False Aneurysm Following Modified Blalock-Taussig Shunt

Abstract

A 3 1/2-year-old female child presented with massive hemoptysis 5 months after a modified Blalock-Taussig (BT) shunt for double-outlet right ventricle with pulmonary stenosis. Computerized tomographic scan and angiography showed a false aneurysm of the subclavian artery at the insertion of the shunt. Successful surgical management is discussed.

Repair of Ventricular Aneurysm After Stage I Modified Sano-Norwood Procedure

“…6,7,11 The causative factor may be the right ventriculotomy required to place the Sano shunt. 3,6,7,[11][12][13] Although both BlalockTaussig and Sano shunts have been used successfully for many years, evidence on which approach offers the greatest benefit is inconclusive. In our case, a rare complication, formation of an aneurysm at the Sano shunt, was successfully treated.…”

“…The increased workload of the right ventricle, which assumes the work of both the right and left ventricles, coupled with diastolic coronary steal, may lead to hemodynamic instability in the immediate postoperative period. 6,7 In addition, shunt thrombosis is a risk because of the small diameter of the shunt. In a neonate weighing 3 to 4 kg, a 3.5-mm shunt may be used to minimize the risk of thrombosis.…”

“…Competition occurs between pulmonary blood flow and coronary artery blood flow. 6,7 This competition markedly increases the risk for sudden cardiac arrest and death. The major theoretical advantage of the Sano shunt is that it eliminates competitive blood flow between the lungs and coronary arteries, possibly leading to greater postoperative hemodynamic stability.…”

Non Traumatic Brachiocephalic Pseudo Aneurysm

“…Pseudo aneurysm arising from the origin of the Blalock Taussig (BT) shunt is a rare yet serious late complication of this procedure. It usually manifests weeks to months after the initial surgery as a mass effect compressing the adjunct organs or as massive hemoptysis [3,4]. Surgical correction is the preferred intervention in a child with this dreaded complication [3,4].…”

“…It usually manifests weeks to months after the initial surgery as a mass effect compressing the adjunct organs or as massive hemoptysis [3,4]. Surgical correction is the preferred intervention in a child with this dreaded complication [3,4]. We previously reported an unprecedented case of an adult who was treated as a child for TOF by modified BT shunt that presented years later with an acute pseudo aneurysm-SVC fistula resulting in physiologic superior vena cava syndrome [5].…”