Occlusion of the modified Blalock-Taussig shunt: unique methods of treatment and review of catheter-based intervention. 
To report unique methods of treatment and review catheter-based intervention for occluded modified Blalock-Taussig shunts (BTS).  Case reports and articles involving children undergoing catheter-based treatment for occluded modified BTS were reviewed.  Literature review detailed 38 patients in whom occluded modified BTS were treated with 39 catheter-based interventions.  Thrombolytics alone were delivered by catheter in 13 cases.  Balloon angioplasty was performed in 23 cases, 5 with stent implantation.  Both thrombolytic delivery and angioplasty were performed in 3 cases, 2 with stent implantation.  Intervention was initially successful at re-establishing modified BTS patency in 35/39 (90%) of cases.  Patency could not be established in 2 patients who then proceeded to the operating for surgical shunt revision.  Two deaths occurred during the procedures.  Three cases at Emory University demonstrate uncommon or unique instances of catheter-based intervention: (1) declotting of a shunt in a patient supported by extracorporeal membrane oxygenation (ECMO); (2) declotting of a shunt via a right axillary arterial approach; and (3) declotting of a shunt using a carotid arterial (ECMO) cannula for percutaneous access.  The use of catheter-based techniques for the treatment of BTS occlusion is highly successful, and potentially avoids high-risk re-operative intervention.  ECMO can provide for a stable patient during the procedure.  Hopefully, with improved technology and innovative procedures, more children in the future with BTS occlusion can be served by successful percutaneous intervention.