title: Balloon angioplasty for Blalock-Taussig shunt failure in the early postoperative period.
abstract: Blalock-Taussig shunt failure is an infrequent but devastating, and often life-threatening, postoperative complication. Percutaneous balloon angioplasty (BA) of a stenotic modified Blalock-Taussig shunt (mBTS) has been successfully used in the setting of progressive shunt failure months to years after shunt creation. Only a few case reports exist where BA was used in the early postoperative period. We report a case series of urgent balloon angioplasty for acute early postoperative mBTS failure. Five patients were performed with BA. BA was performed within the first 24 hr following mBTS placement in three patients. Mean total procedure time was 57 min (range, 34-77 min) and mean total fluoroscopic time was 13.8 min (range, 6.4-24.1 min). Immediate success, defined as increased angiographic diameter, was accomplished in 4/5 procedures. One patient died during the procedure. Two patients survived to Glenn procedure. One patient underwent redo mBTS and one died the day after the BA. In selected patients, BA can relieve acute thrombosis of mBTS. The risk for reintervention and death is high.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Washington Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: MacMillan
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Jones
authors.forename: Flavian M
authors.initials: FM
authors.lastname: Lupinetti
authors.forename: Troy Alan
authors.initials: TA
authors.lastname: Johnston
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011184:Postoperative Period; D011651:Pulmonary Artery / Q000002:abnormalities / Q000601:surgery*; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000601:surgery*; D016896:Treatment Outcome