Success Rate and Outcome of Stenting for the Treatment of Stenosis of Palliative Systemic-to-Pulmonary Arterial Shunts: A Case Series

Ata Firouzi; Ehsan Khalilipur; Zahra Khajali; Zahra Hoseini; Sedighe Saedi; Somaye Ahmadi; Atefe Shafiee; Amir Abdi

doi:doi:10.11648/j.ijmcr.20220103.15

| Peer-Reviewed

Success Rate and Outcome of Stenting for the Treatment of Stenosis of Palliative Systemic-to-Pulmonary Arterial Shunts: A Case Series

Ata Firouzi, Ehsan Khalilipur, Zahra Khajali, Zahra Hoseini, Sedighe Saedi, Somaye Ahmadi, Atefe Shafiee, Amir Abdi

Published in International Journal of Medical Case Reports (Volume 1, Issue 3)

Received: 2 September 2022 Accepted: 19 September 2022 Published: 29 September 2022

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Introduction: Cyanotic congenital heart diseases includes congenital structural anomalies of the heart with shunting resulted in mixing systemic venous blood into the arterial circulation. Two types of surgical therapies are available for the treatment of this anomalies: corrective and palliative. The goal of palliative surgery is to increase the pulmonary blood flow via systemic-to-pulmonary arterial shunting as the conclusive treatment or as a bridge to corrective surgery. Objective: Obstruction of palliative systemic artery-to-pulmonary artery shunts is one of the causes of deterioration in the clinical status, mortality, and morbidity of patients with cyanotic heart disease. For patients contraindicated for the Fontan surgery, a solution is a new shunt insertion or interventional procedures on stenotic shunts. Redo surgery is associated with higher risks of mortality and complications. Method: Herein, we describe 23 patients with obstructed or stenotic systemic artery-to-pulmonary artery shunts who underwent transcatheter stenting at Rajaie Cardiovascular Medical and Research Center between 2011 and 2019. Result: Pulmonary blood flow increased in all the patients, and there were no significant complications or periprocedural deaths. Blalock–Taussig shunt stenting was successful in the early and late stages in all the patients with recorded data. Hematocrit was decreased by a median of 4 units (2–8 units). During the follow-up, 12 patients were rehospitalized, 4 underwent new procedures, and 4 died. Conclusion: Stenting an obstructed or stenotic systemic artery-to-pulmonary artery shunt is a safe and promising alternative to redo surgery with higher success rates and fewer complications compared with balloon angioplasty.

Published in	International Journal of Medical Case Reports (Volume 1, Issue 3)
DOI	10.11648/j.ijmcr.20220103.15
Page(s)	29-35
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Cyanotic Congenital Heart Disease, Palliative Systemic-to-Pulmonary Artery Shunt, Blalock–Taussig Shunt, Central Shunt, Shunt Occlusion

