Percutaneous transcatheter device closure of a congenital left ventricular diverticulum in a 5-year-old child

Ventricular diverticulum is a rare congenital malformation. Although most patients are asymptomatic, it can present with rupture and sudden death, for which surgical repair is indicated. The authors report the case of a 5-year-old boy with a prenatal diagnosis of an isolated left ventricular diverticulum. It was decided for surgical closure; however, a persisting leakage at the patch repair site was observed, for which a transcatheter percutaneous closure approach was used, achieving complete occlusion of the defect. Transcatheter closure of suitable ventricular diverticula is a safe and effective option.

Transient Complete Heart Block after Percutaneous Transcatheter ASD Device Closure

Transcatheter device closure of atrial septal defect (ASD) is associated with increased complications in small children in device size ≥ 19mm or indexed size ≥ 0.18 mm/cm and weight≤ 15 kg. Complete atrioventricular heart block (CHB) is reported as a rare complication of ASD device closure. We report the case of a 7year-old boy, 23kg weight, underwent device closure of ASD and subsequently developed CHB next day after the procedure which was completely resolved by day 3 with steroid treatment. Similar case reports were rarely reported in the literature. Keywords: atrial septal defect, complete heart block, device/height ratio.

Intravascular Hemolysis after Transcatheter Closure of a Huge Tubular Patent Ductus Arteriosus Using Cera-duct Occluder: Managed Successfully by Conservative Treatment

Isolated patent ductus arteriosus (PDA) is seen in approximately 1 in 2000 full-term life birth neonate. Transcatheter device closure is widely considered as the treatment of choice for the patient diagnosed with PDA considering the safety, efficacy and less invasiveness. Residual flow following transcatheter device closure of PDA can result in haemolysis. Our patient was a case of 9.5 years old female child weighing13 kg diagnosed as a case of large tubular PDA with severe pulmonary hypertension by echocardiography. The patient had history of recurrent chest infection, breathlessness on exertion, and growth failure. The PDA was closed by transcatheter approach using Cera-duct occluder. The patient subsequently developed hemolysis which started 18 hrs after the intervention and the resolution of hemolysis achieved by conservative management within 72 hours. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 90-92

Debating the embolization of a large aberrant systemic artery for pulmonary sequestration using an Amplatzer duct occluder: a case report and literature review

Here, we report two rare cases of pulmonary sequestration that were fed by large systemic arteries and embolized with a large Amplatzer duct occluder and their 3-year follow-up, and we discuss the efficacy and safety of the embolization of a large aberrant systemic artery to pulmonary sequestration using an Amplatzer duct occluder. A 9-year-old boy complained of chest pain for 1 month, and a 6-year-old boy initially complained of recurrent cough for 3 months. A series of examinations was launched to evaluate any possible malformation or abnormalities in the patients. Chest CT and CTA identified a right lower pulmonary sequestration with infection. After admission, transcatheter device occlusion was planned after essential antibiotic treatment, and postoperative infection prevention and anti-inflammatory treatment were given. In the following 2 years of follow-up, neither of the children had recurrent chest pain, cough or other related symptoms. However, the CT follow-up demonstrated that a residual mass was visible in both patients. The same chest scan section revealed slight reductions in lung lesions from 38.344 cm2 to 37.119 cm2 (3% reduction) and 14.243 cm2 to 13.178 cm2 (7.5% reduction) for each patient. No follow-up data demonstrated the long-term clinical outcomes of the residual lesion. We do not recommend that embolization be performed for large pulmonary sequestration lesions with an aberrant artery larger than 6 mm that is planned to receive a device larger than 10 mm, as their outcomes showed a higher possibility of rebuilding the vascularization network feeding the pulmonary sequestration, indicating a higher risk for long-term complications.

Case report: echocardiographic detection of rare single coronary artery anomaly in a child with an atrial septal defect

Background A single right coronary artery (RCA) with the left anterior descending (LAD) and circumflex coronary arteries located in the usual anatomic position and supplied by collaterals is the rarest variant of single RCA. Case summary We report a paediatric patient with an incidental finding of single RCA Lipton type RI pattern during assessment for transcatheter device closure of an ostium secundum atrial septal defect (secASD). Transthoracic echocardiography (TTE) revealed a dilated RCA, abnormal flow in the LAD, and no identifiable left main coronary artery. Diagnosis of a single RCA was confirmed with angiography. Dobutamine stress echocardiography revealed no inducible ischaemia. Transcatheter device closure of the secASD was subsequently successfully performed. Discussion TTE in paediatric patients can raise suspicion of coronary artery origin anomalies. Additional modalities, such as computed tomography and angiography, are required to comprehensively determine coronary artery anatomy. Functional assessment of ventricular function is also indicated. Coronary artery anatomy is important to delineate prior to transcatheter device closure of a secASD and should be part of the pre-procedure assessment.

