Transcatheter Treatment of Thrombosis in the Single Ventricle Pathway: An Institutional Experience

• Published in: Congenital heart disease Vol. 11; no. 1; p. 39
• Main Authors: Diab, Yaser A, Ramakrishnan, Karthik, Alfares, Fahad A, Hynes, Conor F, Chounoune, Reginald, Shankar, Venkat, Kanter, Joshua P, Nath, Dilip S
• Format: Journal Article
• Language: English
• Published: United States 01-01-2016
• Subjects: Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - instrumentation; Blalock-Taussig Procedure - adverse effects; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Female; Heart Bypass, Right - adverse effects; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - surgery; Heart Ventricles - abnormalities; Heart Ventricles - surgery; Humans; Male; Palliative Care; Retrospective Studies; Stents; Thrombectomy - adverse effects; Thrombosis - diagnosis; Thrombosis - etiology; Thrombosis - therapy; Time Factors; Treatment Outcome; Single Ventricle Physiology; Congenital Heart Disease; Transcatheter Intervention
• ISSN: 1747-0803
• DOI: 10.1111/chd.12281

Shunt or conduit thrombosis in a single ventricle circuit is a life-threatening complication that requires prompt treatment to rapidly restore shunt/conduit patency. Transcatheter interventions represent an attractive alternative to systemic thrombolysis or open surgical procedures. We report our center's experience with catheter-based approaches in patients with palliated single ventricle who present with shunt/conduit thrombosis.
A retrospective review was performed of all patients with palliated single ventricle physiology who were diagnosed over a 5-year period with shunt/conduit thrombosis and received catheter-based interventions. Patients were followed up to hospital discharge.
Thirteen patients were identified that were diagnosed with thrombosis of a modified Blalock-Taussig shunt (five patients), bidirectional cavopulmonary shunt (one patient), and total cavopulmonary pathway (seven patients). Shunt/conduit thrombosis occurred both early and late after palliation surgery. Catheter-based interventions included balloon angioplasty (one patient), stent implantation (12 patients), and mechanical thrombectomy (one patient). Thrombophilia was identified in seven patients. Technical and clinical success with restoration of normal shunt flow and improvement in clinical status was achieved in 12 patients. Reversible procedure-related complications occurred in three patients with no significant sequelae.
Our experience suggests that percutaneous catheter-based interventions are safe and effective in managing shunt/conduit thrombosis in infants and children with palliated single ventricle circulation.