References

[1]	Wang J, Wu M, Chang C, et al. Balloon angioplasty for obstructed modified systemic-pulmonary artery shunts and pulmonary artery stenoses. J Am Coll Cardiol. 2001 Mar, 37 (3) 940–947. https://doi.org/10.1016/S0735-1097(00)01194-3
[2]	Zahra Hosseini, Mohammad Rafie Khorgami, Zahra Khajali. Iranian Heart Journal. 2020 Oct; 21 (4): 49-55.
[3]	Bonnet M, Petit J, Lambert V, Brenot P, Riou JY, Angel CY, Belli E, Baruteau AE. Catheter-based interventions for modified Blalock-Taussig shunt obstruction: a 20-year experience. Pediatr Cardiol. 2015 Apr; 36 (4): 835-41. doi: 10.1007/s00246-014-1086-0. Epub 2015 Jan 6. PMID: 25560736.
[4]	Lee ML, Chiu IS. Stent implantation for stenotic Blalock-Taussig shunts in a 5.75-year-old boy with pulmonary atresia. Int J Cardiol. 2012 Dec 15; 162 (1): e8-11. doi: 10.1016/j.ijcard.2012.04.146. Epub 2012 May 18. PMID: 22608894.
[5]	Gillespie MJ, Rome JJ. Transcatheter treatment for systemic-to-pulmonary artery shunt obstruction in infants and children. Catheter Cardiovasc Interv. 2008 Jun 1; 71 (7): 928-35. doi: 10.1002/ccd.21448. PMID: 18383162.
[6]	Moszura T, Zubrzycka M, Michalak KW, Rewers B, Dryzek P, Moll JJ, Sysa A, Burczynski P. Acute and late obstruction of a modified Blalock-Taussig shunt: a two-center experience in different catheter-based methods of treatment. Interact Cardiovasc Thorac Surg. 2010 May; 10 (5): 727-31. doi: 10.1510/icvts.2009.219741. Epub 2010 Feb 5. PMID: 20139195.
[7]	Kogon B, Villari C, Shah N, Kirshbom P, Kanter K, Kim D, Raviele A, Vincent R. Occlusion of the modified Blalock-Taussig shunt: unique methods of treatment and review of catheter-based intervention. Congenit Heart Dis. 2007 May-Jun; 2 (3): 185-90. doi: 10.1111/j.1747-0803.2007.00095.x. PMID: 18377463.
[8]	Peuster M, Fink C, Bertram H, Paul T, Hausdorf G. Transcatheter recanalization and subsequent stent implantation for the treatment of early postoperative thrombosis of modified Blalock-Taussig shunts in two children. Cathet Cardiovasc Diagn. 1998 Dec; 45 (4): 405-8. doi: 10.1002/(sici)1097-0304(199812)45:4<405::aid-ccd11>3.0.co;2-a. PMID: 9863746.
[9]	Gopalakrishnan, A., Sasidharan, B., Menon, S. et al. Drug-eluting stent for acute Blalock-Taussig shunt thrombosis in a child—case report. Egypt Heart J 72, 54 (2020). https://doi.org/10.1186/s43044-020-00084-y
[10]	Illner J, Reinecke H, Baumgartner H, Kaleschke G. Stenting of modified Blalock-Taussig shunt in adult with palliated pulmonary atresia and ventricular septal defect: a case report. Eur Heart J Case Rep. 2019 Nov 13; 3 (4): 1-4. doi: 10.1093/ehjcr/ytz201. PMID: 32099958; PMCID: PMC7026590.
[11]	Kouatli A, Al-Ata J, Galal MO, Amin MA, Hussain A. Stent implantation to maintain patency of a stenosed Blalock Taussig shunt. Asian Cardiovasc Thorac Ann. 2005 Sep; 13 (3): 274-6. doi: 10.1177/021849230501300318. PMID: 16113004.
[12]	Bader R, Somerville J, Redington A. Use of self expanding stents in stenotic aortopulmonary shunts in adults with complex cyanotic heart disease. Heart. 1999 Jul; 82 (1): 27-9. doi: 10.1136/hrt.82.1.27. PMID: 10377304; PMCID: PMC1729109.
[13]	Lee KJ, Humpl T, Hashmi A, Nykanen DG, Williams WG, Benson LN. Restoration of aortopulmonary shunt patency. Am J Cardiol. 2001 Aug 1; 88 (3): 325-8. doi: 10.1016/s0002-9149(01)01654-x. PMID: 11472721.
[14]	Krasemann T, Tzifa A, Rosenthal E, Qureshi SA. Stenting of modified and classical Blalock-Taussig shunts--lessons learned from seven consecutive cases. Cardiol Young. 2011 Aug; 21 (4): 430-5. doi: 10.1017/S1047951111000254. Epub 2011 Mar 17. PMID: 21411029.
[15]	Kaestner M, Handke RP, Photiadis J, Sigler M, Schneider MB. Implantation of stents as an alternative to reoperation in neonates and infants with acute complications after surgical creation of a systemic-to-pulmonary arterial shunt. Cardiol Young. 2008 Apr; 18 (2): 177-84. doi: 10.1017/S1047951108001959. Epub 2008 Feb 5. PMID: 18252016.
[16]	Zahn EM, Chang AC, Aldousany A, Burke RP. Emergent stent placement for acute Blalock-Taussig shunt obstruction after stage 1 Norwood surgery. Cathet Cardiovasc Diagn. 1997 Oct; 42 (2): 191-4. doi: 10.1002/(sici)1097-0304(199710)42:2<191:aid-ccd21>3.0.co;2-q. PMID: 9328706.

