Page 41 - Journal of Structural Heart Disease Volume 3, Issue 4

Case Reports
Journal of Structural Heart Disease, August 2017, Volume 3, Issue 4:128-134
DOI: https://doi.org/10.12945/j.jshd.2017.005.17
Received: March 01, 2017 Accepted: March 17, 2017 Published online: August 2017
Transcatheter Retrograde Device Closure of an Isolated Pulmonary Valve Stump Using a De ectable Sheath Technique
John F. Rhodes, MD1, Amanda S. Green, FNP-C1, Robert D.B. Jaquiss, MD2
1 Miami Children’s Health System, Department of Cardiology, Miami, Florida, USA
2 University of Texas Southwestern Medical Center, Department of Cardiovascular & Thoracic Surgery, Dallas, Texas, USA
Abstract
Patients with a single ventricular heart physiology may have a persistent egress through one of the semilunar valves that was surgically closed during the palliative operations. This semi lunar patency results in a blind ending pulmonary artery stump. Consequently, the patient is at risk for thrombus that can then result in a paradoxical embolic event and potentially an ischemic stroke. Patients therefore must undergo a reoperation to close the stump or remain on anticoagulation for life- time. This report demonstrates the use of a retrograde arterial approach and a de ectable delivery sheath to obliterate the proximal pulmonary valve with a vascular device.
Key Words
Stroke • Pulmonary valve • Device closure • Single ventricle • Embolic events
Introduction
The surgical palliation of children with univentricu- lar hearts without obstruction to pulmonary out ow consists of either Damus-Kaye-Stansel anastomo- sis of the two great vessels in the setting of poten- tially obstructed systemic out ow or division of the pulmonary artery leaving the aorta as the sole out- ow pathway if there is no potential for subaortic obstruction [1]. If the latter approach is elected, the
technique of pulmonary artery division must min- imize the potential for thrombus formation in the blind ending pulmonary artery stump and subse- quent risk for systemic embolic events [2, 3, 4]. In the event that such a stump is present, anticoagulation may be employed [5, 6, 7], but if thrombus develops within the stump or embolism occurs, an intervention to exclude the stump may be required. Here, we de- scribe a novel management strategy in such a circum- stance and present long-term follow-up information.
Case Presentation
The original cardiac anatomy of our patient was that of a functionally univentricular heart. There was (right-sided) mitral atresia, a large secundum atrial septal defect, and a large outlet ventricular septal de- fect. The aorta arose from the anterior and leftward (morphologic right) ventricle and was unobstructed, as was the aortic arch. The pulmonary artery arose from the rightward and posterior (morphological left) ventricle and had signi cant valvar and subvalvar obstruction, such that the patient had prostagland- in-dependent pulmonary blood ow (Figure 1).
As a neonate, via sternotomy, the patient un- derwent construction of a right-sided modi ed Blalock-Taussig shunt using a 4-mm-diameter graft. The ductus arteriosus was not ligated at that time
*Corresponding author:
John F. Rhodes, Jr., MD
Department of Cardiology
Miami Children’s Health System
3100 SW 62 Avenue, Miami, Florida 33155, USA
Tel.: +1 305 662 8301; Fax: +1 305 662 8304; E-Mail: jfrhodes47@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
Accessible online at:
http://structuralheartdisease.org/