Page 46 - Journal of Structural Heart Disease Volume 3, Issue 4

133 Case Reports
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Figure 8. Transthoracic echocardiogram with color- ow Doppler at 7-year follow-up demonstrated a well-positioned vascular device and no residual ow into or out of the proximal pulmonary artery. (Panel A) Two-dimensional imaging. (Panel B) Color- ow Doppler imaging.
ature during staged palliation. However, in some cases, the surgeon may not perform these maneu- vers, perhaps because of the presence of impor- tant coronary artery branches around the pulmo- nary annulus or the wish to preserve additional pulmonary blood flow at the time of the Glenn operation. In such circumstances, thrombus may develop within the proximal pulmonary artery immediately distal to the pulmonary valve appa- ratus [7]. If this is recognized, the patient may be treated with long-term anticoagulation [5]. With valve patency, and particularly to-and-from flow across the pulmonary valve, a thrombus may dis- lodge into the systemic circulation [2, 3, 4] and result in stroke [2, 3], with significant consequent morbidity and even mortality [7]. When thrombus is identified or suspected, the most aggressive approach would include surgical thrombectomy and patch closure of the pulmonary annulus. As this would require what in most children would be fourth sternotomy, as well as the use of cardiopulmonary bypass, a trial of medical ther- apy may be undertaken. If that fails or is felt un- likely to be successful, we have demonstrated an
effective alternative to surgery. Also, perventricu- lar techniques should be considered if the femoral arterial system is deemed inadequate for the large deflectable sheath.
In conclusion, this report demonstrates the use of a retrograde arterial approach and a deflect- able delivery sheath to obliterate the proximal pulmonary valve with a vascular device, thus pre- cluding the need for reoperation, perventricular technique, or lifetime anticoagulation and asso- ciated risks. Transcatheter obliteration of a blind ending pulmonary artery stump is feasible and durably effective.
Con ict of Interest
The authors have no con ict of interest relevant to this publication.
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Rhodes, J. F. et al.
Transcatheter Pulmonary Value Stump Device Closure