Successful simultaneous transcatheter treatment for secundum atrial septal defect with valvular pulmonary stenosis in children under transthoracic echocardiography guidance

BACKGROUND Transcatheter device closure of secundum atrial septal defect (ASD) with valvular pulmonary stenosis (PS) under fluoroscopy and/or transesophageal echocardiography (TEE) guidance is a mature technology. However, little study has focused on whether the technology can be guided totally by transthoracic echocardiography (TTE), even in children.METHODS Thirteen children with ASD combined with PS underwent transcatheter device closure totally guided by TTE at our cardiac center from March 2 016 to August 2 019. Percutaneous transcatheter pulmonary valvuloplasty was performed first and then transcatheter closure of the ASD uneventfully.RESULTS All cases were successfully treated with transcatheter balloon pulmonary valvuloplasty and closure of ASD respectively via femoral vein approach solely under TTE guidance. The mean defect size was 8.1±1.4 mm (range: 5.5-10 mm), the preoperative mean pressure gradient across pulmonary valve was 61.2±5.5 mmHg (range: 51-71 mmHg). The mean device size used was 11.1±1.9 mm (range: 8- 14 mm), the mean procedure time was 55.1±8.0 min (range: 45-71 min). There were no serious cardiovascular related complications. During the follow-up period (10 mon to 47mon), no arrhythmias device, thrombosis, residual fistulas or device frame fractures were detected. PS gradient had significant difference before and after procedure during the follow up (t=28.9, P =0.000).CONCLUSION Simultaneous transcatheter treatment for ASD complicated by PS in children under TTE guidance is an safe and effective therapeutic option.

Midazolam for conscious sedation in transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography

Objectives: To investigate the safety and feasibility of midazolam for conscious sedation in transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography. Methods: A retrospective analysis was performed on 55 patients who underwent transcatheter device closure of atrial septal defects from October, 2019 to May, 2020. All patients received intravenous midazolam and local anesthesia with lidocaine to maintain sedation. A group of previous patients with unpublished data who underwent the same procedure with general anesthesia was set as the control group. The relevant clinical parameters, the Ramsay sedation scores, the numerical rating scale, and the post-operative satisfaction questionnaire were recorded and analyzed. Results: In the midazolam group, the success rate of atrial septal defect closure was 98.2%. Hemodynamic stability was observed during the procedure. None of the patients needed additional endotracheal intubation for general anesthesia. Compared with the control group, the midazolam group had no statistically significant differences in the Ramsay sedation score and numerical rating scale scores. Patients in the midazolam group experienced more post-operative satisfaction than those in the control group. Conclusions: Conscious sedation using midazolam is a safe and effective anesthetic technique for transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography.

Transcatheter Device Closure of Perimembranous and Intracristal Ventricular Septal Defects in Children: Medium‐ and Long‐Term Results

Background In children, the practice of transcatheter closure of intracristal ventricular septal defect (icVSD) has been limited. Currently, there is a lack of comparison between device closure of perimembranous ventricular septal defect (pmVSD) and icVSD, and long‐term clinical outcomes are rare. Methods and Results This study included a total of 633 children (39 with icVSD and 594 with pmVSD), aged 18 months to 16 years, who underwent transcatheter closure of ventricular septal defect between January 2014 and December 2018. All patients were followed up until September 2020, with a median follow‐up of 46 months in the pmVSD group and 52 months in the icVSD group. The procedural success rate was 96.3% and 84.6% in pmVSD and icVSD groups, respectively ( P =0.002). The median of age, weight, procedure time, fluoroscopic time, and radiation dose were greater in the icVSD group compared with the pmVSD group. More eccentric ventricular septal defect occluders were used in the icVSD group. Most adverse events were minor without any intervention, with cardiac rhythm/conduction abnormalities being the most common. In the pmVSD group, 2 patients experienced complete atrioventricular block, with one implanting a permanent pacemaker and the other dying of cardiac arrest secondary to reversible complete atrioventricular block 40 days postprocedure. Complete left bundle‐branch block occurred in 14 patients, and 12 cases were transient. In the icVSD group, no complete atrioventricular block or death occurred, and one patient developed transient complete left bundle‐branch block. Conclusions In selected patients, transcatheter device closure of pmVSD and icVSD can be performed safely and successfully, with excellent medium‐ and long‐term results in children.

Transcatheter closure of ventricular septal defects in children less than 10 kg: experience from a tertiary care referral hospital in Eastern India

Objective: To assess the feasibility of percutaneous transcatheter device closure of ventricular septal defects in children weighing less than 10 kg. Background: Although percutaneous transcatheter device closure of ventricular septal defect is a well-established method of treatment in older children and adolescents, there is limited data on device closure in small children weighing less than 10 kg. We present our institutional experience of transcatheter VSD closure in children weighing less than 10 kg. Method: Medical records were reviewed for 16 children, who were selected for device closure of ventricular septal defects based on the inclusion criteria. Results: Out of 65 patients with a diagnosis of ventricular septal defect, 16 children less than 10 kg were attempted for percutaneous device closure. In 13 patients, the device was successfully released, and 3 patients needed surgical closure of the defect. Mean age and weight of the patients were 17.3 ± 12.7 months and 6.8 ± 3.2 kg, respectively. Mean defect size was 6 mm (range 3–10). There was no incidence of device embolisation or heart block or death. Five patients had residual left-to-right shunt immediately after the device release, which got closed by the first month’s follow-up. We had one accidental perforation of right ventricular free wall at the time of crossing of the defect, which was successfully repaired surgically. Conclusion: Percutaneous device closure of ventricular septal defect in small children with weight below 10 kg is feasible with good short-term outcome. Careful patient selection is essential for procedural success and to avoid complications.