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Transvenous closure of large aortopulmonary collateral.

Barwad PW, Gulati GS, Gupta SK, Saxena A, Airan B, Ramakrishnan S - Ann Pediatr Cardiol (2014)

Bottom Line: We present here an unusual case with a large residual APC causing refractory low-output state in the early postoperative period.Usual arterial approach failed due to extensive angulation with ostial narrowing.The large residual APC was successfully closed with an Amplatzer duct occluder (ADO) device delivered through the transvenous route.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Aortopulmonary collaterals (APCs) are occluded either preoperatively or at the time of cardiac surgery in patients with pulmonary atresia and ventricular septal defect (PAVSD). If left untreated, APCs are an important cause of deterioration in the early postoperative period. We present here an unusual case with a large residual APC causing refractory low-output state in the early postoperative period. Usual arterial approach failed due to extensive angulation with ostial narrowing. The large residual APC was successfully closed with an Amplatzer duct occluder (ADO) device delivered through the transvenous route.

No MeSH data available.


Related in: MedlinePlus

DSA image (LAO projection) showing successfully deployed ADO device in the APC with no flow across the device
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Figure 5: DSA image (LAO projection) showing successfully deployed ADO device in the APC with no flow across the device

Mentions: A 6F Swan-Ganz catheter was advanced into the pulmonary artery from the venous side through the conduit gently over a Terumo glidewire so as to avoid injury to surgical anastomotic sites in RVOT. The APC was re-hooked from the arterial side with a Picard catheter and a 0.035" Terumo glidewire was passed across the collateral into the pulmonary artery. This wire was snared using a Microvena snare (Microvena corp. MN, USA) and exteriorized from the venous sheath. Thus, an arteriovenous railroad was created through the collateral and pulmonary artery. A 6F Amplatzer PDA delivery sheath (180° Curve Amplatzer TorqVue Delivery System, Amplatzer Inc, MN, USA) was advanced with difficulty from the venous side through the conduit, pulmonary artery, collateral, and then into the DTA [Figure 4]. Using this sheath, a 10 × 8 mm ADO device was deployed in the APC successfully. Angiography showed good position of the device with no flow across the APC into the pulmonary artery [Figure 5]. Patient was successfully weaned off the ventilator in the next 48 h and was later on discharged from the hospital after 7 days. At a follow-up of 8 months, patient is doing well with no residual surgical problems and has gained 3 kg in weight.


Transvenous closure of large aortopulmonary collateral.

Barwad PW, Gulati GS, Gupta SK, Saxena A, Airan B, Ramakrishnan S - Ann Pediatr Cardiol (2014)

DSA image (LAO projection) showing successfully deployed ADO device in the APC with no flow across the device
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3959058&req=5

Figure 5: DSA image (LAO projection) showing successfully deployed ADO device in the APC with no flow across the device
Mentions: A 6F Swan-Ganz catheter was advanced into the pulmonary artery from the venous side through the conduit gently over a Terumo glidewire so as to avoid injury to surgical anastomotic sites in RVOT. The APC was re-hooked from the arterial side with a Picard catheter and a 0.035" Terumo glidewire was passed across the collateral into the pulmonary artery. This wire was snared using a Microvena snare (Microvena corp. MN, USA) and exteriorized from the venous sheath. Thus, an arteriovenous railroad was created through the collateral and pulmonary artery. A 6F Amplatzer PDA delivery sheath (180° Curve Amplatzer TorqVue Delivery System, Amplatzer Inc, MN, USA) was advanced with difficulty from the venous side through the conduit, pulmonary artery, collateral, and then into the DTA [Figure 4]. Using this sheath, a 10 × 8 mm ADO device was deployed in the APC successfully. Angiography showed good position of the device with no flow across the APC into the pulmonary artery [Figure 5]. Patient was successfully weaned off the ventilator in the next 48 h and was later on discharged from the hospital after 7 days. At a follow-up of 8 months, patient is doing well with no residual surgical problems and has gained 3 kg in weight.

Bottom Line: We present here an unusual case with a large residual APC causing refractory low-output state in the early postoperative period.Usual arterial approach failed due to extensive angulation with ostial narrowing.The large residual APC was successfully closed with an Amplatzer duct occluder (ADO) device delivered through the transvenous route.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Aortopulmonary collaterals (APCs) are occluded either preoperatively or at the time of cardiac surgery in patients with pulmonary atresia and ventricular septal defect (PAVSD). If left untreated, APCs are an important cause of deterioration in the early postoperative period. We present here an unusual case with a large residual APC causing refractory low-output state in the early postoperative period. Usual arterial approach failed due to extensive angulation with ostial narrowing. The large residual APC was successfully closed with an Amplatzer duct occluder (ADO) device delivered through the transvenous route.

No MeSH data available.


Related in: MedlinePlus