Obstruction of modified Blalock-Taussig shunt is serious complication.
The purpose of this study is a retrospective evaluation of the effectiveness of various transcatheter recanalisation methods for the treatment of occlusion or critical stenosis of BT shunts in 24pts, aged from 2 weeks to 8 years.
All 24pts were accepted for BT due to complicated anatomy of CHD (no cardiac flow to pulmonary arteries in 15/24) and/or pulmonary arteries hipoplasia.
In 12pts the occlusion was detected in the postoperative period (1-14days), in 10/24pts it occurred during the long-term follow-up.
Methods of BT recanalisation:| local rtpa infusion via catheter in BT was performed in all 24pts for short period of time (appr 10 min) followed by balloon angioplasty of BT in 22pts and additionally stents implantation to BT in 3pts. Due to severe pulmonary arteries hypoplasia and poor clinical result of BT recanalisation additionally in 1pt stent was implanted to the pulmonary artery, in 1pt to RVOT.
The emergency transcatheter BT recanalization was successful in 22/24pts (92%), with arterial saturation increase (average: 31%; SD - 16%; p<0,001). Unrestricted blood flow in the recanalized BT was achieved in 19/24pts. In 2pts new BT shunt was performed due to suboptimal clinical result of recanalisation.
No procedure related complications were observed.
Conclusions:
1) Emergency transcatheter recanalization of occluded Blalock-Taussig shunts is safe and effective, so it is an alternative to surgical treatment.
2) The presence of fixed lesions with neointimal hypertrophy significantly reduces the effectiveness of isolated balloon angioplasty and indicates endovascular stent implantation