Systemic-pulmonary shunts in infants and children

Lamberti, John J.; Carlisle, James H.; Waldman, J. Deane; Lodge, Frederick A.; Kirkpatrick, Stanley E.; George, Lily; Mathewson, James W.; Turner, Searle W.; Pappelbaum, Stanley J.

doi:10.1016/s0022-5223(19)38389-8

Cited by 44 publications

(15 citation statements)

References 11 publications

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“…The overall incidence of occlusion in our cohort is higher than noted in other studies done in similar age-groups. 24 " 7 Like Lamberti et al, 10 we found that central shunts are more prone to occlusion than other types of shunt, though the differences we noted did not reach statistical significance due to the small size of our sample and the importance of administration of Aspirin. Our data show that the incidence of occlusion is also influenced by the diameter of the shunt.…”

Section: Figuresupporting

confidence: 45%

Reduced frequency of occlusion of aorto-pulmonary shunts in infants receiving Aspirin

et al. 1999

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Section: Figuresupporting

confidence: 45%

Reduced frequency of occlusion of aorto-pulmonary shunts in infants receiving Aspirin

et al. 1999

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“…Our discharge survival of 96% compares favorably with the range of 85%-94% reported by others for cohorts not restricted to small patients. [4][5][6][11][12][13][14][15][16][17][18] Recently, Petrucci and colleagues 5 reported on a multiinstitutional series from the STS Congenital Heart Surgery Database of more than 1200 patients; 592 patients weighed between 1.5 and 3.0 kg at the time of SPS. Discharge survival was 84.4% in patients weighing 2-2.5 kg and 89% in all patients weighing less than 3 kg.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of systemic to pulmonary artery shunts in patients weighing less than 3 kg: Analysis of shunt type, size, and surgical approach

Myers

Ghanayem

Cao

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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“…Extracardiac shunts (ECS) are commonly used for the palliation of patients with congenital heart disease (CHD) who are not candidates for early complete repair . There are several forms of CHD where repair must be accomplished in stages .…”

Section: Introductionmentioning

confidence: 99%

“…palliation of patients with congenital heart disease (CHD) who are not candidates for early complete repair. [1][2][3][4] There are several forms of CHD where repair must be accomplished in stages. 2,5 After placement of a palliative ECS, a period of months may be required to achieve sufficient somatic growth, pulmonary artery growth, and fall in pulmonary vascular resistance to allow candidacy for definitive intracardiac repair.…”

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confidence: 99%

Prevention of Arteriovenous Shunt Occlusion Using Microbubble and Ultrasound Mediated Thromboprophylaxis

Kutty

Hammel

et al. 2014

JAHA

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BackgroundPalliative shunts in congenital heart disease patients are vulnerable to thrombotic occlusion. High mechanical index (MI) impulses from a modified diagnostic ultrasound (US) transducer during a systemic microbubble (MB) infusion have been used to dissolve intravascular thrombi without anticoagulation, and we sought to determine whether this technique could be used prophylactically to reduce thrombus burden and prevent occlusion of surgically placed extracardiac shunts.Methods and ResultsHeparin‐bonded ePTFE tubular vascular shunts of 4 mm×2.5 cm (Propaten; W.L Gore) were surgically placed in 18 pigs: a right‐sided side‐to‐side arteriovenous (AV, carotid‐jugular) shunt, and a left‐sided arterio‐arterial (AA, carotid‐carotid) interposition shunt in each animal. After shunt implantation, animals were randomly assigned to one of 3 groups. Transcutaneous, weekly 30‐minute treatments (total of 4 treatments) of either guided high MI US+MB (Group 1; n=6) using a 3% MRX‐801 MB infusion, or US alone (Group 2; n=6) were given separately to each shunt. The third group of 6 pigs received no treatments. The shunts were explanted after 4 weeks and analyzed by histopathology to quantify luminal thrombus area (mm2) for the length of each shunt. No pigs received antiplatelet agents or anticoagulants during the treatment period. The median overall thrombus burden in the 3 groups for AV shunts was 5.10 mm2 compared with 4.05 mm2 in AA (P=0.199). Group 1 pigs had significantly less thrombus burden in the AV shunts (median 2.5 mm2) compared with Group 2 (median 5.6 mm2) and Group 3 (median 7.5 mm2) pigs (P=0.006). No difference in thrombus burden was seen between groups for AA shunts.ConclusionTranscutaneous US with intravenous MB is capable of preventing thrombus accumulation in arteriovenous shunts without the need for antiplatelet agents, and may be a method of preventing progressive occlusion of palliative shunts.

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Systemic-pulmonary shunts in infants and children

Cited by 44 publications

References 11 publications

Reduced frequency of occlusion of aorto-pulmonary shunts in infants receiving Aspirin

Reduced frequency of occlusion of aorto-pulmonary shunts in infants receiving Aspirin

Outcomes of systemic to pulmonary artery shunts in patients weighing less than 3 kg: Analysis of shunt type, size, and surgical approach

Prevention of Arteriovenous Shunt Occlusion Using Microbubble and Ultrasound Mediated Thromboprophylaxis

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