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Transcatheter occlusion of Blalock-Taussig shunts: technical options
P E Burrows1, T C Edwards, L N Benson
1Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada.
Insights
Transcatheter shunt occlusion in children can be achieved with various techniques. Distal flow control or transvenous placement of ductal occluder devices are most effective for successful Blalock-Taussig shunt occlusion.
Area of Science:
- Pediatric Cardiology
- Interventional Radiology
- Vascular Surgery
Background:
- Blalock-Taussig shunts are used to palliate cyanotic heart disease in children.
- Transcatheter shunt occlusion is an alternative to surgical revision.
- Comparing embolization techniques is crucial for optimizing outcomes.
Purpose of the Study:
- To describe and compare the results of four different embolization techniques for transcatheter Blalock-Taussig shunt occlusion in pediatric patients.
- To identify the safest and most effective methods for shunt occlusion.
Main Methods:
- Retrospective review of 18 pediatric patients undergoing Blalock-Taussig shunt occlusion.
- Evaluation of three devices: coils, balloons, and ductal occluders.
- Analysis of four techniques: direct transarterial, transarterial with proximal/distal flow control, and transvenous delivery.
Main Results:
- Successful shunt occlusion in 14 out of 17 attempted cases.
- Device embolization to the pulmonary circulation occurred in 5 patients, primarily with transarterial delivery without or with proximal flow control.
- Transarterial occlusion with distal flow control (8/9 success) and transvenous ductal occluder delivery (3/3 success) were the most reliable methods, avoiding distal stenosis.
Conclusions:
- Transcatheter embolization of Blalock-Taussig shunts carries a risk of pulmonary device embolization.
- Distal flow control during transarterial placement or transvenous delivery of ductal occluder devices are recommended to minimize this risk.
- These techniques offer reliable shunt occlusion with improved safety profiles.
Purpose:
This review of findings in children undergoing transcatheter shunt occlusion was carried out to describe and compare the results of four different embolization techniques.
Patients And Methods:
A retrospective review of clinical, radiologic, and cardiac catheterization records was carried out for 18 consecutive pediatric patients referred for Blalock-Taussig shunt occlusion at one institution. Technical aspects included the use of three devices--steel wire/fiber coils, detachable latex balloons, and ductal occlusion devices--and four techniques--direct transarterial placement, transarterial placement with proximal or with distal flow control, and transvenous delivery.
Results:
Occlusion of the shunt was attempted in 17 patients (mean age, 6.2 years). Shunt occlusion was successful in 14 patients. Embolization of a device into the pulmonary circulation occurred in five patients, and was most frequent with transarterial delivery without flow control or with proximal flow control (in four of six). Transarterial occlusion with distal flow control and transvenous delivery of ductal occluder devices were the most reliable methods of occluding shunts without distal stenosis, with success in eight of nine cases with the former technique and all of three with the latter technique.
Conclusions:
Transarterial embolization of Blalock-Taussig shunts carries a risk of device embolization to the pulmonary circulation; this is best avoided by the use of distal flow control or transvenous placement of a ductal occlusion device.