Balloon angioplasty for obstructed modified systemic-pulmonary artery shunts and pulmonary artery stenoses

OBJECTIVES The results of Percutaneous balloon angioplasty for obstructed m odified Blalock-Taussig (BT) or central shunts and pulmonary artery (PA) st enoses were studied to assess its role as an alternative to second shunt an d surgical PA angioplasty. BACKGROUND Obstruction of a modified shunt and PA stenosis related to the s hunt or ductus are not infrequent. A second shunt with or without PA angiop lasty is required if the PA size, morphology or age of the patient is subop timal for definitive surgery. METHODS From June 1994 to May 1999, balloon angioplasty for obstructed syst emic to-PA shunts nas performed in 46 patients, with ages ranging from 1 mo nth to 7.4 years (2.2 +/- 1.9 years). Among the 46 patients, 32 had modifie d BT shunts, 5 had bilateral shunts, 7 had modified central shunts, and 2 h ad both modified BT and central shunts. Stenoses were seen in 27 main branc h PAs, and interruption was present in three. A concurrent balloon angiopla sty was attempted in 28 main branch PAs, but it was performed in only 25 ve ssels. RESULTS Balloon dilation for obstructed modified shunts was considered to b e effective in 42 patients (91%), while angioplasty for PA stenosis was eff ective in 14 vessels and not effective in 11 vessels. After balloon dilatio n angioplasty, oxygen saturation in the aorta increased from 74.4 +/- 4.3% to 80.8 +/- 3.6% (p < 0.01) in these 46 patients. One patient died of pneum onia. Eight patients required an additional modified BT shunt soon after th e procedure because of severe stenosis or interruption at main branch PA. A fter a mean follow-up period of 11.6 +/- 5.4 months, 29 patients underwent a repeated imaging study to evaluate the morphology and size of the PAs. Of these 29 patients, 26 underwent open heart surgery, with two mortalities. CONCLUSIONS When a second shunt is under consideration because of obstructi on of the modified shunt, balloon angioplasty is a possible alternative pro cedure. Pulmonary artery stenosis, if present, can be simultaneously dilate d, (J Am Coil Cardiol 2001;37:940-7) (C) 2001 by the American College of Ca rdiology.