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Perventricular closure of pulmonary stump in a 16-kg child
Scott Darby1, Michel Ilbawi, Zahid Amin
1Department of Pediatrics, Georgia Regents University, Children's Medical Center, Augusta, Georgia.
Insights
Closure of the pulmonary artery stump after Fontan operation is crucial to prevent clots. A novel perventricular approach using a ventricular septal defect device successfully closed a pulmonary stump in a pediatric patient.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Interventional Cardiology
Background:
- The Fontan operation, a palliative procedure for complex congenital heart disease, can lead to blind pouch formation of the pulmonary artery (PA).
- This PA stump poses a significant risk for thromboembolic events, necessitating its closure.
- Secondary closure of the PA stump can be challenging due to patient anatomy and stump size.
Observation:
- A 3-year-old, 16-kg child with a history of Fontan operation presented with a challenging PA stump requiring closure.
- A perventricular approach was utilized for device insertion.
- A muscular ventricular septal defect (VSD) device was employed for the closure.
Findings:
- Successful closure of the pulmonary artery stump was achieved using a perventricular approach with a VSD device.
- This represents a novel and effective method for managing difficult PA stumps post-Fontan operation.
- The procedure was performed in a pediatric patient, highlighting its applicability in this population.
Implications:
- This technique offers a viable alternative for PA stump closure when traditional methods are difficult.
- It may reduce the risk of thromboembolic events in Fontan survivors.
- Further research and larger studies are warranted to confirm the long-term efficacy and safety of this perventricular approach.
Abstract:
Blind pouch formation of the pulmonary artery (PA) in patients having undergone a Fontan operation can present a serious risk for thromboembolic events. Either primary or secondary closure of this stump is necessary to reduce this risk. Unfortunately, secondary closure is oftentimes difficult due to the size and anatomy of the presenting patient. We describe the insertion of a muscular ventricular septal defect (VSD) device via a perventricular approach for successful closure of a pulmonary stump in a 3-year old, 16-kg child. To our knowledge, this is the first report of a perventricular approach for successful closure of a PA stump.
