title: Transcatheter Treatment of Thrombosis in the Single Ventricle Pathway: An Institutional Experience.
abstract: BACKGROUND
  Shunt or conduit thrombosis in a single ventricle circuit is a life-threatening complication that requires prompt treatment to rapidly restore shunt/conduit patency. Transcatheter interventions represent an attractive alternative to systemic thrombolysis or open surgical procedures. We report our center's experience with catheter-based approaches in patients with palliated single ventricle who present with shunt/conduit thrombosis.
  
  
  METHODS
  A retrospective review was performed of all patients with palliated single ventricle physiology who were diagnosed over a 5-year period with shunt/conduit thrombosis and received catheter-based interventions. Patients were followed up to hospital discharge.
  
  
  RESULTS
  Thirteen patients were identified that were diagnosed with thrombosis of a modified Blalock-Taussig shunt (five patients), bidirectional cavopulmonary shunt (one patient), and total cavopulmonary pathway (seven patients). Shunt/conduit thrombosis occurred both early and late after palliation surgery. Catheter-based interventions included balloon angioplasty (one patient), stent implantation (12 patients), and mechanical thrombectomy (one patient). Thrombophilia was identified in seven patients. Technical and clinical success with restoration of normal shunt flow and improvement in clinical status was achieved in 12 patients. Reversible procedure-related complications occurred in three patients with no significant sequelae.
  
  
  CONCLUSIONS
  Our experience suggests that percutaneous catheter-based interventions are safe and effective in managing shunt/conduit thrombosis in infants and children with palliated single ventricle circulation.
authors.affiliation: Department of Hematology, Children's National Health System, Washington, DC, USA.
authors.forename: Yaser A
authors.initials: YA
authors.lastname: Diab
authors.affiliation: Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ramakrishnan
authors.affiliation: Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA.
authors.forename: Fahad A
authors.initials: FA
authors.lastname: Alfares
authors.affiliation: Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA.
authors.forename: Conor F
authors.initials: CF
authors.lastname: Hynes
authors.affiliation: Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA.
authors.forename: Reginald
authors.initials: R
authors.lastname: Chounoune
authors.affiliation: Department of Critical Care, Children's National Health System, Washington, DC, USA.
authors.forename: Venkat
authors.initials: V
authors.lastname: Shankar
authors.affiliation: Division of Cardiology, Children's National Health System, Washington, DC, USA.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Kanter
authors.affiliation: Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA.
authors.forename: Dilip S
authors.initials: DS
authors.lastname: Nath
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D058366:Blalock-Taussig Procedure / Q000009:adverse effects*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D018610:Heart Bypass, Right / Q000009:adverse effects*; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery*; D006801:Humans; D008297:Male; D010166:Palliative Care; D012189:Retrospective Studies; D015607:Stents; D017131:Thrombectomy / Q000009:adverse effects; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Congenital Heart Disease; Single Ventricle Physiology; Transcatheter Intervention