Transcatheter occlusion of Blalock-Taussig shunts: technical options.
OBJECTIVE
This review of findings in children undergoing transcatheter shunt occlusion was carried out to describe and compare the results of four different embolization techniques.


METHODS
A retrospective review of clinical, radiologic, and cardiac catheterization records was carried out for 18 consecutive pediatric patients referred for Blalock-Taussig shunt occlusion at one institution. Technical aspects included the use of three devices--steel wire/fiber coils, detachable latex balloons, and ductal occlusion devices--and four techniques--direct transarterial placement, transarterial placement with proximal or with distal flow control, and transvenous delivery.


RESULTS
Occlusion of the shunt was attempted in 17 patients (mean age, 6.2 years). Shunt occlusion was successful in 14 patients. Embolization of a device into the pulmonary circulation occurred in five patients, and was most frequent with transarterial delivery without flow control or with proximal flow control (in four of six). Transarterial occlusion with distal flow control and transvenous delivery of ductal occluder devices were the most reliable methods of occluding shunts without distal stenosis, with success in eight of nine cases with the former technique and all of three with the latter technique.


CONCLUSIONS
Transarterial embolization of Blalock-Taussig shunts carries a risk of device embolization to the pulmonary circulation; this is best avoided by the use of distal flow control or transvenous placement of a ductal occlusion device.
Burrows
P E
PE
Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada.
Edwards
T C
TC
Benson
L N
LN
D000293:Adolescent; D002404:Catheterization / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D015641:Radiography, Interventional; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D014654:Vascular Patency