TY - JOUR
T1 - Impact of Vascular Geometry on Thrombosis in Pediatric Patients With Modified Blalock-Taussig-Thomas Shunt
T2 - A Pilot Study
AU - Penn, Ethan
AU - Qiao, Yi
AU - Platten, Kimsey
AU - Bugenhagen, Scott M.
AU - Rohatgi, Ram
AU - Miller, Jacob R.
AU - Fang, Jiaxiao
AU - Mercer, Kelsey
AU - Kulp, Blaire
AU - Wang, Jinli
AU - Genin, Guy M.
AU - Bark, David
AU - Rabinowitz, Edon J.
N1 - Publisher Copyright:
© 2025 The Author(s).
PY - 2025/3/18
Y1 - 2025/3/18
N2 - BACKGROUND: Thrombosis in modified Blalock-Taussig-Thomas shunts (mBTTS) poses a life-threatening risk for infants with shunt-dependent congenital heart disease. Although hemodynamics influence thrombosis, the specific geometric contributors remain unclear. This study aimed to identify key variables to inform future hemodynamic analysis, hypothesizing that brachiocephalic, subclavian artery, mBTTS, and/or pulmonary artery (PA) geometry play a critical role in clot formation. METHODS AND RESULTS: We retrospectively analyzed 11 infants with hypoplastic left heart syndrome who underwent mBTTS placement. Using computed tomography and magnetic resonance imaging, we generated 3-dimensional models of the shunt and surrounding vasculature. Geometric variables related to shunt positioning and vascular insertion were measured and compared between patients with (n=5) and without (n=6) thrombotic occlusions. Significant differences in vascular geometry were observed between occluded and nonoccluded shunts. Occluded shunts had longer PA lengths (12.4 mm versus 8.4 mm, P=0.0130), increased variance in PA radius (0.03 versus 0.008, P=0.0216), greater PA tortuosity (1.03 versus 1.01, P=0.0043), and increased variance in torsion across the brachiocephalic and subclavian arteries (3200 mm−1 versus 17 500 mm−1, P=0.0390). These findings support our hypothesis that the vascular geometry surrounding the mBTTS plays a critical factor in clot formation. Additional variations in PA, brachiocephalic and subclavian artery geometry approached significance. CONCLUSIONS: Significant geometric differences in the PA, brachiocephalic, and subclavian arteries were associated with mBTTS thrombosis, supporting the hypothesis that vascular geometry plays a critical role in clot formation. These findings provide a foundation for future hemodynamic analyses and may inform surgical planning to reduce thrombosis risk in patients with mBTTSs.
AB - BACKGROUND: Thrombosis in modified Blalock-Taussig-Thomas shunts (mBTTS) poses a life-threatening risk for infants with shunt-dependent congenital heart disease. Although hemodynamics influence thrombosis, the specific geometric contributors remain unclear. This study aimed to identify key variables to inform future hemodynamic analysis, hypothesizing that brachiocephalic, subclavian artery, mBTTS, and/or pulmonary artery (PA) geometry play a critical role in clot formation. METHODS AND RESULTS: We retrospectively analyzed 11 infants with hypoplastic left heart syndrome who underwent mBTTS placement. Using computed tomography and magnetic resonance imaging, we generated 3-dimensional models of the shunt and surrounding vasculature. Geometric variables related to shunt positioning and vascular insertion were measured and compared between patients with (n=5) and without (n=6) thrombotic occlusions. Significant differences in vascular geometry were observed between occluded and nonoccluded shunts. Occluded shunts had longer PA lengths (12.4 mm versus 8.4 mm, P=0.0130), increased variance in PA radius (0.03 versus 0.008, P=0.0216), greater PA tortuosity (1.03 versus 1.01, P=0.0043), and increased variance in torsion across the brachiocephalic and subclavian arteries (3200 mm−1 versus 17 500 mm−1, P=0.0390). These findings support our hypothesis that the vascular geometry surrounding the mBTTS plays a critical factor in clot formation. Additional variations in PA, brachiocephalic and subclavian artery geometry approached significance. CONCLUSIONS: Significant geometric differences in the PA, brachiocephalic, and subclavian arteries were associated with mBTTS thrombosis, supporting the hypothesis that vascular geometry plays a critical role in clot formation. These findings provide a foundation for future hemodynamic analyses and may inform surgical planning to reduce thrombosis risk in patients with mBTTSs.
KW - biomechanics
KW - blaylock taussig thomas shunt
KW - clot
KW - congenital heart disease
KW - hemodynamics
KW - shear stress
KW - thrombosis
UR - http://www.scopus.com/inward/record.url?scp=105001223117&partnerID=8YFLogxK
U2 - 10.1161/JAHA.124.038357
DO - 10.1161/JAHA.124.038357
M3 - Article
C2 - 40055876
AN - SCOPUS:105001223117
SN - 2047-9980
VL - 14
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 6
M1 - e038357
ER -