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

Jou-Kou Wang, MD^*, Mei-Hwan Wu, MD, FACC^*, Chung-I. Chang, MD, Ing-Sh Chiu, MD and Hung-Chi Lue, MD, FACC^*

^* Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan

View larger version (22K): [in a new window]   Figure 1 A flow chart of the 46 patients in whom balloon angioplasty for obstructed shunt was performed. F/U = follow-up.

View larger version (96K): [in a new window]   Figure 2 Left side panels: A, C, E, G: angiograms at a subclavian artery showing stenosis (arrow) at the subclavian artery (A), stenosis (arrow) at anastomotic site of subclavian-to-graft (C), stenosis in graft (E) and graft-to-pulmonary artery stenosis (curved arrow) (G). There were shunt-related pulmonary artery stenoses noted on panels C and G (arrow). Right side panels: B, D, F, H (after angioplasty): repeat angiograms at the subclavian artery after angioplasty showing stenoses at the subclavian artery (arrow) (B), anastomotic sites (D and H) and graft (F) were relieved. There was dissection (white arrow) in the subclavian artery noted on panel D. The shunt-related pulmonary artery stenosis was partially relieved after a concurrent angioplasty using a larger size balloon (panel H).

View larger version (76K): [in a new window]   Figure 3 (A) Significant stenosis related to a ductus at the right pulmonary artery is illustrated. (B) After balloon angioplasty, pulmonary artery stenosis was relieved.

View larger version (151K): [in a new window]   Figure 4 (A and B) A selective angiogram illustrating multiple stenoses, (arrowheads) in the modified Blalock-Taussig shunt in a patient who underwent unifocalization of the pulmonary arteries. There were stenoses in distal pulmonary arteries. (C and D) After angioplasty, the stenoses in the shunt were relieved with increased pulmonary blood flow. There was occlusion of a left distal pulmonary artery (arrow).

View larger version (61K): [in a new window]   Figure 5 (a) Significant stenosis (arrowhead) at the left pulmonary artery related to a modified Blalock-Taussig shunt is shown. Balloon dilation was performed in this patient. (b) A repeated pulmonary arteriogram 18 months after balloon angioplasty showing mild stenosis (arrowhead) at the left pulmonary artery. (c) After the repeated angioplasty, the stenosis at the left pulmonary artery was completely relieved.