For patients with severe pulmonary hypertension, high pressure in the lung arteries strains the heart and limited blood is returned from the lungs back into the heart to go out the rest of the body. By placing a connection between the left pulmonary artery to the descending aorta, a pop-off is created that decreases strain on the right pumping chamber of the heart (right ventricle) to help prevent heart failure. Therefore, the shunt is flowing in the “reverse” direction away from the lungs. (A classic Potts shunt is a right-to-left connection from the pulmonary artery to the aorta.) The surgery is primarily performed on children.

The procedure requires a heart surgeon to cut into the chest to do the procedure. Sometimes this may require heart-lung bypass. The reverse Potts shunt can be a direct connection between the lung artery and descending aorta or use an artificial valved tube between the two vessels.

Because some amount of blood skips going through the lungs into the descending aorta, the lower part of the body will have lower oxygen levels (usually 5-10%) than the upper part (which includes the heart itself and the brain).

The reverse Potts shunt is currently used when medical therapy is not able to lower the pressures in the lungs to less than the systemic (body) blood pressure. Studies in pediatric patients have shown that the reverse Potts shunt can improve patient activity level, allow for decreasing some PH medications and potentially delay the need for lung transplant. Overall, it does not cure the PH, it allows the heart to better handle it.

The procedure is not without risks and should only be performed in experienced pediatric PH centers. Close follow up is needed by an experienced pediatric PH program.