STENT IMPLANTATION FOR RELIEF OF EARLY POSTOPERATIVE STENOSIS OF BLALOCK-TAUSSIG-SHUNTS

Peuster M, Fink C, Paul T, Bertram H, Hausdorf G

Department of Pediatric Cardiology and Pediatric Intensive Care Hannover Medical School, Germany

OBJECTIVE: The use of the modified Blalock-Taussig shunt (MBTS) in the treatment of pulmonary oligemia in patients with cyanotic congenital heart disease is well established. Stenosis of the MBTS is a serious complication and its occurence requires rapid and effective therapy. Often reoperation is needed to restore sufficient pulmonary blood flow. We report on 3 patients with early postoperative stenosis of the MBTS who were treated successfully with balloon dilatation and stent implantation.

CASE REPORTS: 6 week old baby with tetralogy of fallot and hypoplastic pulmonary arteries was palliated at 4 weeks of age with a MBTS. Postoperatively farther hypoxemic spells were observed, cardiac catheterization revealed stenosis of the MBTS at the insertion into the right pulmonary artery. After balloon dilatation of the stenosis a GR II Flex stent was implanted. Angiography after 4 months demonstrated a patent MBTS. A 75 days old ne-wborn with tricuspid- and pulmonary atresia was palliated at 10 days of age with a MBTS. After prostaglandin e) was discontinued arterial oxygen saturation dropped. Cardiac catheterization showed a complete thrombosis of the MBTS. Balloon dilatation was performed. Due to the irregular lumen of the MBTS a Palmaz-stent was implanted. 6 months postinterventionally angiography demonstrated an unrestricted flow across the MBTS. A 3 week old baby with pulmonary atresia and ventricular septal defect was palliated with a MBTS at 5 days of age. Postoperatively arterial oxygen saturations dropped. Stenosis of the subclavian artery proximally to the MBTS was diagnosed. Balloon dilatation of the stenosis and implantation of a Palmaz stent was performed. Angiography 3 months postinterventionally demonstrated an unrestricted flow accross the MBTS.

CONCLUSION: In patients with stenosis or thrombosis of MBTS balloon angioplasty and stent implantation can be an effective alternative to fibrinolytic therapy or surgical revision of the shunt.