Cite This Article

Plain Text BibTeX RIS

APA Style

Ata Firouzi, Ehsan Khalilipur, Zahra Khajali, Zahra Hoseini, Sedighe Saedi, et al. (2022). Success Rate and Outcome of Stenting for the Treatment of Stenosis of Palliative Systemic-to-Pulmonary Arterial Shunts: A Case Series. International Journal of Medical Case Reports, 1(3), 29-35. https://doi.org/10.11648/j.ijmcr.20220103.15

Copy | Download

ACS Style

Ata Firouzi; Ehsan Khalilipur; Zahra Khajali; Zahra Hoseini; Sedighe Saedi, et al. Success Rate and Outcome of Stenting for the Treatment of Stenosis of Palliative Systemic-to-Pulmonary Arterial Shunts: A Case Series. Int. J. Med. Case Rep. 2022, 1(3), 29-35. doi: 10.11648/j.ijmcr.20220103.15

Copy | Download

AMA Style

Ata Firouzi, Ehsan Khalilipur, Zahra Khajali, Zahra Hoseini, Sedighe Saedi, et al. Success Rate and Outcome of Stenting for the Treatment of Stenosis of Palliative Systemic-to-Pulmonary Arterial Shunts: A Case Series. Int J Med Case Rep. 2022;1(3):29-35. doi: 10.11648/j.ijmcr.20220103.15

Copy | Download

@article{10.11648/j.ijmcr.20220103.15,
  author = {Ata Firouzi and Ehsan Khalilipur and Zahra Khajali and Zahra Hoseini and Sedighe Saedi and Somaye Ahmadi and Atefe Shafiee and Amir Abdi},
  title = {Success Rate and Outcome of Stenting for the Treatment of Stenosis of Palliative Systemic-to-Pulmonary Arterial Shunts: A Case Series},
  journal = {International Journal of Medical Case Reports},
  volume = {1},
  number = {3},
  pages = {29-35},
  doi = {10.11648/j.ijmcr.20220103.15},
  url = {https://doi.org/10.11648/j.ijmcr.20220103.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmcr.20220103.15},
  abstract = {Introduction: Cyanotic congenital heart diseases includes congenital structural anomalies of the heart with shunting resulted in mixing systemic venous blood into the arterial circulation. Two types of surgical therapies are available for the treatment of this anomalies: corrective and palliative. The goal of palliative surgery is to increase the pulmonary blood flow via systemic-to-pulmonary arterial shunting as the conclusive treatment or as a bridge to corrective surgery. Objective: Obstruction of palliative systemic artery-to-pulmonary artery shunts is one of the causes of deterioration in the clinical status, mortality, and morbidity of patients with cyanotic heart disease. For patients contraindicated for the Fontan surgery, a solution is a new shunt insertion or interventional procedures on stenotic shunts. Redo surgery is associated with higher risks of mortality and complications. Method: Herein, we describe 23 patients with obstructed or stenotic systemic artery-to-pulmonary artery shunts who underwent transcatheter stenting at Rajaie Cardiovascular Medical and Research Center between 2011 and 2019. Result: Pulmonary blood flow increased in all the patients, and there were no significant complications or periprocedural deaths. Blalock–Taussig shunt stenting was successful in the early and late stages in all the patients with recorded data. Hematocrit was decreased by a median of 4 units (2–8 units). During the follow-up, 12 patients were rehospitalized, 4 underwent new procedures, and 4 died. Conclusion: Stenting an obstructed or stenotic systemic artery-to-pulmonary artery shunt is a safe and promising alternative to redo surgery with higher success rates and fewer complications compared with balloon angioplasty.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Success Rate and Outcome of Stenting for the Treatment of Stenosis of Palliative Systemic-to-Pulmonary Arterial Shunts: A Case Series
AU  - Ata Firouzi
AU  - Ehsan Khalilipur
AU  - Zahra Khajali
AU  - Zahra Hoseini
AU  - Sedighe Saedi
AU  - Somaye Ahmadi
AU  - Atefe Shafiee
AU  - Amir Abdi
Y1  - 2022/09/29
PY  - 2022
N1  - https://doi.org/10.11648/j.ijmcr.20220103.15
DO  - 10.11648/j.ijmcr.20220103.15
T2  - International Journal of Medical Case Reports
JF  - International Journal of Medical Case Reports
JO  - International Journal of Medical Case Reports
SP  - 29
EP  - 35
PB  - Science Publishing Group
SN  - 2994-7049
UR  - https://doi.org/10.11648/j.ijmcr.20220103.15
AB  - Introduction: Cyanotic congenital heart diseases includes congenital structural anomalies of the heart with shunting resulted in mixing systemic venous blood into the arterial circulation. Two types of surgical therapies are available for the treatment of this anomalies: corrective and palliative. The goal of palliative surgery is to increase the pulmonary blood flow via systemic-to-pulmonary arterial shunting as the conclusive treatment or as a bridge to corrective surgery. Objective: Obstruction of palliative systemic artery-to-pulmonary artery shunts is one of the causes of deterioration in the clinical status, mortality, and morbidity of patients with cyanotic heart disease. For patients contraindicated for the Fontan surgery, a solution is a new shunt insertion or interventional procedures on stenotic shunts. Redo surgery is associated with higher risks of mortality and complications. Method: Herein, we describe 23 patients with obstructed or stenotic systemic artery-to-pulmonary artery shunts who underwent transcatheter stenting at Rajaie Cardiovascular Medical and Research Center between 2011 and 2019. Result: Pulmonary blood flow increased in all the patients, and there were no significant complications or periprocedural deaths. Blalock–Taussig shunt stenting was successful in the early and late stages in all the patients with recorded data. Hematocrit was decreased by a median of 4 units (2–8 units). During the follow-up, 12 patients were rehospitalized, 4 underwent new procedures, and 4 died. Conclusion: Stenting an obstructed or stenotic systemic artery-to-pulmonary artery shunt is a safe and promising alternative to redo surgery with higher success rates and fewer complications compared with balloon angioplasty.
VL  - 1
IS  - 3
ER  -

