I. B. Vijayalakshmi

Use of an Amplatzer Duct Occluder for Closing an Aortico-Left Ventricular Tunnel in a Case of Noncompaction of the Left Ventricle

Aortico-left ventricular tunnel (ALVT) is a very rare congenital anomaly. Noncompaction of the left ventricle or “spongy myocardium” is another rare congenital cardiomyopathy. We report probably the first case in which these two rare anomalies causing pump failure coexisted in a 4-year-old male and the tunnel was successfully treated nonsurgically. Transcatheter closure of ALVT with the Amplatzer duct occluder is feasible and safe in a case of noncompaction of the LV with reduced LV function.

Treatment of congenital non-ductal shunt lesions with the amplatzer duct occluder II.

Amplatzer Duct Occluder II (ADO II) is especially designed for closing long ducts in infants. The experience with off‐label use of ADO II in non‐ductal positions is limited. Aim: To evaluate feasibility of use of ADO II in non‐ductal positions, incidence of complete heart block (CHB), advantages and disadvantages. Material and Results: Out of 79 defects closed with ADO II, 61 had perimembranous, 12 apical/mid‐muscular ventricular septal defects (VSD), 4 Gerbode defects, one each of coronary arterio‐venous fistula and aorto‐right ventricular tunnel. Age ranged from 8 months to 21 years (mean 8.9 ± 4.02 years, median 9 years). The mean fluoroscopy time was 5.2 ± 1.1 min with range 4.2–9.2 min. Complete closure was achieved in all. Three cases developed transient junctional bradycardia, treated with steroids. One patient who developed CHB (1.3%) needed temporary pacing. Discussion: ADO II is a low profile device. It can be easily delivered through a 5F guiding catheter and needs very short fluoroscopic time as arteriovenous loop is not needed. The cost is 1/3 of regular ventricular septal occluders. The CHB that is a major challenge for closure of VSDs is less common with soft, specially designed ADO II, which does not compress the conducting system. Conclusions: Use of the ADO II in non‐ductal positions can be achieved with high success and low complication rates, especially CHB; its use is also associated with significantly reduced procedure time and device cost. Device size availability restricts use of the ADO II to defects up to 6 mm in diameter.

Amplatzer duct occluder ii for closure of congenital Gerbode defects

Congenital left ventricle to right atrial communications (Gerbode defects) are extremely rare (0.08%) type of ventricular septal defects. They were traditionally closed by surgery in the past. There are few case reports and small series of acquired and congenital Gerbode defects, closed with various types of devices. Aim of our study is to assess the feasibility, efficacy, and complications of transcatheter closure of congenital Gerbode defects with Amplatzer duct occluder II (ADO II).

A patient with aneurysms of both aortic coronary sinuses of Valsalva obstructing both ventricular outflow tracts

Congenital unruptured aneurysms affecting both the right and left sinuses of Valsalva are extremely rare. To the best of our knowledge, there has been only one previously documented case. We report here a patient presenting with congestive cardiac failure who also had unruptured aneurysms of both the right and left sinuses of Valsalva. The aneurysms produced obstruction of the outflow tracts of both ventricles, burrowing as they did into the muscular ventricular septum.

Challenges in Device Closure of a Large Patent Ductus Arteriosus in Infants Weighing Less Than 6 Kg

INTRODUCTION Transcatheter closure of patent ductus arteriosus (PDA) has replaced surgery in most institutions. Despite improvements in techniques and the devices available, closure of large PDA in very small infants remains a challenge. AIM To assess the challenges, feasibility, and efficacy of device closure of large PDA, in infants weighing ≤6 kg. MATERIALS AND METHODS Analysis of device closure of a PDA was done in 61 infants ≤6 kg. Their ages, ranged from 9 days-12 months (mean 8.9 months), weight ranged from 2.2 to 6 kg (mean 5.3 kg), and PDA measured 3.2-8.7 mm (mean 4.8 mm). The fluoroscopy time was 3-18 minutes. The largest device used was 12 × 10 mm. RESULTS Successful device placement was achieved in 60/61 infants (98.4%). Mild aortic obstruction occurred in 2 cases (3.3%), as the device got displaced towards the aorta after release. The device embolized in 2 cases (3.3%). In one it was retrieved by a novel method like fastening the screw in the aorta and was closed with a 4 × 6 ADO II. In the other infant, with a single kidney, died of uremia after device retrieval. Mild left pulmonary artery (LPA) obstruction occurred in one case (1.6%). Four cases (6.6%) had minor vascular complications. The postprocedure weight gain after 3 months was between 2.5 kg ± 250 mg. CONCLUSIONS Device closure of large PDA in infants weighing ≤6 kg with left ventricular failure is challenging but possible, safe and effective. Retrieval of embolized device could be tricky.

Unusual cases of right-sided and left-sided May-Thurner syndrome.

May-Thurner syndrome is a rare clinical entity involving venous obstruction of the left lower extremity. The May-Thurner syndrome is a phenomenon commonly described as an acquired stenosis of the left common iliac vein secondary to compression of the left common iliac vein between the right common iliac artery and the underlying vertebral body. We report one case of May-Thurner syndrome, and another rare case of reverse May-Thurner syndrome, incidently detected during intervention, in a case of aortic stenosis and mitral stenosis with dextrocardia and situs inversus.

Transposition of great arteries with natural partial Senning: A rare case report

The association of transposition of the great arteries (TGA) and anomalous pulmonary venous connection is extremely rare. Children with transposition of the great arteries improved dramatically with the advent of the atrial repair. In this report, we describe a 40-day old male infant with TGA and associated anomalous pulmonary venous connection who presented with the history of cyanosis and hurried breathing. This patient underwent successful balloon atrial septostomy and discharged with uneventful recovery.