A Case of Successfully Treated by Local Low-dose Urokinase Infusion in Neonate with Blalock-Taussing Shunt Partially Occluded by Thrombus

ABSTRACT

For some cyanotic children with deficient pulmonary blood flow, the Blalock-Taussig shunt is a life-saving or temporizing form of palhation. Extensive experience has been gathered, and mortality and morbidity as well as the incidence of shunt stenosis and thrombosis have significantly decreased. However, even nowadays, the most frequently encountered complication excluding mortality in early postoperative course is occlusion of the shunt. We experienced a case of Blalock-Taussig shunt occlusion with thrombus. We diagnosed him as ventricular septal defect with pulmonary atresia by echocardiography and performed a right classic Blalock-Taussig shunt at 7th day of age, Oxygen saturation was gradually decreased since the 6th day postoperative. He was diagnosed as thrombosis of shunt at 12th day postoperative by cardiac angiography, and then was treated with a local low-dose urokinase infusion(1,000U/kg/hr) through Cobra catheter(Cook. In. Co.). After 21 hours, thrombolysis of shunts was comfirmed. We stopped the urokinase and medicated low-dose aspirin(5mg/kg/day). After the eighth day, shunt flow by echocardiography was patent.