A 7-month-old boy weighing 6 kg was admitted to the intensive care with cyanotic spell. He was diagnosed to have double outlet right ventricle with severe pulmonary stenosis and normally related great arteries. He was stabilized with intravenous morphine, ketamine, and esmolol infusion. The branch pulmonary arteries were noted to be hypoplastic, and a large conal branch was noted across the right ventricular outflow tract, precluding an emergent biventricular repair. Hence, a 4-mm polytetrafluoroethylene Blalock-Taussig shunt was placed between the right brachiocephalic trunk and the main pulmonary artery. The oxygen saturation improved to 80%, and he was discharged on day 16 on aspirin 5 mg/kg/day and clopidogrel 0.5 mg/kg/day.
He was readmitted in a collapsed state 10 days later. Shunt murmur was absent, and echocardiography suggested blocked Blalock-Taussig shunt. After intubation and mechanical ventilation, he was rushed to the catheterization lab where angiography confirmed totally occluded Blalock-Taussig shunt. One hundred units/kilogram of intravenous heparin bolus was administered. Over a 5F Judkin’s right guide catheter from the femoral arterial access, the aortopulmonary shunt was wired with a hydrophilic coated coronary guidewire into the left pulmonary artery. The blocked shunt was predilated with a 4 mm × 8 mm non-compliant balloon at 10 atm following which a 4 mm × 18 mm sirolimus-eluting stent was deployed at nominal pressures covering both ends of the shunt (Fig. 1). The saturation improved to 85%, and he was discharged on dual antiplatelets. Aspirin was continued at 5 mg/kg/day, and clopidogrel dose was increased to 1 mg/kg/day. The stent remained patent at 9 months’ follow-up. He is planned for reassessment of intracardiac repair on follow-up.