They allow growth of pulmonary arteries and maintain regulated blood flow to the lungs till a proper age and body weight suitable for definitive corrective repair is reached. We have reviewed the BT shunt with its anaesthtic considerations and management of associated complications. The systemic to pulmonary artery shunts are done as palliative procedures for a variety of complex cyanotic congenital heart diseases. The systemic to pulmonary artery shunt provide the first line of management in these critically ill cyanotic neonates.
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Cardiac catheterization is an effective intervention for treating different congenital heart conditions and immediate and delayed postoperative sequelae. The Amplatzer device has been used since for percutaneous closure of patent ductus arteriosus. The patient presented with serious postoperative heart failure that improved after percutaneous closure of the shunt with an Amplatzer ductal device. The boy, now aged 7 years, was diagnosed with L-transposition of the great vessels with pulmonary atresia, interventricular septal defect and hypoplasia of the right ventricle as a neonate.
During the neonatal period, a left-modified Blalock-Taussig shunt was performed, which was followed by a bidirectional Glenn intervention when he was 2 years old. Cardiac catheterization performed before completion of the Fontan procedure showed that the caliber of the pulmonary arteries was good. Mean blood pressure was 14 mm Hg and there was a patent Blalock-Taussig shunt. An extracardiac conduit was placed between the inferior vena cava and the right pulmonary artery.
The Blalock-Taussig shunt was left open because of the difficulty of access. Immediately after the operation, the child presented serious systemic venous congestion refractory to treatment, so we decided to perform percutaneous closure of the shunt. We tried to close the shunt via a femoral artery approach, but advance was almost impossible because of the tight angle between the shunt and the descending aorta. After placement of the device, an angiogram showed total closure of the shunt Figure 1C , with no protrusion of the device into the left pulmonary artery.
The mean pulmonary pressure after closure decreased to 16 mmHg and the patient was discharged the following week. The shunt was accessed via the left axillary artery B. A patent systemic-pulmonary shunt in patients who have undergone a Fontan operation has a clearly negative hemodynamic effect.
Given that surgical ligation may be technically difficult, such shunts can be closed by percutaneous catheterization. Different devices have been used such as coils, detachable balloons, Rashkind ductal occluders 2 and Gianturco-Grifka vascular occlusion devices. Other techniques have been used to prevent embolization of pulmonary circulation, such as the use of guidewires 5 or placing a stent in the pulmonary artery.
For our patient, we decided to use the Amplatzer ductal device due to the high risk of embolism with use of coils and the patient's unstable condition. Before performing the occlusion, we estimated the length of the device after implantation.
We could thus ensure that it would be shorter than the shunt to avoid protrusion into the pulmonary artery or left subclavian artery, and we did indeed confirm that there was no protrusion. The importance of access via the left axillary artery for performing the procedure should be emphasized. The technique would have been almost impossible by via the femoral vein and the childs clinical situation would have required further high-risk surgery.
Descargar PDF. Hospital Universitario La Paz. The shunt was accessed via the left axillary artery B.. Texto completo. To the Editor: Cardiac catheterization is an effective intervention for treating different congenital heart conditions and immediate and delayed postoperative sequelae.
Catheter closure of moderate to large sized patent ductus arteriosus using the new Amplatzer duct occluder: immediate and short-term results.. J Am Coll Cardiol, 31 , pp. Transcatheter occlusion of Blalock-Taussig shunts: technical options..
J Vasc Interv Radiol, 4 , pp. Cathet Cardiovasc Intervent, 48 , pp. Coil embolization to occlude aortopulmonary collateral vessels and shunts in patients with congenital heart disease.. J Am Coll Cardiol, 13 , pp.
Wire-snare technique with distal flow control for coil occlusion of a modified Blalock-Taussig shunt.. Cathet Cardiovasc Intervent, 49 , pp. Transcatheter closure of surgical shunts in patients with congenital heart disease..
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[Mortality-associated Factors in Pediatric Patients With Blalock-Taussig Shunt]
The Blalock—Thomas—Taussig shunt commonly called the Blalock—Taussig shunt is a surgical procedure used to increase pulmonary blood flow for palliation in duct dependent cyanotic heart defects like pulmonary atresia, which are common causes of blue baby syndrome. In modern surgery, this procedure is temporarily used to direct blood flow to the lungs and relieve cyanosis while the infant is waiting for corrective or definitive surgery. One branch of the subclavian artery or carotid artery is separated and connected with the pulmonary artery. The first area of application was tetralogy of Fallot. The procedure is no longer in use in its original form.
Background: Congenital heart disease with decreased pulmonary flow survival has increased due to systemic pulmonary fistulae SPF ; nevertheless, complications may occur. The purpose of this study was to identify mortality-related surgical and biochemical factors in pediatric patients with modified Blalock-Taussig shunt. Methods: A cohort was formed with congenital heart disease newborns who survived Blalock-Taussig-type palliative systemic pulmonary fistulae surgery. At admission to the intensive care unit, surgical time, diameter polytetrafluoroethylene vascular graft, arterial blood gases and central venous saturation were recorded.