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Catheter-Based Interventions for Modified Blalock–Taussig Shunt Obstruction: A 20-Year Experience

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Abstract

Thrombotic occlusion of a modified Blalock–Taussig (BT) shunt is rare, leading to life-threatening hypoxemia. Rescue percutaneous interventions may allow recanalization of the systemic-to-pulmonary shunt but data on large patients’ scales are lacking. We aimed to describe safety and effectiveness of catheter-based interventions to restore modified BT shunt patency. All patients who attempted transcatheter intervention for thrombotic occlusion of a modified BT shunt at our Institution from 1994 to 2014 were reviewed. Characteristics, management, and outcomes of the 28 identified patients were analyzed. Thirty-three procedures were performed at a median age of 0.6 years old (range 0.03–32.1 years) and a median weight of 5.8 kg (range 2.2–82 kg). Percutaneous intervention consisted in 33 balloon angioplasty (100 %) and 14 stent implantations (42.4 %). Thrombolytic agents were also used in 6.1 % cases. No peri-procedural death occurred but complications were observed in five patients (15.2 %), including one catheter-induced transient complete atrioventricular block, one cardiac tamponade, and one massive thrombo-embolic stroke. Early procedural success was obtained in 28 patients (84.8 %) and remained long-lasting in 26 patients (78.8 %). A young age and a low body-weight at the time of the procedure were significantly associated with procedural failure (p = 0.0364 and p = 0.0247, respectively). Although technically challenging and carrying potential major complications, transcatheter intervention can be considered as an efficient rescue strategy to restore patency in case of thrombotic obstruction of a modified BT shunt.

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Acknowledgments

We gratefully acknowledge Mrs. Bénédicte Mennelet-Clouet, Mrs. Odile Messeguer, and Mrs Annette Popineau for their kind assistance.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Standards

The present study was approved by our institutional review board in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Authors and Affiliations

  1. Department of Pediatric and Congenital Cardiac Surgery, M3C-National Reference Centre for Complex Congenital Heart Diseases, Marie Lannelongue Hospital, Paris, France

    Mathilde Bonnet, Jérôme Petit, Virginie Lambert, Emre Belli & Alban-Elouen Baruteau

  2. Department of Adult and Pediatric Interventional Cardiology, Marie Lannelongue Hospital, Paris, France

    Jérôme Petit, Philippe Brenot, Jean-Yves Riou, Claude-Yves Angel & Alban-Elouen Baruteau

  3. Marie Lannelongue Hospital, INSERM UMR 999, Paris, France

    Virginie Lambert

  4. Paris Sud University, Le Kremlin Bicêtre, Paris, France

    Alban-Elouen Baruteau

  5. l’Institut du Thorax, INSERM UMR 1087, CNRS UMR 6291, Nantes University, Nantes, France

    Alban-Elouen Baruteau

Authors
  1. Mathilde Bonnet
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  2. Jérôme Petit
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  3. Virginie Lambert
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  7. Emre Belli
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  8. Alban-Elouen Baruteau
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Correspondence to Alban-Elouen Baruteau.

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Bonnet, M., Petit, J., Lambert, V. et al. Catheter-Based Interventions for Modified Blalock–Taussig Shunt Obstruction: A 20-Year Experience. Pediatr Cardiol 36, 835–841 (2015). https://doi.org/10.1007/s00246-014-1086-0

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  • DOI: https://doi.org/10.1007/s00246-014-1086-0

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