Stenting of central aortopulmonary shunt in a child with pulmonary atresia, ventricular septal defect, and severely hypoplastic pulmonary arteries.

A male infant was born at 28 weeks gestation weighing 850 g. He was diagnosed with pulmonary atresia, ventricular septal defect and major aorto-pulmonary collaterals with severely hypoplastic true pulmonary arteries. A 3.5 mm Gore-Tex central shunt was anastomosed from the ascending aorta to the main pulmonary artery at 4 months of age and a weight of 3.5 kg. The left pulmonary artery measured 1-2 mm and the right pulmonary artery measured 1 mm. His saturations increased from 70% to 85% following placement of the central shunt. At 16 months of age, his oxygen saturation decreased to 68%. Cardiac catheterization, using a retrograde approach, and angiography demonstrated a moderate degree of stenosis within the distal shunt and a severe left pulmonary arterial stenosis. A 4 x 18 mm Multi-Link Vision coronary stent was implanted within the stenotic central shunt and angioplasty of the left pulmonary arterial stenosis was performed. The oxygen saturation improved to 84% after the procedure. Although stenting of the Blalock-Taussig shunt has been described previously, this represents one of the first reports of stenting of a central aortopulmonary shunt. This significantly improved the patient's oxygen saturation and allowed the potential for some further central pulmonary arterial growth prior to unifocalization procedure.