Copy | Download

Author Information

Ata Firouzi

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Ehsan Khalilipur

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Zahra Khajali

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Zahra Hoseini

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Sedighe Saedi

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Somaye Ahmadi

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Atefe Shafiee

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Amir Abdi

School of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Ata Firouzi, Ehsan Khalilipur, Zahra Khajali, Zahra Hoseini, Sedighe Saedi, et al. (2022). Success Rate and Outcome of Stenting for the Treatment of Stenosis of Palliative Systemic-to-Pulmonary Arterial Shunts: A Case Series. International Journal of Medical Case Reports, 1(3), 29-35. https://doi.org/10.11648/j.ijmcr.20220103.15

Copy | Download

ACS Style

Ata Firouzi; Ehsan Khalilipur; Zahra Khajali; Zahra Hoseini; Sedighe Saedi, et al. Success Rate and Outcome of Stenting for the Treatment of Stenosis of Palliative Systemic-to-Pulmonary Arterial Shunts: A Case Series. Int. J. Med. Case Rep. 2022, 1(3), 29-35. doi: 10.11648/j.ijmcr.20220103.15

Copy | Download

AMA Style

Ata Firouzi, Ehsan Khalilipur, Zahra Khajali, Zahra Hoseini, Sedighe Saedi, et al. Success Rate and Outcome of Stenting for the Treatment of Stenosis of Palliative Systemic-to-Pulmonary Arterial Shunts: A Case Series. Int J Med Case Rep. 2022;1(3):29-35. doi: 10.11648/j.ijmcr.20220103.15

