Wehman Brody, Pasrija Chetan, Kaushal Sunjay, Pham Phat P
Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Department of Pediatrics, Division of Pediatric Cardiology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Ann Pediatr Cardiol. 2014 Sep;7(3):213-6. doi: 10.4103/0974-2069.140855.
We describe a new technique for treatment of shunt thrombosis in infants with complex anatomical defects. A 2-month-old girl with Tetralogy of Fallot underwent placement of a modified Blalock-Taussig shunt (MBTS) at day of life (DOL) 6 with revision at DOL 20. Following this surgery, the patient became hypotensive and hypoxic with new evidence of lack of flow through the MBTS on echocardiography. Angiography showed an occluded MBTS and right pulmonary artery with patent distal branches with normal pulmonary venous return. Balloon angioplasty was attempted but failed to fully recanalize the right pulmonary artery (RPA) and MBTS. An AngioJet catheter was then passed through the shunt and RPA to perform rheolyticthrombectomy. Subsequent angiogram showed a widely patent RPA and MBTS. An echocardiogram at 1-month post-thrombectomy showed a widely patent MBTS with continuous flow seen entering both branch pulmonary arteries. The AngioJet system for thrombectomy provides a viable option for complex thrombus removal in patients refractory to other methods.
我们描述了一种治疗患有复杂解剖缺陷婴儿分流血栓形成的新技术。一名2个月大的法洛四联症女孩在出生后第6天接受了改良布莱洛克-陶西格分流术（MBTS）植入，并在出生后第20天进行了修复。此次手术后，患者出现低血压和低氧血症，超声心动图显示有新证据表明MBTS无血流通过。血管造影显示MBTS和右肺动脉闭塞，远端分支通畅，肺静脉回流正常。尝试进行球囊血管成形术，但未能使右肺动脉（RPA）和MBTS完全再通。然后将AngioJet导管通过分流管和RPA以进行血栓消融术。随后的血管造影显示RPA和MBTS广泛通畅。血栓切除术后1个月的超声心动图显示MBTS广泛通畅，可见持续血流进入双侧肺动脉分支。AngioJet血栓切除系统为其他方法治疗无效的患者去除复杂血栓提供了一种可行的选择。
