Balloon dilatation of a Waterston aortopulmonary anastomosis.

Abstract

SUMMARY Percutaneous balloon dilatation of a Waterston anastomosis was performed in a child who had had four shunt operations. Initially, the procedure was apparently successful, but pulmonary oedema developed and he died 12 hours after the procedure.Balloon dilatation of a Waterston anastomosis is technically possible and may prove to be an alternative to reoperation in certain patients. But further experience with the technique is necessary to determine the optimum size of the inflated balloon, and to avoid the risk of producing an excessive increase in pulmonary blood supply.Percutaneous balloon dilatation is useful for the treatment of a wide variety of stenotic lesions associated with congenital heart disease. The technique may prove to be valuable for the dilatation of surgical aortopulmonary anastomoses; however, published data seem to be restricted to a single report of balloon angioplasty of a stenosed Blalock-Taussig shunt.' We report the case of a patient who had balloon angioplasty of a Waterston anastomosis after four shunt operations. The blood supply to the right lung was increased to such an extent that pulmonary oedema developed and he died 12 hours later.Case report X thirteen year old boy with pulmonary atresia and rentricular septal defect had had a Waterston shunt constructed in the neonatal period. Later he had a left Blalock-Taussig shunt when he was two and revision of this shunt when he was five. When he was nine he had an ascending aorta to left pulmonary artery Goretex shunt. The last operation was complicated by severe haemorrhage from multiple small collateral vessels. Four years after his last operation his cyanosis and exercise tolerance had again worsened. Reinvestigation showed that his principal pulmonary blood supply was to the right pulmonary artery from the 13 year old Waterston shunt. Necropsy showed gross congestion and oedema of the right lung with a surrounding pleural effusion and confirmed the angiographic findings of pulmonary atresia with ventricular septal defect and occluded central and Blalock-Taussig shunts. There were dense mediastinal and pericardial adhesions and the heart was not enlarged. There was no extravas-596 on 12 May 2018 by guest. Protected by copyright.