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Implantation of stents as an alternative to reoperation in neonates and infants with acute complications after surgical creation of a systemic-to-pulmonary arterial shunt

Published online by Cambridge University Press:  05 February 2008

Michael Kaestner ,
Ronald P. Handke ,
Joachim Photiadis ,
Matthias Sigler  and
Martin B.E. Schneider
Michael Kaestner*
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, Asklepiosklinik St. Augustin GmbH, Deutsches Kinderherzzentrum, Sankt Augustin, Germany
Ronald P. Handke
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, Asklepiosklinik St. Augustin GmbH, Deutsches Kinderherzzentrum, Sankt Augustin, Germany
Joachim Photiadis
Affiliation:
Department of Thoracic and Cardiac Surgery, Asklepiosklinik St. Augustin GmbH, Deutsches Kinderherzzentrum, Sankt Augustin, Germany
Matthias Sigler
Affiliation:
Department of Pediatric Cardiology and Intensive Care, Georg August Universität Göttingen, Heart Center, Göttingen, Germany
Martin B.E. Schneider
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, Asklepiosklinik St. Augustin GmbH, Deutsches Kinderherzzentrum, Sankt Augustin, Germany
*
Correspondence to: Dr med. Michael Kaestner, Asklepiosklinik St. Augustin GmbH, Deutsches Kinderherzzentrum, Department of Pediatric Cardiology and Congenital Heart Disease, Arnold Janssen Straße 29, 53757 Sankt Augustin, Germany. Tel: +49-2241-249650; Fax: +49-2241-249652; E-mail: [email protected]
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Abstract

Creation of a systemic-to-pulmonary shunt is still the firstline treatment in neonates with duct-dependent pulmonary circulation, or in patients with hypoplastic left heart syndrome as a part of the first stage of the Norwood sequence. Acute complications after such surgery, such as stenosis, thrombosis, or kinking, are potentially lifethreatening. These complications require immediate revision or exchange of the shunt. In this report, we discuss interventional treatment as an alternative to surgery in 5 patients with acute stenosis or complete occlusion of a shunt.

The age of the patients ranged from 12 to 62 days, with a median of 30 days, and their weights ranged between 2.2 and 4.6 kilogrammes, with a median of 3.2 kilogrammes. In 3 patients, the shunts were central or of modified Blalock-Taussig type, while the 2 patients with hypoplastic left heart syndrome had shunts from the right ventricle to the pulmonary arteries. We implanted 6 coronary arterial and 2 peripheral stent systems. The diameter of the balloon used for implantation had a ratio to the shunt of 0.9. to 1.

All shunts were successfully reopened by stenting. During follow-up, 3 patients underwent further procedures on an elective basis. We have one patient on the waiting list for further surgical intervention, but one patient died of septicaemia unrelated to the interventional procedure one month after implantation.

In our limited experience, implantation of stents is an effective and long-lasting treatment for complications of shunts in an emergency situation.

Keywords

Congenital heart diseaseheart surgerycatheterizationcyanosis
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 2 , April 2008 , pp. 177 - 184
Copyright
Copyright © Cambridge University Press 2008

