title: Late-onset Blalock-Taussig shunt occlusion due to a subclavian artery pseudoaneurysm.
abstract: 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.
authors.affiliation: Department of Pediatric Cardiology, Second University of Naples, Naples, Italy. santoropino@tin.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santoro
authors.forename: Gaetano
authors.initials: G
authors.lastname: Palma
authors.forename: Ettore
authors.initials: E
authors.lastname: Merlino
authors.forename: Maurizio Cappelli
authors.initials: MC
authors.lastname: Bigazzi
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Palladino
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
authors.forename: Carlo
authors.initials: C
authors.lastname: Vosa
mesh_terms: 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*