Amplatzer vascular plug closure of a Blalock–Taussig shunt through a Glenn shunt

We describe an unusual route and uncommon device use for the percutaneous closure of a modified Blalock–Taussig (BT) shunt. A 4‐year‐old male had presented with severe upper body swelling after a bidirectional Glenn shunt done one month earlier. The BT shunt which was clipped during the surgery was found to be patent. The BT shunt was finally closed from the bidirectional Glenn using an Amplatzer vascular plug, resulting in symptom relief. © 2008 Wiley‐Liss, Inc.     

Transcatheter occlusion of a classical BT shunt with the Amplatzer Duct Occluder II

We report on a 57‐year‐old woman who underwent transcatheter occlusion of a residual classical Blalock‐Taussig shunt with the Amplatzer® Duct Occluder II (ADO II) 35 years following definitive surgical correction for tetralogy of Fallot. © 2008 Wiley‐Liss, Inc.     

Complete blalock–taussig shunt obstruction in < 24 hours post‐operative period in a neonate treated emergently using transcatheter angioplasty and low dose local recombinant TPA

A 12‐day‐old infant with pulmonary atresia, intact ventricular septum, and pulmonary blood flow through a ductus arteriosus developed complete shunt obstruction within 12 hr of creation of a modified Blalock–Taussig shunt. Low dose recombinant tissue plasminogen activator was administered locally as two 0.03 mg/kg bolus injections and was followed by balloon angioplasty. This resulted in complete recanalization of the shunt without any hemorrhagic complications. © 2013 Wiley Periodicals, Inc.     

63‐year Survival after Blalock‐Taussig Shunt Operation in a Patient with Single Ventricle,Tricuspid Atresia,and Pulmonary Stenosis

A 63‐year‐old female with complex congenital heart disease underwent a classical Blalock‐Taussig (B‐T) shunt operation at the age of 3 years in 1948. The cardiac morphology was not amenable to further definite surgical repair in that period of time. With this palliative operation, the patient survived to the age of 63 years and now presented with exercise intolerance and significant desaturation. Cardiac catheterization with angiography revealed a severe stenosis of the B‐T shunt at the pulmonary end. Balloon dilation and stent implantation could be performed successfully. Follow‐up after 5 months showed a patent B‐T shunt and an increase of oxygen saturation from 65% to 80% and mild improvement of pulmonary blood flow and exercise tolerance.     

Stent implantation to maintain patency of a stenosed Blalock Taussig shunt

A 14-year-old female with complex congenital heart disease underwent a left-sided classical Blalock Taussig (BT) shunt 15 days after birth. Ten years after the operation her oxygen saturation had decreased significantly. An angiography revealed a severely stenosed BT shunt. Balloon dilation including implantation of a 6 x 13 mm stent was performed successfully. Immediately after intervention, oxygen saturation rose from 55% to 80 84% in room air. Follow-up at a year and a half later showed the classical BT shunt was still patent.     

Stenting of a stenosed major aortopulmonary collateral artery in a baby with pulmonary atresia and a ventricular septal defect: Rescue from critical hypoxia in the immediate postoperative stage of unifocalization supported by extracorporeal membrane oxygenation

A 4‐month baby with pulmonary atresia, ventricular septal defect, major aortopulmonary collateral arteries (MAPCAs) and an extremely hypoplastic central pulmonary artery developed critical hypoxia following right unifocalization combined with a right Blalock‐Taussig shunt. To increase pulmonary blood flow we stented the left lower MAPCA during extracorporeal membrane oxygenation (ECMO) support. He was successfully weaned from ECMO 2 days after stenting. Percutaneous intervention for a stenosed MAPCA is an effective means of increasing pulmonary blood flow in critically hypoxic patients following unilateral unifocalization, even in the immediate postoperative stage. © 2008 Wiley‐Liss, Inc.     

William Osler, Maude Abbott, Paul Dudley White, and Helen Taussig: the origins of congenital heart disease in North America

In 1965, Helen Taussig traced the evolution of knowledge of congenital heart disease (CHD) during the 20th century, beginning with the William Osler-Maude Abbott lineage at McGill University in Montreal, Canada. Osler encouraged Abbott in her CHD pathologic observations. Abbott's London Exhibit (1934) preceded her classic text Atlas of Congenital Cardiac Disease (1936). Taussig's friendship with Abbott (1935) began in Boston; Abbott brought Taussig to meet Paul Dudley White whose text Heart Disease (1931) featured Abbott's work. Taussig visited Abbott (Montreal 1938). Abbott's statistical approach was based on post-mortem malformations; Taussig's concern was why CHD babies died. Abbott (1927) suggested surgery for a patent ductus arteriosus; Taussig conceived of creating a patent ductus arteriosus shunt to improve lung blood flow in cyanotic "blue babies". Surgeon Alfred Blalock and Taussig collaborated with the blue baby shunt operations (1944-1945), opening the field of cardiac surgery in cyanotic babies. Taussig's Congenital Malformations of the Heart text came 2 years later. Sequential contributions by Osler, Abbott, White, and Taussig were landmarks in the evolution of knowledge of CHD in North America.     

