Page 24 - Journal of Structural Heart Disease Volume 3, Issue 4

Case Report
Journal of Structural Heart Disease, August 2017, Volume 3, Issue 4:111-114
DOI: https://doi.org/10.12945/j.jshd.2017.0014.16
Retrograde Percutaneous Closure of a
Received: November 13, 2016 Accepted: Febraury 11, 2017 Published online: August 2017
Perimemberanous Ventricular Septal Defect
with an Occluder Device in a Child with
Interrupted Inferior Vena Cava
Amal El-Sisi, MD, MRCP1, Safaa Ali, MD2
1 Pediatric Department of Faculty of Medicine, Cairo University Hospital, Cairo, Egypt
2 Pediatric Department of Faculty of Medicine, Assistant Professor, Sohag University Hospital, Souhag, Egypt
Abstract
Femoral venous access is the typical route for the ante- grade approach to percutaneous closure of a perimem- beranous ventricular septal defect (PM VSD). In this case report, we attempted percutaneous PM VSD closure in a ve-year-old child with interrupted inferior vena cava (IVC) using a retrograde arterial approach. The Amp- latzer Duct Occluder II was chosen due to its symmetrical design that can be deployed using either a retrograde or antegrade approach. We found the retrograde percuta- neous PM VSD closure by o -label use of this device to be an easy and feasible option in this case of interrupted IVC, whereas the use of an antegrade approach would have been imprecise and potentially time-consuming. Copyright © 2017 Science International Corp.
Key Words
Ventricular Septal defect • Percutaneous closure • Interrupted inferior vena cava • Amplatzer Duct Occluder II
Introduction
The incidence of congenital interruption of infe- rior vena cava (IVC) without other visceroatrial situs abnormalities is 0.08–0.1%. Interrupted IVC usually continues via the azygos system to join the superior vena cava [1]. Interrupted IVC is usually an inciden-
tal and unexpected nding during cardiac cathe- terization. Although managing interrupted IVC is challenging, it is not impossible through the use of certain approaches. In particular, previous reports have described the retrograde transcatheter closure of perimemberanous ventricular septal defect (PM VSD) by the o -label use of an Amplatzer Duct Oc- cluder II (ADO II) device (St. Jude Medical, St. Paul, Minnesota) [2, 3, 4].
Case Presentation
A ve-year-old boy diagnosed with PM VSD at the age of six months was referred to our hospital for therapeutic intervention. Electrocardiography (ECG) showed left ventricular hypertrophy and cardiomeg- aly. Pulmonary plethora was shown by chest X-ray. Transthoracic echocardiography showed a moder- ate-sized PM VSD partially covered by septal aneu- rysm. The left ventricular opening was 5 mm, and the right ventricular opening was 8 mm. The aortic rim was 6 mm. Pulmonary systolic pressure was 47 mmHg. There was a gradient of 85 mmHg between the left and the right ventricles. The left atrium and ventricle were dilated. There was no aortic regurgitation or any other associated cardiac anomaly. Unfortunately, the subcostal window was obtained without focusing on
*Corresponding Author:
Safaa Ali
Pediatric Department of Faculty of Medicine
Souhag University Hospital
Medina Street, Markaz Gerga, Sohag, Egypt
Tel. +20 1064818849; Fax: +09321 14768.; E-Mail: safaah003@gmail.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2017 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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