Occlusion of the Modified Blalock?Taussig Shunt: Unique Methods of Treatment and Review of Catheter-based Intervention

Abstract

The use of catheter-based techniques for the treatment of BTS occlusion is highly successful, and potentially avoids high-risk re-operative intervention. ECMO can provide for a stable patient during the procedure. Hopefully, with improved technology and innovative procedures, more children in the future with BTS occlusion can be served by successful percutaneous intervention.

Complete blalock–taussig shunt obstruction in < 24 hours post‐operative period in a neonate treated emergently using transcatheter angioplasty and low dose local recombinant TPA

“…Local and systemic thrombolysis for MBTS occlusion in association with angioplasty and stent placement has been reported successfully. However, the shunt occlusion occurred several days to months after surgery in these patients . Thrombolytic therapy for this indication is generally contraindicated due to high risk for hemorrhagic complications under the following circumstances: immediate post‐operative period , patients in critical condition such as in shock, acidosis, or with coagulation disturbances, evidence of overt or occult bleeding, and in patients with intracranial bleed or evidence of brain ischemia .…”

Hypoplastic Left Heart Syndrome

“…Mechanical disruption using catheter manipulation and/or balloon angioplasty, pharmacological dissolution with urokinase or recombinant tissue plasminogen activator, and rheolytic catheter thrombectomy have been used individually or in combination (158–160,165). In cases of extreme cyanosis, the use of ECMO prior to catheter intervention has been described (164). …”

Transcatheter stenting of the systemic‐to‐pulmonary artery shunt: A 7‐year experience from a single tertiary center

“…In our experience, the median time to shunt failure was ∼2 months, however we intervened in patients at all stages after shunt placement, including in two patients with acute obstruction requiring ECMO support. It is possible to perform catheter‐based shunt intervention on a patient supported by ECMO and it may even be preferred in the unstable patient . We demonstrated the effectiveness of stent implantation in multiple scenarios of shunt failure, including acute post‐operative shunt occlusion, inter‐stage shunt dysfunction and the chronic palliative shunt.…”