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Asian Cardiovasc Thorac Ann 2000;8:91
© 2000 Asia Publishing EXchange Pte Ltd

LETTER TO THE EDITOR

Simple Maneuver to Visualize Blalock-Taussig Shunt During Angiography

Jabadurai Ratnaraj, MD, Natarajan Sivakadaksham, MD, DM, Christopher Roy, MS, MCh, MP Naresh Kumar, MS, MCh, FRCS

Department of Cardiovascular Diseases
Harvey Heart Hospitals Ltd
20 Pycrofts Garden Road
Nungambakkam
Chennai 600006, India
A 1-year-old child with tricuspid atresia, pulmonary atresia, and hypoplastic right ventricle had been palliated at birth by a modified Blalock-Taussig shunt between the bifurcation of the right innominate artery and the origin of the right pulmonary artery, using a 5-mm soft-walled polytetrafluoroethylene tube (Gore-Tex; WL Gore, Flagstaff, AZ, USA). The child was reinvestigated for recurrent progressive cyanosis and polycythemia by catheterization and angiography to delineate the anatomy. A right heart study confirmed tricuspid and pulmonary atresia. Aortic root injection showed filling of the pulmonary arteries but the shunt could not be visualized adequately to assess any shunt-related problems. Attempts at selective catheterization and injection of the shunt were frustrated repeatedly by a fairly acute take-off by the shunt from the bifurcation of the right innominate artery and fast streaming of contrast medium into the subclavian and carotid arteries (Figure 1AGo). At this point, slight carotid compression of the right side was applied synchronously with injection of dye at the junction of the shunt and the right innominate artery. This forced dye through the shunt, giving clear delineation (Figure 1BGo). Contrast medium flowing into the pulmonary artery through the shunt showed stenosis of the distal end of the shunt and of the right pulmonary artery. The child underwent a takedown of the Blalock-Taussig shunt and a bidirectional Glenn shunt was performed with aug-mentation of the stenosed segment of the right pulmonary artery.



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  		Figure 1. (A) Rapid streaming of contrast medium into the right innominate artery. (B) Digital compression of the right carotid artery enhances filling of the right Blalock-Taussig shunt and pulmonary arterial tree.

 
Visualization of the pulmonary arterial tree and a shunt does not usually pose a problem during angiographic studies. However, in certain situations where delineation of the shunt and pulmonary arteries is critical and the anatomy is difficult, maneuvers such as balloon occlusion aortography or use of floatation balloon catheters may be required.1,2 Ipsilateral axillary artery compression for reopening an acutely blocked Blalock-Taussig shunt has been reported recently.3 This simple maneuver is an adjunct to better visualization of shunts in small babies where selective catheterization may be difficult or impossible due to anatomical constraints.

References

  1. Ino T, Shimazaki S, Nishimoto K, Akimoto K, Iwahara M, Yabuta K, et al. Balloon occlusion aortography. Eur J Pediatr 1991;150:220–3.[Medline]

  2. Lee ML, Chiu IS, Wu MH, Wang JK, Lue HC, Chaou WT, et al. Transarterial approach of the pulmonary artery in anatomically corrected malposition of the great arteries by manipulating a catheter inverted with balloon floating maneuver. Int J Cardiol 1998;67:1–7.[Medline]

  3. Sharma AV, Bhan A, Sharma R, Saxena N. Noninvasive reopening of acutely blocked Blalock-Taussig shunt. Ann Card Anesthes 1999;2:65–6.





This Article
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