Page 81 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
3-dimensional assessment revealed a crescent shaped PVL mainly along the previous right coronary cusp measuring 4 x 8 mm in dimension. It was decided for optimal fitting to utilize a rectangular Occlutech paravalvular leak device (PDL) with a waist for closure (61PLD10W). The dimensions of the waist of the device are 10 x 4 mm. The PVL could be crossed with a straight Terumo Glide wire through a regular Judkins right coronary catheter. The wire was exchanged for a Safari stiff (small) guidewire in the left ven- tricle. A 7F Occlutech delivery sheath could be advanced with some rotations over the stiff guide wire. The PDL was step-wise developed along the tunnel of the PVL. There were intermittent ST-segment changes that subsided after slight repositioning of the device. Angiography and TTE showed good position of the PLD and minimal residual shunting. The device was released and remained in stable position. There was no interference with the leaflets of the mechanical aortic valve, the diastolic blood pressure rose from 38 to 60 mmHg. The femoral arterial access site was close using an 8F AngioSeal. Post-intervention the patient was advised to take ASS and clopidogrel for 6/12 months, respectively, in addition to phenprocoumon. On day one after the procedure there was mild hemolysis that sub- sided the next day. By transthoracic echocardiography (TEE), there was no residual paravalvular leak detectable on day two post intervention. At his 4-week follow-up visit, his edema had almost resolved and there was no residual PVL aortic leak by TTE. In 6 months, we plan a TEE to evaluate his mitral valve regurgitation to assess wether an intervention of the mitral valve can be avoided after reduction of the volume load due to the aortic PVL. The Occlutech PDL is available in 4 different shapes and a variety of sizes that may represent an additional tool to the Amplatzer Vascular Plug III and other devices for percuta- neous closure of the variety of PVL.
107. PERCUTANEOUS CLOSURE OF A LEFT VENTRICULAR PSEUDOANEURYSM AFTER TRANSCATHETER VENTRICULAR SEPTAL DEFECT CLOSURE
Selman GOKALP1, Sezen Ugan ATIK2, Irfan Levent SALTIK1
1Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, Department of Pediatrics, Division of Pediatric Cardiology, Istanbul, Turkey. 2Istanbul Mehmet Akif Ersoy Research and Training Hospital, Department of Pediatric Cardiology, Istanbul, Turkey
Left ventricular (LV) pseudoaneurysm is very rare in chil- dren. Untreated pseudoaneurysms lead to sudden cardiac death due to rupture. Although open surgery is conven- tional treatment, recently, percutaneous closure of LV pseudoaneurysms has been described. Here, we present
the case of a child who underwent transcatheter ventricu- lar septal defect (VSD) closure at 8 months who then devel- oped a LV pseudoaneurysm,detected 16 months later, which was percutaneously closed.
Case Report: A 3-month-old boy with Down syndrome diagnosed with a 5-mm apical VSD, 7-mm atrial septal defect (ASD), and patent ductus arteriosus (PDA). Five months later VSD and PDA were closed percutaneously by Amplatzer® Duct Occluder II (ADO II) device. To prevent arterial injury, an antegrade approach was performed. His postoperative course was unremarkable, echocardi- ography showed minimal residual shunt from the VSD. At 16 months after the initial procedure, echocardiography revealed a LV pseudoaneurysm immediately next to the ADOII device. Because the pseudoaneurysm was very close to the device, open surgery carried a high risk, so we decided on percutaneous closure. Left ventriculography demonstrated a pseudoaneurysm in the posterolateral aspect of the LV, measured 21× 17-mm with an 8-mm con- necting neck. A 9-mm Amplatzer ® septal occluder (ASO), was deployed in the standard manner across the LV myocar- dial wall. To prevent device embolization, both discs were embedded in the pseudoaneurysm cavity. Left ventriculog- raphy confirmed total occlusion of the pseudoaneurysm. The following day, echocardiography was uneventful with complete closure of pseudoaneurysm. Three days after the procedure, pericardial effusion started and increased upto 24 mm on postoperative day 10 despite anti-inflammatory treatment. The diagnostic pericardiocentesis was unreveal- ing; microbiological cultures were negative. After starting steroid the patient was discharged without any effusion. An echocardiogram 2 months later showed closed VSD and pseudoaneurysm without any residual shunt.
Discussion: To the best of our knowledge, this is the first case report of percutaneous LV pseudoaneurysm closure after transcatheter device closure of VSD. Even there is no direct perforation during the procedure, damage to the LV free wall by the manipulations may predisposes for pseudoaneurysm development. Time lapse between the procedure and development of pseudoaneurysm might be related with this factor. Fortunately, the patient was asymptomatic and the pseudoaneurysm was recognized incidentally. Nevertheless, we could not determine the exact time for development of pseudoaneurysm. It would likely become recognizable when large enough to be visu- alized on echocardiography. The rarity of this condition in children poses a challenge for treatment. Although surgery is an option, there is limited experience with high mortal- ity rates. Transcatheter treatment is less prevalent. Device
Hijazi, Z
22nd Annual PICS/AICS Meeting