Management of pulmonary atresia or critical pulmonary stenosis and intact ventricular septum with a small or hypoplastic right ventricle

Twenty-one neonates and infants less than 3 months old undergoing cardiac surgery for an obstructed right ventricular outflow tract, intact ventricular septum and a small or hypoplastic right ventricle were retrospectively analyzed, in order to assess the effects of a change in management protocol. Seven of the 8 patients with critical pulmonary stenosis survived surgery using a transannular outflow patch, whereas only 1 of the 8 patients with pulmonary atresia survived the same operation. Two patients in the latter group died 2 and 3 months after surgery but with complications arising from surgery. Of 5 patients with pulmonary atresia who had a modified Blalock Taussig shunt, 3 patients survived the surgery and were discharged home. These results significantly indicate that there is an unacceptably high mortality for the relief of pulmonary atresia (with intact septum) using a transannular outflow patch, and a Blalock Taussig shunt is the preferred operation. The transannular outflow patch is a safe operation for neonates with critical pulmonary stenosis, irrespective of the size of the right ventricle.     

Treatment of Refractory Pulmonary Arterial Hypertension with Inhaled Epoprostenol in an Infant with Congenital Heart Disease

Epoprostenol is a potent arterial vasodilator, and its administration by inhalation localizes its effects to the pulmonary circulation. In this case report, we describe a 3‐month‐old male patient with significant refractory pulmonary hypertension after pulmonary artery banding and placement of a Blalock–Taussig shunt. This patient continued to have significant hypoxic episodes despite maximal therapy with sedation, alkalinization, sildenafil, and inhaled nitric oxide. After the addition of inhaled epoprostenol, improvements in both clinical response and echocardiography‐based hemodynamics were observed. The case supports a synergistic role among the agents in the treatment of pulmonary arterial hypertension from congenital heart disease.     

The Paediatric Cardiology Hall of Fame: Helen Brooke Taussig MD. May 24, 1898 to May 21, 1986.

The life and accomplishments of Helen Taussig are reviewed at the centennial of her birth in 1898. Now, a little over 50 years since the first Blalock Taussig shunt in 1944, her legacy remains a model of brilliant scientific innovation and loving patient care.     

Stenting of the ductus arteriosus for ductal‐dependent pulmonary blood flow—current techniques and procedural considerations

The use of prostaglandin‐E1 immediately after birth and subsequent surgical creation of the modified Blalock‐Taussig shunt (BTS) shunt have remarkably improved the prognosis and survival of children with congenital heart disease and ductal‐dependent pulmonary blood flow (PBF). Despite the advancement in surgical techniques, bypass strategies, and postoperative management, significant morbidity and mortality after BTS still remain. Patent ductus arteriosus stenting has been shown to be as an acceptable alternative to BTS placement in select infants with ductal‐dependent PBF. Newer procedural techniques and equipment, along with operator experience have all contributed to procedural refinement associated with improved outcomes over the recent years. In this article, we review the procedural and periprocedural details, with an emphasis on recent advances of this procedure.     

Seroma following modified Blalock-Taussig shunt resulting in subsequent occlusion of the shunt which was opened by balloon angioplasty

We report the case of a 9-year-old boy with tetralogy of Fallot who had undergone left modified Blalock Taussig shunt. The patient developed seroma around the shunt which was excised surgically. The patient developed total occlusion of the shunt post-operatively with clinical deterioration. We used emergency percutaneous angioplasty to successfully treat the patient.     

Modified Blalock-Taussig shunt with an umbilical vein graft

We describe a modification of the Blalock Taussig anastomosis, with the interposition of a glutaraldehyde-tanned umbilical vein graft between the subclavian and pulmonary arteries. This operation was performed in 64 children: 11 were less than 1 month of age (17.2%), and 23 were between 1 and 6 months of age (34.9%). Hospital deaths occurred in six patients-all less than 6 months of age (9.4%). There was no instance of shunt occlusion noted. The clinical course was uneventful among survivors, except for one patient who died of endocarditis in the late postoperative follow-up. The shunt procedure may be performed very rapidly, with minimal dissection, allowing the use of a graft larger than the diameter of the subclavian artery. This modification of the Blalock Taussig operation compares favorably with our previous experience with other shunt procedures and may be considered a valuable alternative in the palliative surgical treatment of several malformations with severe pulmonary oligemia.     

