Page 21 - Journal of Structural Heart Disease Volume 3, Issue 4

Case Report
108
the pressure wire back at the tip of the catheter, we con rmed equal pressure signals from the wire and catheter to ensure no signi cant drift. Values used for predicted oxygen consumption (ml/min/m2) when calculating pulmonary blood ow were taken from tables created by Seckeler et al. using a new predic- tive equation [4].
Patient 1 had a diagnosis of double inlet left ven- tricle with atrioventricular and ventriculoarterial dis- cordance and a hypoplastic left-sided right ventricle. A pulmonary artery band was placed at 1 month of age. At 2.5 months of age, he underwent atrial septal stent implant (8 × 18 mm Genesis, Cordis, Ireland) for
a restrictive atrial septum in the context of increasing stenosis of the left atrioventricular valve. At 6 months of age, pre-bidirectional cavopulmonary anastomo- sis cardiac catheterization demonstrated an elevated mean pulmonary pressure of 23 mmHg. Left ventricu- lar end diastolic pressure was 4 mmHg, and right atrial pressure was 4 mmHg. We obtained a mean pulmo- nary capillary wedge pressure of 12 mmHg and decid- ed to proceed with obtaining direct left atrial pressure given the importance of an accurate determination of PVR. The obtuse angulation of the atrial stent prevent- ed a uid- lled hemodynamic catheter from passing into the left atrium (Figure 1A-C). Using a pressure wire,
AB
C
Figure 1. Panel A. Two-dimensional echocardiogram, four-chamber apical view. The atrial stent was seen lying in an almost horizontal anterior posterior position. Panel B. Two-dimensional echocardiogram, subcostal view directed at the atrial septum. The atrial stent protrudes 2/3:1/3 into the right atrial cavity, precluding passage of a uid- lled catheter to the left atrium. Panel C. Anterior-posterior chest radiograph demonstrating atrial stent position.
Journal of Structural Heart Disease, August 2017 Volume 3, Issue 4:107-110