Greedy Fat Radiologists Want Big Pizzas

Many shunt procedures for congenital heart disease connect a vessel to a pulmonary artery. A mnemonic for these shunts (in order of blood flow from the superior vena cava down into the descending aorta) is "Greedy Fat Radiologists Want Big Pizzas":

Glenn	SVC	to	PA
Fontan	RA	to	PA
Rastelli	RV	to	PA
Waterston-Cooley	Ascending aorta	to	PA
Blalock-Thomas-Taussig	Subclavian artery	to	PA
Potts	Descending aorta	to	PA

The Waterston and Potts shunts are out of favor due to the high incidence of pulmonary hypertension and CHF.

The Rastelli procedure is used in patients with D-transposition of the great vessels and ventricular septal defects with some degree of left ventricular outflow obstruction (small or abnormal pulmonary valve). Performing the Jatene (arterial switch) procedure in such cases may result in pulmonary stenosis. Rastelli procedure is indicated in such cases. It involves 1) Dividing the pulmonary artery just above the pulmonic valve, 2) Creating an intraventricular tunnel that redirects blood from the left ventricle through the ventricular septal defect into the ascending aorta, and 3) Creating an external conduit from the right ventricle to the pulmonary artery.

At the end of the Rastelli procedure left ventricular blood goes to the aorta and right ventricular blood goes to the pulmonary arteries, correcting the transposition at the ventricular level.

The Rastelli procedure can also be used in cases of pulmonary outflow tract obstruction with an overriding aorta.

References

Gaca AM, Jaggers JJ, Dudley LT, Bisset GS 3rd. Repair of congenital heart disease: a primer-part 1. Radiology. 2008 Jun;247(3):617-31.