Late-onset Blalock-Taussig shunt occlusion due to a subclavian artery pseudoaneurysm.
A 3-month-old infant with tetralogy of Fallot presented with progressive severe cyanosis and intractable acidosis about 2 months after a successful modified right-sided Blalock-Taussig shunt. At cardiac catheterization, the suspected shunt malfunction was confirmed. It was due to a bulky, pear-like mass arising from the right subclavian artery and compressing the polytetrafluoroethylene conduit. Any attempt to recanalize the shunt by percutaneous techniques proved unsuccessful. At surgery, a huge dilation of the anterior wall of the right subclavian artery, that sharply bent the prosthetic conduit, was found. Pathologic examination revealed that the compressing mass was pseudo-aneurysmal in nature. Despite a second successful shunt operation with a dramatic clinical improvement, the patient died due to multiorgan failure 72 hours following surgery. Extrinsic compression by a false aneurysm is a rare cause of shunt occlusion that should always be suspected in patients presenting with a rapidly progressive shunt malfunction late after a successful shunt procedure.
Santoro
Giuseppe
G
Department of Pediatric Cardiology, Second University of Naples, Naples, Italy. santoropino@tin.it
Palma
Gaetano
G
Merlino
Ettore
E
Bigazzi
Maurizio Cappelli
MC
Palladino
Maria Teresa
MT
Calabrò
Raffaele
R
Vosa
Carlo
C
D000138:Acidosis / Q000209:etiology*; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003490:Cyanosis / Q000209:etiology*; D017809:Fatal Outcome; D006801:Humans; D007223:Infant; D011859:Radiography; D013348:Subclavian Artery / Q000000981:diagnostic imaging*; D013771:Tetralogy of Fallot / Q000601:surgery*