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Interventional Management of Acute Thrombosis of the Modified Blalock-taussig Shunt in a Case of Tricuspid Atresia

László Hadadi
László Hadadi
, 
Roxana Toma
Roxana Toma
, 
Marian Pop
Marian Pop
, 
Cristina Blesneac
Cristina Blesneac
 and 
Anca Ioana Sglimbea
Anca Ioana Sglimbea
   | Mar 18, 2023
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Article Category: Case Report
Published Online: Mar 18, 2023
Page range: 29 - 34
DOI: https://doi.org/10.2478/rjc-2023-0005
Keywords
© 2023 László Hadadi et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Schematic representation of tricuspid valve atresia after the implantation of a modified Blalock-Taussig shunt. ASD – atrial septal defect; IVC – inferior vena cava; LA – left atrium; LPA – left pulmonary artery; LV – left ventricle; mBTS – modified Blalock-Taussig shunt; PA – main pulmonary artery; PDA – (persistent) ductus arteriosus; RA – right atrium; RPA – right pulmonary artery; RV – right ventricle; SVC – superior vena cava; VSD – ventricular septal defect.
Schematic representation of tricuspid valve atresia after the implantation of a modified Blalock-Taussig shunt. ASD – atrial septal defect; IVC – inferior vena cava; LA – left atrium; LPA – left pulmonary artery; LV – left ventricle; mBTS – modified Blalock-Taussig shunt; PA – main pulmonary artery; PDA – (persistent) ductus arteriosus; RA – right atrium; RPA – right pulmonary artery; RV – right ventricle; SVC – superior vena cava; VSD – ventricular septal defect.

Figure 2

Three-dimensional reconstruction of contrast-enhanced computer tomography of the chest before shunt implantation. Antero-posterior (A) and lateral (B) view showing the anatomy of the heart and aortic arch. Both common carotid arteries (CCA) originate from the brachiocephalic trunk. A large persistent ductus arteriosus (PDA) is also present.
Three-dimensional reconstruction of contrast-enhanced computer tomography of the chest before shunt implantation. Antero-posterior (A) and lateral (B) view showing the anatomy of the heart and aortic arch. Both common carotid arteries (CCA) originate from the brachiocephalic trunk. A large persistent ductus arteriosus (PDA) is also present.

Figure 3

Three-dimensional virtual rendering of contrast-enhanced computer tomography of the aorta and pulmonary arteries. The mBTS between the brachiocephalic trunk and pulmonary artery is also visible. mBTS – modified Blalock-Taussig shunt; PA – pulmonary artery.
Three-dimensional virtual rendering of contrast-enhanced computer tomography of the aorta and pulmonary arteries. The mBTS between the brachiocephalic trunk and pulmonary artery is also visible. mBTS – modified Blalock-Taussig shunt; PA – pulmonary artery.

Figure 4

Aortography (A, B) and selective angiography of the mBTS (C, D) from postero-anterior (A, C) and latero-lateral views (B, D) showing the anatomy of the aortic arch and pulmonary branches. A bending and a stenosis at the distal part of the mBTS is also visible. The main pulmonary artery is hypoplastic. AO – aorta; mBTS – modified Blalock-Taussig shunt; RPA – right pulmonary artery.
Aortography (A, B) and selective angiography of the mBTS (C, D) from postero-anterior (A, C) and latero-lateral views (B, D) showing the anatomy of the aortic arch and pulmonary branches. A bending and a stenosis at the distal part of the mBTS is also visible. The main pulmonary artery is hypoplastic. AO – aorta; mBTS – modified Blalock-Taussig shunt; RPA – right pulmonary artery.

Figure 5

Selective angiography of the modified Blalock-Taussig shunt from postero-anterior (A, C) and latero-lateral views (B, D) confirmed the suspicion of acute shunt thrombosis: an intraluminal filling defect is present at the distal part of the conduit (A, B), with persisting contrast staining (C, D).
Selective angiography of the modified Blalock-Taussig shunt from postero-anterior (A, C) and latero-lateral views (B, D) confirmed the suspicion of acute shunt thrombosis: an intraluminal filling defect is present at the distal part of the conduit (A, B), with persisting contrast staining (C, D).

Figure 6

Selective angiography of the modified Blalock-Taussig shunt from postero-anterior (A) and latero-lateral views (B) after catheter-directed thrombolysis showing the persistence of intraluminal filling defect at the site of shunt stenosis.
Selective angiography of the modified Blalock-Taussig shunt from postero-anterior (A) and latero-lateral views (B) after catheter-directed thrombolysis showing the persistence of intraluminal filling defect at the site of shunt stenosis.

Figure 7

Stent implantation into the modified Blalock-Taussig shunt (A, B) and final result after the intervention (C, D).
Stent implantation into the modified Blalock-Taussig shunt (A, B) and final result after the intervention (C, D).
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