Catheter-Based Interventions for Modified Blalock–Taussig Shunt Obstruction: A 20-Year Experience

Abstract

Thrombotic occlusion of a modified Blalock-Taussig (BT) shunt is rare, leading to life-threatening hypoxemia. Rescue percutaneous interventions may allow recanalization of the systemic-to-pulmonary shunt but data on large patients' scales are lacking. We aimed to describe safety and effectiveness of catheter-based interventions to restore modified BT shunt patency. All patients who attempted transcatheter intervention for thrombotic occlusion of a modified BT shunt at our Institution from 1994 to 2014 were reviewed. Characteristics, management, and outcomes of the 28 identified patients were analyzed. Thirty-three procedures were performed at a median age of 0.6 years old (range 0.03-32.1 years) and a median weight of 5.8 kg (range 2.2-82 kg). Percutaneous intervention consisted in 33 balloon angioplasty (100 %) and 14 stent implantations (42.4 %). Thrombolytic agents were also used in 6.1 % cases. No peri-procedural death occurred but complications were observed in five patients (15.2 %), including one catheter-induced transient complete atrioventricular block, one cardiac tamponade, and one massive thrombo-embolic stroke. Early procedural success was obtained in 28 patients (84.8 %) and remained long-lasting in 26 patients (78.8 %). A young age and a low body-weight at the time of the procedure were significantly associated with procedural failure (p = 0.0364 and p = 0.0247, respectively). Although technically challenging and carrying potential major complications, transcatheter intervention can be considered as an efficient rescue strategy to restore patency in case of thrombotic obstruction of a modified BT shunt.

Surgically placed radiopaque markers: Proof‐of‐concept of a novel technique to facilitate percutaneous interventions in neonates and infants

“…Over recent decades, neonates and infants have increasingly been undergoing catheterizations after surgery for congenital heart defects for therapeutic purposes in elective and urgent clinical settings. 1,2,5,7,9 This non-controlled proof-of-concept analysis demonstrates that surgically placed radiopaque markers that reveal the proximal entry of a systemic-to-pulmonary artery shunt or the arterial duct proved to be feasible and a beneficial method to facilitate postoperative percutaneous procedures in 25 cardiac catheterizations at our center. The strategy we describe is easy to implement surgically and would be similarly helpful for interventionalists at other pediatric-cardiology centers.…”

“…[1][2][3][4] Since these procedures involve small shunts with diameters usually between 3.0 and 4.5 mm (which often branch off at a sharp angle from the aorta), probing can be difficult, especially when done in urgent situations. [5][6][7][8][9] In the context of hybrid palliation, bilateral pulmonary artery bandings are applied followed by stenting the arterial duct to ensure systemic circulation in congenital cardiac lesions with severe stenosis or an interrupted aorta. 10,11 Of utmost importance are the implanted stent's accurate positioning and length so as to avoid both a stenosis of the duct and impairment of the pulmonary arteries or posterior aortic wall-factors difficult to achieve in certain scenarios.…”

Recanalisation of Totally Occluded Modified Blalock Taussig Shunt by Balloon Angioplasty 48 Hours after its Construction

“…Then, progressive or one step ballooning, depending on balloon tractability, may restore the shunt patency. Additionally, some advocate the use of local or systematic thrombolytic therapy combined with a successful balloon angioplasty procedure [3][4][5][6][7]. Stenting may be needed particularly in distant from surgery interventions and residual narrowing.…”

Transcatheter Treatment of Thrombosis in the Single Ventricle Pathway: An Institutional Experience

“…15 Similar to our experience, limited data from case reports and single-center experiences suggest that catheter-based intervention represents an effective approach for the treatment of mBT shunt and Fontan pathway obstruction. [16][17][18][19] Shunt/conduit thrombosis represents a serious potentially life-threatening complication that continues to be encountered in a proportion of infants and children with univentricular circulation, particularly in the presence of hemodynamic and/or prothrobmbotic risk factors. Our experience suggests that percutaneous catheter-based interventions are effective with acceptable morbidity in managing serious shunt/conduit thrombosis across all stages of single ventricle heart palliation surgery.…”