Document Detail


Acute and late obstruction of a modified Blalock-Taussig shunt: a two-center experience in different catheter-based methods of treatment.
MedLine Citation:
PMID:  20139195     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Modified Blalock-Taussig (B-T) shunt occlusion results in a sudden reduction of pulmonary vascular perfusion, causing dramatic saturation drop and cyanosis which pose a direct hazard to a child's life. The results of percutaneous local r-tpa infusion, balloon angioplasty and additionally stent implantation in obstructed modified B-T shunts were studied to assess their role as an alternative to a re-do surgery. We outline two pediatric centers' experience (period 2004-2008) regarding the effectiveness of various emergency treatment methods for occlusion or critical stenosis of systemic-to-pulmonary arterial shunts in 23 children. Local r-tpa infusion via catheter was performed in 12/23 patients, balloon angioplasty in 22/23 and additionally stent implantation in 3/23 children. Procedures were successful in 22/23 patients (96%), with an increase in arterial saturation [average: 30%; standard deviation (S.D.) 15%; Shapiro-Wilk test; dependent t-test-P<0.01]. Unrestricted contrast flow was achieved in 18 patients, reduced central flow in three and minimal flow in one child. Neither local nor systemic complications occurred. Our experience demonstrates the possibility of successful early shunt recanalization with the use of local thrombolytic therapy combined with the balloon angioplasty. The presence of old fixed thrombus with neointimal hypertrophy in the shunt constitutes an indication for endovascular stent implantation.
Authors:
Tomasz Moszura; Maria Zubrzycka; Krzysztof W Michalak; Bozena Rewers; Pawel Dryzek; Jacek J Moll; Andrzej Sysa; Piotr Burczynski
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-02-05
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  10     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-20     Completed Date:  2010-08-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  727-31     Citation Subset:  IM    
Copyright Information:
2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.
Affiliation:
Research Institute, Department of Cardiology, Polish Mother's Memorial Hospital, Łódź, Rzgowska, Poland. tmoszura@wp.pl
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MeSH Terms
Descriptor/Qualifier:
Angiography / methods
Balloon Dilatation / methods*
Cardiac Surgical Procedures / adverse effects,  methods
Child, Preschool
Cohort Studies
Emergency Treatment
Female
Follow-Up Studies
Graft Occlusion, Vascular / radiography,  therapy*
Heart Bypass, Right / adverse effects*,  methods
Heart Catheterization / methods*
Heart Defects, Congenital / diagnosis,  surgery*
Humans
Infant
Infant, Newborn
Male
Postoperative Complications / mortality,  therapy
Retrospective Studies
Risk Assessment
Survival Analysis
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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