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Occlusion of the Modified Blalock?Taussig Shunt: Unique Methods of Treatment and Review of Catheter-based Intervention

2007; Wiley; Volume: 2; Issue: 3 Linguagem: Inglês

10.1111/j.1747-0803.2007.00095.x

1747-0803

Brian Kogon, Craig R. Villari, N. Sarita Shah, Paul Kirshbom, Kirk R. Kanter, Dennis Kim, A Raviele, Robert Vincent,

Renal and Vascular Pathologies

Objective. To report unique methods of treatment and review catheter-based intervention for occluded modified Blalock–Taussig shunts (BTS). Methods. Case reports and articles involving children undergoing catheter-based treatment for occluded modified BTS were reviewed. Results. Literature review detailed 38 patients in whom occluded modified BTS were treated with 39 catheter-based interventions. Thrombolytics alone were delivered by catheter in 13 cases. Balloon angioplasty was performed in 23 cases, 5 with stent implantation. Both thrombolytic delivery and angioplasty were performed in 3 cases, 2 with stent implantation. Intervention was initially successful at re-establishing modified BTS patency in 35/39 (90%) of cases. Patency could not be established in 2 patients who then proceeded to the operating for surgical shunt revision. Two deaths occurred during the procedures. Three cases at Emory University demonstrate uncommon or unique instances of catheter-based intervention: (1) declotting of a shunt in a patient supported by extracorporeal membrane oxygenation (ECMO); (2) declotting of a shunt via a right axillary arterial approach; and (3) declotting of a shunt using a carotid arterial (ECMO) cannula for percutaneous access. Conclusions. The use of catheter-based techniques for the treatment of BTS occlusion is highly successful, and potentially avoids high-risk re-operative intervention. ECMO can provide for a stable patient during the procedure. Hopefully, with improved technology and innovative procedures, more children in the future with BTS occlusion can be served by successful percutaneous intervention.