Percutaneous transluminal balloon angioplasty of stenotic standard Blalock-Taussig shunts: Effect on choice of initial palliation in cyanotic congenital heart disease

Abstract

To date, attempted balloon dilation of stenotic standard Blalock-Taussig shunts has been largely disappointing. It has been suggested that this may be due to the use of balloons of insufficient diameter. Balloon dilation of stenotic Blalock-Taussig shunts was attempted with use of relatively large balloons in five patients (11 to 67 months old) with cyanotic heart disease who were becoming progressively cyanotic and polycythemic (hemoglobin 17.9 +/- 1.1 g/dl) because of discrete shunt stenosis at the site of pulmonary anastomosis. Balloon diameters selected were equal to or within 1 mm of the unobstructed proximal shunt diameter. Before balloon dilation the diameter at the site of the stenosis was 2.8 +/- 0.8 mm (range 1.7 to 4); after balloon dilation it was 5.7 +/- 1.1 mm (range 4.5 to 7.5). The diameter increased in all patients (range 2.0 to 3.5 mm); the mean increase was 2.8 +/- 0.2 mm (p less than 0.005). Expressed as a percent, the increase in diameter at the stenosis ranged from 80% to 182.4% (mean 108.2 +/- 16.8%). Before balloon dilation the systemic oxygen saturation was 72.8 +/- 9.2% (range 55% to 80%) and after balloon dilation it was 83.6 +/- 2.9% (range 80% to 87%). A satisfactory increase (range 6% to 25%) in blood oxygen saturation was seen in all patients; the mean increase was 10.8 +/- 3.2% (p less than 0.01). At follow-up, the oxygen saturation by pulse oximetry was 85.8 +/- 2.9% (mean 5.8 +/- 1.7 months after balloon dilation) and the hemoglobin was 15.6 +/- 1.9 g/dl (mean 6.6 +/- 1.5 months after balloon dilation).(ABSTRACT TRUNCATED AT 250 WORDS)

Frühe postoperative Dysfunktion eines modifizierten Blalock-Taussig-Shunts: Erfolgreiche Therapie mit Angioplastie und Stentimplantation in der Arteria subclavia

“…Zur Therapie der späten Shuntdysfunktion wird seit längerem die Ballonangioplastie eingesetzt (9)(10)(11)(12)(13)(14)(15). Bei Patienten mit früher Shuntdysfunktion ist die operative Therapie mit Thrombektomie oder Shuntrevision das am häufigsten gewählte Vorgehen, welches jedoch mit Komplikationen wie der Stenosierung oder Distorsion der Pulmonalarterie (16), Phrenikusparese, Perigraft-Reaktion, Subclavian steel und einem erneuten Shuntversagen behaftet ist (1)(2)(3)(4)(5)(6).…”

Interventional cardiac catheterization

“…Systemic-to-pulmonary artery shunts (both classical and modified Blalock-Taussig shunts) have been dilated successfully, with significant improvement in oxygen saturations (87,89,116).…”

Stenting and overdilating small Gore‐Tex vascular grafts in complex congenital heart disease

“…Balloon angioplasty to treat acutely stenosed shunts and conduits has been reported since the 1990s [5][6][7][8][9][10]. This was rapidly replaced by stent implantation (due to safety concerns), described in case reports and small series [1,[11][12][13][14][15][16][17][18].…”