title: Catheter-based interventions for modified Blalock-Taussig shunt obstruction: a 20-year experience.
abstract: Thrombotic occlusion of a modified Blalock-Taussig (BT) shunt is rare, leading to life-threatening hypoxemia. Rescue percutaneous interventions may allow recanalization of the systemic-to-pulmonary shunt but data on large patients' scales are lacking. We aimed to describe safety and effectiveness of catheter-based interventions to restore modified BT shunt patency. All patients who attempted transcatheter intervention for thrombotic occlusion of a modified BT shunt at our Institution from 1994 to 2014 were reviewed. Characteristics, management, and outcomes of the 28 identified patients were analyzed. Thirty-three procedures were performed at a median age of 0.6 years old (range 0.03-32.1 years) and a median weight of 5.8 kg (range 2.2-82 kg). Percutaneous intervention consisted in 33 balloon angioplasty (100 %) and 14 stent implantations (42.4 %). Thrombolytic agents were also used in 6.1 % cases. No peri-procedural death occurred but complications were observed in five patients (15.2 %), including one catheter-induced transient complete atrioventricular block, one cardiac tamponade, and one massive thrombo-embolic stroke. Early procedural success was obtained in 28 patients (84.8 %) and remained long-lasting in 26 patients (78.8 %). A young age and a low body-weight at the time of the procedure were significantly associated with procedural failure (p = 0.0364 and p = 0.0247, respectively). Although technically challenging and carrying potential major complications, transcatheter intervention can be considered as an efficient rescue strategy to restore patency in case of thrombotic obstruction of a modified BT shunt.
authors.affiliation: Department of Pediatric and Congenital Cardiac Surgery, M3C-National Reference Centre for Complex Congenital Heart Diseases, Marie Lannelongue Hospital, Paris, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Bonnet
authors.forename: Jérôme
authors.initials: J
authors.lastname: Petit
authors.forename: Virginie
authors.initials: V
authors.lastname: Lambert
authors.forename: Philippe
authors.initials: P
authors.lastname: Brenot
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Riou
authors.forename: Claude-Yves
authors.initials: CY
authors.lastname: Angel
authors.forename: Emre
authors.initials: E
authors.lastname: Belli
authors.forename: Alban-Elouen
authors.initials: AE
authors.lastname: Baruteau
mesh_terms: D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon / Q000379:methods*; D058366:Blalock-Taussig Procedure / Q000009:adverse effects* / Q000379:methods; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000628:therapy; D015607:Stents; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents