Balloon dilation recanalization of completely occluded modified Blalock-Taussig shunt

1994 ◽  
Vol 4 (2) ◽  
pp. 178-180 ◽  
Author(s):  
Omar Galal ◽  
Shakeel A. Qureshi
Keyword(s):  
Pulmonary Artery ◽  
Cardiac Catheterization ◽  
Doppler Echocardiography ◽  
Guide Wire ◽  
Pulmonary Atresia ◽  
Balloon Dilation ◽  
Shunt Flow ◽  
Angioplasty Balloon ◽  
Blalock Taussig Shunt

SummaryA two-month-old boy, with complex pulmonary atresia, became increasingly cyanosed 10 days after a modified 5 mm right Blalock-Taussig shunt. There was no shunt flow on auscultation or Doppler echocardiography. Despite anticoagulation with heparin, the shunt remained occluded. After demonstration of the occluded shunt at angiography, a guide wire was easily passed through the occlusion and into the pulmonary artery. Balloon dilation was then successfully accomplished with a 6 mm diameter angioplasty balloon resulting in a patent shunt. The shunt was still widely patent at cardiac catheterization six months later.

scholarly journals An Unusual Cause of Hypoxia: Ventricular Septal Defect, Pulmonary Artery Atresia, and Major Aortopulmonary Collaterals Diagnosed in the Adult Cardiac Catheterization Lab

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Katia Bravo-Jaimes ◽  
Brian Walton ◽  
Poyee Tung ◽  
Richard W. Smalling
Keyword(s):  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Cardiac Catheterization ◽  
Mortality Risk ◽  
Septal Defect ◽  
Pulmonary Atresia ◽  
High Mortality Risk ◽  
Catheterization Laboratory ◽  
Aortopulmonary Collaterals ◽  
Major Aortopulmonary Collaterals

The association of pulmonary atresia, ventricular septal defect (VSD) and major aortopulmonary collaterals (MAPCA) is an extreme form of tetralogy of Fallot (TOF). It carries a high mortality risk if not intervened on during infancy with only 20% of unoperated patients surviving into adulthood. We present the case of a 40-year-old man who presented for evaluation prior to retinal surgery and was found to have hypoxia and a loud murmur. Cardiac catheterization was performed in the general catheterization laboratory, demonstrating a membranous VSD, pulmonary atresia, and MAPCA. We highlight the challenges and limitations that an adult interventional cardiologist may have when encountering these patients.

scholarly journals Balloon Valvuloplasty via the Pulmonary Artery Trunk for Treating Neonates With Severe Pulmonary Valve Disease

2021 ◽  
Vol 24 (1) ◽  
pp. E185-E187
Author(s):  
Kun-an Huang ◽  
Xiaofu Dai ◽  
Dongshan Liao ◽  
Qianzhen Li
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Valve ◽  
Pulmonary Atresia ◽  
Balloon Dilation ◽  
Systolic Pressure ◽  
Valve Disease ◽  
Balloon Valvuloplasty ◽  
Peripheral Vessel ◽  
Percutaneous Balloon ◽  
The Right

Background: Percutaneous balloon pulmonary valvuloplasty has proven to be a standard of care for neonates with severe pulmonary valve disease. However, the peripheral vessel injury, tricuspid chordae tendineae rupture, and cardiac tamponade could occur. Recently, we performed balloon valvuloplasty through pulmonary artery trunk. To date, the obtained outcome was promising. Methods: Between January 2018 and December 2018, three neonates with critical pulmonary stenosis and two with membranous pulmonary atresia with intact ventricular septum were enrolled in our center. Balloon valvuloplasty through pulmonary artery trunk was performed in all patients. A 2-cm parasternal incision was made in the left third intercostal space. A guidewire was used to advance or perforate the pulmonary valve from the pulmonary artery trunk into the right ventricle, followed by balloon dilation of the valve. Results: The procedure was successful in all patients. The oxygen saturation increased immediately after the balloon dilation, while the right ventricular systolic pressure and the gradient across the pulmonary valve decreased. No severe complications occurred. Conclusions: Balloon valvuloplasty through the pulmonary artery trunk is a safe and feasible alternative procedure. Thus, it could serve as a supplementary choice for treating severe pulmonary valve disease.

scholarly journals Effects of Patent Ductus Arteriosus on the Hemodynamics of Modified Blalock–Taussig Shunt Based on Patient-Specific Simulation

2021 ◽  
Vol 12 ◽  
Author(s):  
Jiwen Xiong ◽  
Qi Sun ◽  
Yi Qian ◽  
Liwei Hu ◽  
Zhirong Tong ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Computer Aided Design ◽  
Ductus Arteriosus ◽  
Pulmonary Atresia ◽  
Patient Specific ◽  
Physiological Data ◽  
Shunt Flow ◽  
Relative Residence Time ◽  
Blalock Taussig Shunt ◽  
Patent Ductus

The question of preserving the patent ductus arteriosus (PDA) during the modified Blalock–Taussig shunt (MBTS) procedure remains controversial. The goal of this study was to investigate the effects of the PDA on the flow features of the MBTS to help with preoperative surgery design and postoperative prediction. In this study, a patient with pulmonary atresia and PDA was included. A patient-specific three-dimensional model was reconstructed, and virtual surgeries of shunt insertion and ductus ligation were performed using computer-aided design. Computational fluid dynamics was utilized to analyze the hemodynamic parameters of varied models based on the patient-specific anatomy and physiological data. The preservation of the PDA competitively reduced the shunt flow but increased total pulmonary perfusion. The shunt flow and ductal flow collided, causing significant and complicated turbulence in the pulmonary artery where low wall shear stress, high oscillatory shear index, and high relative residence time were distributed. The highest energy loss was found when the PDA was preserved. The preservation of PDA is not recommended during MBTS procedures because it negatively influences hemodynamics. This may lead to pulmonary overperfusion, inadequate systemic perfusion, and a heavier cardiac burden, thus increasing the risk of heart failure. Also, it seems to bring no benefit in terms of reducing the risk for thrombosis.

Recanalization of an occluded modified Blalock-Taussig shunt by balloon angioplasty within 12 hours of its construction

2000 ◽  
Vol 10 (6) ◽  
pp. 641-643 ◽  
Author(s):  
M. O. Galal ◽  
K. Attas ◽  
G. Baslaim
Keyword(s):  
Pulmonary Artery ◽  
Balloon Angioplasty ◽  
Coronary Angioplasty ◽  
Percutaneous Transluminal Coronary Angioplasty ◽  
Angioplasty Balloon ◽  
Right Pulmonary Artery ◽  
Transluminal Coronary Angioplasty ◽  
The Right ◽  
Percutaneous Transluminal ◽  
Blalock Taussig Shunt

AbstractAn infant developed severe desaturation within a few hours of construction of a modified Blalock-Taussig shunt. Echocardiography revealed that the shunt had become occluded, and this was confirmed angiographically. At catheterisation, therefore, we passed a 0.014”percutaneous transluminal coronary angioplasty wire through the occluded shunt into the right pulmonary artery and then dilated the shunt successfully using a 5 mm coronary angioplasty balloon. Six weeks later, the shunt remained patent.

Pulmonary atresia with ventricular septal defect and tetralogy of Fallot: transannular path augmentation versus systemic to pulmonary artery shunt for first-stage palliation

2020 ◽  
Vol 30 (11) ◽  
pp. 1679-1687
Author(s):  
Marien Lenoir ◽  
Virginie Fouilloux ◽  
Beatrice Desnous ◽  
Bilal Rahmani ◽  
Nabila El Gueddari ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Hospital Mortality ◽  
Right Ventricle ◽  
Tetralogy Of Fallot ◽  
Septal Defect ◽  
Pulmonary Atresia ◽  
Biventricular Repair ◽  
Palliative Procedure ◽  
Blalock Taussig Shunt

AbstractBackground:Pulmonary atresia with ventricular septal defect and severe tetralogy of Fallot require a palliative procedure for pulmonary artery rehabilitation. For first-stage palliation, two main surgical options are still debated: right ventricle to pulmonary artery connection and modified Blalock–Taussig shunt. We compared the clinical outcomes of the two procedures.Methods:From 1995 to 2018, 88 patients needed palliation (pulmonary atresia with ventricular septal defect n = 47; tetralogy of Fallot n = 41). Among these patients, 70 modified Blalock–Taussig shunt and 18 transannular path augmentation were performed before 6 months of age. Using a 1:1 propensity score match analysis, 20 patients were included in the analysis. The primary outcome was in-hospital mortality and pulmonary artery growth.Results:After matching, the pre-operative Nakata was smaller in transannular path augmentation 54 ± 24 mm2/m2 than modified Blalock–Taussig shunt 109 ± 31 mm2/m2 (p < 0.001). The age and weight were similar (p = 0.31 and p = 0.9, respectively). There was no difference in in-hospital mortality (p = 0.3). The Nakata index before biventricular repair and delta Nakata were smaller in modified Blalock–Taussig shunt group (206 ± 80 mm2/m2, 75 ± 103 mm2/m2) than transannular path augmentation (365 ± 170 mm2/m2, 214 ± 165 mm2/m2; p = 0.03; p < 0.001). Median time to biventricular repair was similar (p = 0.46). The rate of interstage reintervention was similar (p = 0.63).Conclusions:The transannular path augmentation is better for the rehabilitation of the native pulmonary artery. Despite a smaller pulmonary artery, right ventricle to pulmonary artery connection is equivalent to modified Blalock–Taussig shunt for rate of biventricular repair and time to biventricular repair.

scholarly journals Non-invasive Assessment of Pulmonary Artery Wave Reflection in Dogs With Suspected Pulmonary Hypertension

2021 ◽  
Vol 8 ◽  
Author(s):  
Tomohiko Yoshida ◽  
Katsuhiro Matsuura ◽  
Goya Seijirow ◽  
Akiko Uemura ◽  
Zeki Yilmaz ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Survival Time ◽  
Cardiac Catheterization ◽  
Validation Study ◽  
Doppler Echocardiography ◽  
Wave Reflection ◽  
Flow Profile ◽  
Pulmonary Arterial ◽  
Echocardiographic Evidence

Background: Pulmonary arterial wave reflection (PAWR) occurs when the forward blood flow out the right ventricle is reflected by the pulmonary arterial tree, generating a backward wave. PAWR assessed by cardiac catheterization has been used to obtain information regarding pulmonary artery hemodynamics in pulmonary hypertension (PH) in people. However, diagnostic cardiac catheterization is not commonly used in small animal medicine because it is invasive and requires anesthesia.Hypothesis/Objective: To investigate whether PAWR can be assessed non-invasively in dogs with suspected PH using Doppler echocardiography, based on wave intensity analysis (WIA). In addition, the method was validated in a dog model of acute pulmonary embolism.Animals: Fifty-one client-owned dogs with tricuspid valve regurgitation were included in the clinical study (35 with suspected PH and 16 without echocardiographic evidence of PH) and eight healthy beagle dogs were included in the validation study.Methods: PAWR was assessed by separating pulmonary artery pulse pressure waveforms, which were estimated from the flow profile of tricuspid regurgitation, into forward (Pf) and backward pressures (Pb) using WIA. Reflection coefficient (RC) was defined as the ratio of peak Pb to peak Pf. We investigated the relationships between RC, cause, and survival time in dogs with suspected PH. In addition, we performed a validation study to compare PAWR obtained by cardiac catheterization and PAWR by Doppler echocardiography in dogs with experimentally-induced PH.Results: RC was significantly higher in dogs with suspected PH than in dogs without echocardiographic evidence of PH (0.18 ± 0.13 vs. 0.59 ± 0.21, P &lt; 0.001). A characteristic reflected waveform appeared depending on the cause of PH. Kaplan-Meier survival curves showed that dogs with RC &gt; 0.48 had a significantly shorter survival time than dogs with RC &lt;0.48 (x2 = 9.8, log-rank test, p = 0.0018, median survival time 353 days vs. 110 days). In the validation study, RC obtained by Doppler echocardiography was significantly correlated with RC obtained by cardiac catheterization (r = 0.81, P &lt; 0.001).Conclusions: PAWR analysis performed by echocardiography seems feasible in dogs and could provide useful information for classification and prognosis in canine PH.

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