{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:32:19Z","timestamp":1786649539298,"version":"build-2736575974"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The modified Blalock\u2013Taussig\u2013Thomas shunt (mBTTS) is a palliative surgical procedure for tetralogy of Fallot (TOF). It enhances left heart filling, which may cause alterations observable in electrocardiography (ECG) and trans thoracic echocardiography (TTE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>This study aims to assess if the ECG and TTE changes in TOF children undergoing mBTT shunt surgery reflect the improved pulmonary blood flow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Tertiary care hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>A prospective observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Method:<\/jats:title>\n                    <jats:p>Thirty-five (35) children diagnosed with TOF, who underwent mBTTS surgery, were included in this study. Pre-operative assessments included a 12-lead ECG and TTE, which were repeated 6 h postoperatively. Hemodynamic and arterial blood gas parameters were also recorded. Statistical analysis was done using a paired t-test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In ECG, pre-operative P axis and QRS axis were found to be 62.05 \u00b1 20.82 and 139.88 \u00b1 22.52, respectively, and they were reduced to 54.94 \u00b1 18.91 (P value of 0.007) and 107.68 \u00b1 27.18 (P value &lt; 0.001) postoperatively. Other parameters, including P wave duration, P wave amplitude in augmented vector lead (aVL), Morris and Marcuz index, were significantly increased in the post-operative ECG. Pre-operative left atrial (LA) reservoir volume and left ventricular end-diastolic volume (LV-EDV) were found to be 5.42 \u00b1 1.28 mL and 10.54 \u00b1 1.78 mL, respectively, and they were increased to 10.44 \u00b1 2.73 (P value \u2264 0.001) and 11.40 \u00b1 1.73 (P value \u2264 0.001) postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Changes observed in the hemodynamics, blood gas parameters, ECG, and TTE are consistent with improved pulmonary blood flow.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/aca.aca_174_25","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T13:00:12Z","timestamp":1776171612000},"page":"199-203","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["A Comparative Study to Evaluate the Pre and Post-Operative Electrocardiographic and Echocardiographic Changes in Children with Tetralogy of Fallot Undergoing Modified Blalock\u2013Taussig\u2013Thomas Shunt Surgery"],"prefix":"10.4103","volume":"29","author":[{"given":"KG","family":"Krithika","sequence":"first","affiliation":[{"name":"Department of Cardiac Anesthesia and Critical Care, Cardio Thoracic Sciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minati","family":"Choudhury","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anesthesia and Critical Care, Cardio Thoracic Sciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anesthesia and Critical Care, Cardio Thoracic Sciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arindam","family":"Choudhury","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anesthesia and Critical Care, Cardio Thoracic Sciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rama","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardio Thoracic Sciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"R1-20260415","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1016\/j.jacc.2013.07.100","article-title":"Adult congenital and pediatric cardiology section, American college of cardiology. 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