Copy | Download

@article{10.11648/j.ijmcr.20220103.15,
  author = {Ata Firouzi and Ehsan Khalilipur and Zahra Khajali and Zahra Hoseini and Sedighe Saedi and Somaye Ahmadi and Atefe Shafiee and Amir Abdi},
  title = {Success Rate and Outcome of Stenting for the Treatment of Stenosis of Palliative Systemic-to-Pulmonary Arterial Shunts: A Case Series},
  journal = {International Journal of Medical Case Reports},
  volume = {1},
  number = {3},
  pages = {29-35},
  doi = {10.11648/j.ijmcr.20220103.15},
  url = {https://doi.org/10.11648/j.ijmcr.20220103.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmcr.20220103.15},
  abstract = {Introduction: Cyanotic congenital heart diseases includes congenital structural anomalies of the heart with shunting resulted in mixing systemic venous blood into the arterial circulation. Two types of surgical therapies are available for the treatment of this anomalies: corrective and palliative. The goal of palliative surgery is to increase the pulmonary blood flow via systemic-to-pulmonary arterial shunting as the conclusive treatment or as a bridge to corrective surgery. Objective: Obstruction of palliative systemic artery-to-pulmonary artery shunts is one of the causes of deterioration in the clinical status, mortality, and morbidity of patients with cyanotic heart disease. For patients contraindicated for the Fontan surgery, a solution is a new shunt insertion or interventional procedures on stenotic shunts. Redo surgery is associated with higher risks of mortality and complications. Method: Herein, we describe 23 patients with obstructed or stenotic systemic artery-to-pulmonary artery shunts who underwent transcatheter stenting at Rajaie Cardiovascular Medical and Research Center between 2011 and 2019. Result: Pulmonary blood flow increased in all the patients, and there were no significant complications or periprocedural deaths. Blalock–Taussig shunt stenting was successful in the early and late stages in all the patients with recorded data. Hematocrit was decreased by a median of 4 units (2–8 units). During the follow-up, 12 patients were rehospitalized, 4 underwent new procedures, and 4 died. Conclusion: Stenting an obstructed or stenotic systemic artery-to-pulmonary artery shunt is a safe and promising alternative to redo surgery with higher success rates and fewer complications compared with balloon angioplasty.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Success Rate and Outcome of Stenting for the Treatment of Stenosis of Palliative Systemic-to-Pulmonary Arterial Shunts: A Case Series
AU  - Ata Firouzi
AU  - Ehsan Khalilipur
AU  - Zahra Khajali
AU  - Zahra Hoseini
AU  - Sedighe Saedi
AU  - Somaye Ahmadi
AU  - Atefe Shafiee
AU  - Amir Abdi
Y1  - 2022/09/29
PY  - 2022
N1  - https://doi.org/10.11648/j.ijmcr.20220103.15
DO  - 10.11648/j.ijmcr.20220103.15
T2  - International Journal of Medical Case Reports
JF  - International Journal of Medical Case Reports
JO  - International Journal of Medical Case Reports
SP  - 29
EP  - 35
PB  - Science Publishing Group
SN  - 2994-7049
UR  - https://doi.org/10.11648/j.ijmcr.20220103.15
AB  - Introduction: Cyanotic congenital heart diseases includes congenital structural anomalies of the heart with shunting resulted in mixing systemic venous blood into the arterial circulation. Two types of surgical therapies are available for the treatment of this anomalies: corrective and palliative. The goal of palliative surgery is to increase the pulmonary blood flow via systemic-to-pulmonary arterial shunting as the conclusive treatment or as a bridge to corrective surgery. Objective: Obstruction of palliative systemic artery-to-pulmonary artery shunts is one of the causes of deterioration in the clinical status, mortality, and morbidity of patients with cyanotic heart disease. For patients contraindicated for the Fontan surgery, a solution is a new shunt insertion or interventional procedures on stenotic shunts. Redo surgery is associated with higher risks of mortality and complications. Method: Herein, we describe 23 patients with obstructed or stenotic systemic artery-to-pulmonary artery shunts who underwent transcatheter stenting at Rajaie Cardiovascular Medical and Research Center between 2011 and 2019. Result: Pulmonary blood flow increased in all the patients, and there were no significant complications or periprocedural deaths. Blalock–Taussig shunt stenting was successful in the early and late stages in all the patients with recorded data. Hematocrit was decreased by a median of 4 units (2–8 units). During the follow-up, 12 patients were rehospitalized, 4 underwent new procedures, and 4 died. Conclusion: Stenting an obstructed or stenotic systemic artery-to-pulmonary artery shunt is a safe and promising alternative to redo surgery with higher success rates and fewer complications compared with balloon angioplasty.
VL  - 1
IS  - 3
ER  -

Copy | Download