Page 27 - Journal of Structural Heart Disease Volume 5, Issue 2

Case Report
40
Figure 1. APF diameter measuring 7 mm.
inferior vena cava, superior vena cava, Fontan baffle and pulmonary artery pressures to be all at a mean of 25 mm Hg implying increased pressure in Fontan circuit without obstruction. Pulmonary angiogram also showed contrast washout in pulmonary artery suggesting additional flow coming from high pres- sure setting (Video 4). Retrograde left heart cathe- terization performed with 6-French pigtail catheter revealed left ventricular pressure of 90/10 mmHg and no gradient to the ascending or descending aor- ta where pressure was 90/35 mmHg. An aortogram was performed in postero-anterior and lateral pro- jections demonstrating competent aortic and neo- aortic valve and normal coronary flow. Angiogram confirmed presence of aortopulmonary artery fistu- la (Video 5). The diameter of fistula was measured to be 7 mm (Figure 1) prior to advancing balloon sizing catheter. After creating arteriovenous loop, a balloon sizing catheter was advanced from the venous side and softly inflated across the fistula. The decision was made to close the fistula using Amplatzer duct oc- cluder 10/8 mm in size. After successful positioning of the device and its release, a post-release aortogram confirmed good position and a trivial residual shunt- ing through the device which was expected (Video 6). Post-release TEE also confirmed the device to be in a
Video 4. Contrast washout in pulmonary artery suggesting ad- ditional flow coming from high pressure setting (pulmonary an- giogram). View supplemental video at https://doi.org/10.12945/j. jshd.2019.014.18.vid.04.
Video 5. Aortopulmonary artery fistula. View supplemental video at https://doi.org/10.12945/j.jshd.2019.014.18.vid.05.
Video 6. Device position with trivial residual shunting. View sup- plemental video at https://doi.org/10.12945/j.jshd.2019.014.18. vid.06.
Journal of Structural Heart Disease, April 2019
Volume 5, Issue 2:38-42