Ischemic prevention for stent implantation via brachial artery in children

An 11‐year‐old boy received stent implantation for peripheral pulmonary stenosis through the left modified Blalock‐Taussig shunt from the left brachial approach because of the hairpin‐shaped route from a femoral or carotid approach. A temporary bypass between the left radial and the femoral arteries was established to prevent ischemic complication of the left forearm. There was no ischemic change of the left forearm in the physiological monitoring despite the long procedure (more than 4 hr) and brachial arterial spasms. No complications occurred after the procedure. The temporary bypass will support fewer complications in various catheter interventions through a brachial arterial approach in children. © 2009 Wiley‐Liss, Inc.     

Tricuspid Atresia with Absent Pulmonary Valve and Intact Ventricular Septum: A Rare Association

The absence of the pulmonary valve in connection with tricuspid atresia and intact ventricular septum is a rare malformation, associated with a poor prognosis. The right ventricle is severely hypertrophied, resembling a cardiac mass protruding into the left ventricular outflow tract. We report such a case that underwent successful palliation with a Blalock–Taussig shunt followed by a superior cavopulmonary anastomosis.     

Transhepatic closure of atrial septal defect and assisted closure of modified Blalock/Taussig shunt.

The details of transhepatic closure of moderate - large size atrial septal defect as well as assisted closure of a modified Blalock Taussig shunt in a 2 1/2 year old patient with occluded femoral vessels are discussed. The technical variations as well as the potential advantages of this route are outlined.     

Compression of the left mainstem bronchus by patent ductus arteriosus in neonates under consideration for ductal stenting

Stent angioplasty of patent ductus arteriosus has been shown to be a viable alternative to operative shunt placement in cyanotic neonates. With broader implementation of this strategy, novel complications are bound to arise. We present a series of cases evaluated for ductal stent angioplasty in which a dilated and torturous ductus arteriosus compressed the left mainstem bronchus. After reviewing our recent experience with ductal stenting and isolated Blalock‐Taussig shunts, our best estimate of the incidence of bronchial compression by the dilated ductus is 4.6% (3/64, 95% confidence interval 1.0–12.9%). Awareness of the airway and other nonvascular contents of the thorax is an important consideration prior to ductal stenting.     

Is there a possible role for haemostasis in the development of perigraft reaction complicating the modified Blalock Taussig shunt?

The perigraft reaction is an unusual complication found in patients in whom a modified Blalock Taussig shunt has been created using a polytetrafluoroethylene graft. We found that, in two infants, consistent laboratory findings during such a perigraft reaction were hypofibrinogenemia, increased levels of thrombin-antithrombin III complex, prothrombin fragment 1 and 2 and products of degradation of fibrin. Normalization of the levels of fibrinogen produced resolution of the perigraft reaction.     

Pulmonary thromboembolism after Fontan operation

The fatal outcome in an eleven-year-old girl, one month after an extra-cardiac Fontan operation is reported. She was diagnosed with tricuspid atresia and had a Blalock Taussig shunt and a bidirectional Glenn procedure. The Fontan operation was performed using a Dacron conduit, fenestrated with a 6 mm Goretex tube. The first week after the operation she received low molecular weight heparin, then it was stopped and aspirin was started. One month after surgery she was admitted to the hospital because of sudden cyanosis, dyspnea, chest pain and syncope. A diagnosis of left pulmonary artery thrombosis without right to left shunt across the fenestrated tube was made. She was carried to the cardiac catheterization laboratory where a mechanical lysis of the thrombi was attempted. A local infusion of rtPA was started without improvement and she died 3 hours later.     

Permanent Transvenous Left Ventricular Endocardial Pacing in a Patient with Univentricular Atrioventricular Connection

Chronotropic incompetence is associated with poorer effort tolerance and worse mortality outcomes, not only in the general cardiac population but also in patients with congenital heart disease. When present in complex patients, pacing options may be limited by difficult pacing access, and an open surgical approach for epicardial lead placement may not always be desirable. We describe a case of symptomatic chronotropic incompetence in a patient with tricuspid atresia, valvar and subpulmonary stenosis, normally related great vessels, and a modified Blalock–Taussig shunt, awaiting cardiac transplantation, whom we palliated with a transvenous endocardial pacing strategy. This technique may provide an alternative pacing strategy for highly selected patients, where few other treatment options are available.