Page 14 - Journal of Structural Heart Disease Volume 2, Issue 5

215 Original Research Article
Figure 2. Panel A. Initial ascending aortogram demonstrates the sinus of Valsalva aneurysm (white arrow) with rupture into the right ventricular out ow. Mild aortic regurgitation is evident. Panel B. Outline of the guiding sheath across the defect from the aorta and positioned distal in the right pulmonary artery. Panel C. Final ascending aortogram demonstrates the Amplatzer Ductal Occluder II in a good position (white arrow) with ne residual ow across the ruptured aneurysm.
patients had complete closures at discharge. Five had a residual shunt (four small and one moderate with self-abating hemolysis). Trivial aortic regurgitation (AR) occurred in four. On median follow-up of 24 months (range 1–60 months), 15 patients were in New York Heart Association class I. The residual shunt disappeared in three and was small in two; procedure- related AR vanished in two of four. There was no AR progression, recurrence, infective endocarditis, or device embolization. A variety of other devices have been described in case reports with good success [4-9]. The majority of these closures were in adult patients with delivery from the femoral venous
approach following the creation of an arteriovenous loop. In our case, the patient was young, and the low pro le of the ADO II allowed us to retrogradely deliver the device from the aorta without the need to create an arteriovenous loop or use a sti sheath and dilator, which may be more likely to induce hemodynamic instability in a small child. The waist of the device was delivered within the aneurysmal sac toward the aortic end to ensure optimal ow occlusion from the higher pressure aorta. There was no impingement on the aortic or pulmonary valves, and the “soft” nature of the device, which has made it popular for closing perimembranousVSDs[10],wasattractivetoensure
Kenny, D. et al.
Ruptured Sinus of Valsalva Aneurysm Closure