Systemic pulmonary shunts were performed in 41 consecutive neonates with congenital cyanotic heart disease between 1981 and 1992. The lesions comprised pulmonary atresia with intact interventricular septum (16 cases), pulmonary atresia with ventricular septal defect (9 cases), tetralogy of Fallot (5 cases), transposition of the great arteries (3 cases) and different complex cardiac lesions (8 cases). A polytetrafluoroethylene tube was used in 40 neonates, 5 mm in diameter in 39 cases, anastomosed to be subclavian artery in 21 patients (group A) and on the ascending aorta or innominate artery in 19 patients (group B). A retrospective analysis of the results was undertaken in all patients with a mean follow-up period of 6.5 years (range: 19 months-12.5 years). There were 4 early deaths (9.7%) and 8 late deaths (19.5%) giving a total mortality of 29.2%. Of the late deaths, 4 occurred in the first year, 3 suddenly at home and 4 in relation with the surgical correction. Occlusion of the shunt was suspected in only one case. The actuarial survival rate was 78% at one year, 75.5% at 7 years and 66% at 10 years. Eleven of the 12 deaths were in children with pulmonary atresia with intact interventricular septum (8 cases) and complex cardiac malformations (3 cases). Early complications were observed in 15 of the 37 survivors of the initial procedure. Cardiac failure occurred in 83% of group B and 22% of group A (p < 0.01). The probability of shunt efficacy was 89% at 1 year, 63% at 2 years and 45% at 3 years.(ABSTRACT TRUNCATED AT 250 WORDS)