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References

1. de Leval, MR, McKay, R, Jones, M, Stark, J, Macartney, FJ. Modified Blalock-Taussig shunt. Use of subclavian artery orifice as flow regulator in prosthetic systemic-pulmonary artery shunts. J Thorac Cardiovasc Surg 1981; 81: 112–119.CrossRefGoogle ScholarPubMed
2. Gazzaniga, AB, Elliot, MP, Sperling, DR, et al. Microporus expanded polytetrafluoroethylene arterial prosthesis for construction of aortopulmonary shunts: experimental and clinical results. Ann Thorac Surg 1976; 21: 322–327.CrossRefGoogle Scholar
3. Norwood, WI, Lang, P, Casteneda, AR, Campbell, DN. Experience with operation for patients with hypoplastic left heart syndrome. J Thorac Cardiovosc Surg 1981; 82: 511–519.CrossRefGoogle Scholar
4. Norwood, WI, Lang, P, Hansen, DD. Physiologic repair of aortic atresia-hypoplastic left heart syndrome. N Engl J Med 1983; 308: 23–26.CrossRefGoogle ScholarPubMed
5. Gates, RN, Laks, H, Johnson, K. Side-to-side Aorto-Gore-Tex central shunt. Ann Thorac Surg 1998; 65: 515–516.CrossRefGoogle ScholarPubMed
6. Alkhulaifi, AM, Lacour-Gayet, F, Serraf, A, Belli, E, Planché, C. Systemic pulmonary shunts in neonates: early clinical outcome and choice of surgical approach. Ann Thorac Surg 2000; 69: 1499–1504.CrossRefGoogle ScholarPubMed
7. Sano, S, Ishino, K, Kawada, M, et al. Right ventricle-pulmonary artery shunt in first stage palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2003; 126: 504–510.CrossRefGoogle ScholarPubMed
8. Ilbawi, MN, Grieco, J, DeLeon, SY, et al. Modified Blalock-Taussig Shunt in newborn infants. J Thorac Cardiovasc Surg 1984; 88: 770–775.CrossRefGoogle ScholarPubMed
9. Tamisier, D, Vouhe, PR, Vernant, F, Lecá, F, Massot, C, Neveux, JY. Modified Blalock-Taussig shunts: results in infants less than 3 month of age. Ann Thorac Surg 1990; 49: 797–801.CrossRefGoogle Scholar
10. Fenton, KN, Siewers, RD, Rebovich, B, Pigula, FA. Interim mortality in infants with systemic to pulmonary artery shunts. Ann Thorac Surg 2003; 76: 152–157.CrossRefGoogle ScholarPubMed
11. Peuster, M, Fink, C, Windhagen-Mahnert, B, Paul, T, Hausdorf, G. Early postoperative failure of a modified Blalock-Taussig-Shunt: Successful therapy with angioplasty and subsequent implantation of a Palmatz-Schatz stent into the subclavian artery. Z Kardiol 2000; 89: 114–117.CrossRefGoogle Scholar
12. Godart, F, Qureshi, AS, Simha, A, et al. Effects of modified Blalock-Taussig shunt on the pulmonary arterial tree. Ann Thorac Surg 1998; 66: 512–518.CrossRefGoogle ScholarPubMed
13. Cotrufo, M, Arciprete, P, Cainiello, G, et al. Right pulmonary artery development after modified Blalock-Taussig shunt (MBTS) in infants with pulmonary atresia, ventricular septal defect and confluent pulmonary arteries. Eur J Cardiothorac Surg 1989; 3: 12–15.CrossRefGoogle ScholarPubMed
14. Guyton, RA, Owens, JE, Waumett, JD, Dooley, KJ, Hatcher, CR Jr, Williams, WH. The Blalock-Taussig shunt: Low risk, effective palliation, and pulmonary artery growth. J Thorac Cardiovasc Surg 1983; 85: 917–922.CrossRefGoogle ScholarPubMed
15. Gale, AW, Arciniegas, E, Green, EW, Blackstone, EH, Kirklin, JW. Growth of the pulmonary anulus and pulmonary arteries after Blalock-Taussig shunt. J Thorac Cardiovasc Surg 1979; 77: 459–465.CrossRefGoogle ScholarPubMed
16. Kirklin, JW, Bargeron, LM, Pacifico, AD. The enlargement of small pulmonary arteries by preliminary palliative operations. Circulation 1977; 56: 612–617.CrossRefGoogle ScholarPubMed
17. Mullen, JC, Lemermeyer, G, Bentley, MJ. Modified Blalock-Taussig shunts: to heparinize or not to heparinize. Can J Cardiol 1996; 12: 645–647.Google ScholarPubMed
18. Moszura, T, Ostrowska, K, Dryzek, P, Moll, J, Sysa, A. Thrombolysis and stent implantation in a child with an acute occlusion of the Blalock-Taussig – a case report. Kardiol Pol 2004; 60: 354–356.Google Scholar
19. Malm, TK, Holmqvist, C, Olsson, CG, et al. Successfull thrombolysis of an occluded modified Blalock shunt three days after operation. Ann Thorac Surg 1998; 65: 1453–1455.CrossRefGoogle Scholar
20. Peuster, M, Fink, C, Bertram, H, Paul, T, Hausdorf, G. Transcatheter recanalisation and subsequent stent implantation for the tratment of early postoperative thrombosis of modified Blalock-Taussig-Shunts in two children. Cathet Cardiovasc Diagn 1998; 45: 405–408.3.0.CO;2-A>CrossRefGoogle Scholar
21. Rao, PS, Levy, JM, Chopra, PS. Balloon angioplasty of stenosed Blalock-Taussig anastomosis: role of balloon-on-a-wire in dilating occluded shunts. Am Heart J 1990; 120: 1173–1178.CrossRefGoogle ScholarPubMed
22. MacMillan, M, Jones, TK, Lupinetti, FM, Johnston, TA. Balloon angioplasty for Blalock-Taussig shunt failure in the early postoperative period. Catherter Cardiovasc Interv 2005; 66: 585–589.CrossRefGoogle ScholarPubMed
23. Zahn, EM, Chang, AC, Aldousany, A, Burke, RP. Emergent stent placement for acute Blalock-Taussig shunt obstruction after stage 1 Norwood surgery. Cathet Cardiovasc Diagn 1997; 42: 191–194.3.0.CO;2-Q>CrossRefGoogle ScholarPubMed
24. Sivakumar, K, Anil, SR, Ravichandra, M, Natarajan, KU, Kamath, P, Kumar, RK. Emergency transcatheter balloon recanalization of acutely thrombosed modified Blalock-Taussig shunts. Indian Heart J 2001; 53: 743–748.Google ScholarPubMed
25. Sigler, M, Bartmus, D, Paul, T. Histology of a surgically removed stenotic modified Blalock-Taussig shunt after previous endovascular stenting. Heart 2005; 91: 1097.CrossRefGoogle ScholarPubMed