Supervised and provided critical revision  \nof the manuscript: S.W.  \nConflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.  \nCorresponding author: Amar Rayhan.  \nE-mail: [amarrayhan22@gmail.com](amarrayhan22@gmail.com)  \n[Doi: 10.5606/tgkdc.dergisi.2025.48327](Doi: 10.5606/tgkdc.dergisi.2025.48327)  \n[Received:](Received: September 03)[ September 03](Received: September 03) , 2025  \nAccepted: September 05, 2025  \nPublished online: October 20, 2025  \nCite this article as: Ikhwani AD, Rayhan A, Wardoyo S. Response to Letter to the Editor: Is the modified Blalock-Taussig shunt becoming obsolete?. Turk Gogus Kalp Dama 2025;33(4):588-589 . doi: 10.5606/tgkdc.dergisi.2025.4","cbCaipMA1lOaiDvd","https://ap.wps.com/l/cbCaipMA1lOaiDvd","pdf",146763,"English","# Response to Letter to the Editor\n## Background and appreciation of comments\n## Rationale for early repair vs selective use\n## Patient selection and infrastructure requirements\n## Future role of the mBT shunt\n## Declarations","[{\"question\":\"What is the document’s main purpose?\",\"answer\":\"It responds to comments on a systematic review and meta-analysis about whether the modified Blalock-Taussig (mBT) shunt is becoming obsolete.\"},{\"question\":\"Why may early complete repair not be appropriate for all infants?\",\"answer\":\"Infants with small pulmonary arteries and those who are premature, have low birth weight, or oxygen saturation below 70% face higher risk, including inadequate pulmonary blood flow or persistent cyanosis.\"},{\"question\":\"Under what conditions is the mBT shunt expected to remain important?\",\"answer\":\"It remains critical for symptomatic neonates with tetralogy of Fallot until early repair becomes universally feasible and appropriate infrastructure and specialized teams are available.\"}]","Response to Letter to the Editor - Is the modified Blalock-Taussig shunt becoming obsolete? | PDF",1790712295]