日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Infective obstruction of a modified Blalock–Taussig shunt (mBTS) has remained poorly investigated. Here, we present six cases of this condition and discuss the therapeutic strategy. The underlying congenital heart diseases were tetralogy of Fallot (n＝2), complete atrioventricular septal defect with pulmonary atresia (n＝1), pulmonary atresia with an intact ventricular septum (n＝1), tricuspid atresia (n＝1), and truncus arteriosus communis persistens (n＝1). Only two cases had infection during the diagnosis of mBTS obstruction. The bacterial pathogens were methicillin-resistant coagulase-negative staphylococci (n＝3), Salmonella spp. (n＝1), Serratia marcescens (n＝1), and Staphylococcus epidermidis (n＝1). Furthermore, three cases had pseudoaneurysm at the proximal anastomotic site of the mBTS. Pulmonary blood flow supply was established by mBTS recanalization through catheterization (n＝1), right ventricular outflow tract reconstruction (n＝1), original BTS utilization (n＝2), and a larger-sized right ventricle-pulmonary artery conduit (n＝1). Only one patient with no alternative therapeutic options was applied with prosthetic materials. Foci of infection, such as artificial shunt graft and pseudoaneurysm, were completely removed, except in one patient who underwent effective catheterization. In conclusion, possible infection must be considered in patients with mBTS obstruction. Pseudoaneurysm at the proximal anastomotic site of the mBTS suggests infective obstruction. Furthermore, the therapeutic strategy includes 1) treatment for hypoxemia, 2) establishment of a new supply of pulmonary blood flow, 3) surgery without using prosthetic materials, and 4) removal of infection foci.