Transvenous closure of large aortopulmonary collateral
Parag W Barwad1, Gurpreet Singh Gulati2, Saurabh K Gupta1
1Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Insights
Aortopulmonary collaterals (APCs) can cause issues after heart surgery. A transvenous approach using an Amplatzer duct occluder successfully closed a large residual APC, resolving a low-output state.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Aortopulmonary collaterals (APCs) require closure in patients with pulmonary atresia and ventricular septal defect (PAVSD) to prevent postoperative complications.
- Untreated or residual APCs can lead to significant morbidity, including low-output states, in the early postoperative period.
Observation:
- A case of a large residual APC causing a refractory low-output state post-cardiac surgery is presented.
- The standard arterial approach for closure was unsuccessful due to anatomical challenges, including angulation and ostial narrowing.
Findings:
- Successful closure of the large residual APC was achieved using an Amplatzer duct occluder (ADO) device.
- The ADO device was delivered effectively via a transvenous route, overcoming the limitations of the arterial approach.
Implications:
- This case highlights the transvenous approach as a viable alternative for managing complex residual APCs when the arterial route is not feasible.
- Successful closure of residual APCs can prevent or treat postoperative low-output states, improving patient outcomes in PAVSD management.
Abstract:
Aortopulmonary collaterals (APCs) are occluded either preoperatively or at the time of cardiac surgery in patients with pulmonary atresia and ventricular septal defect (PAVSD). If left untreated, APCs are an important cause of deterioration in the early postoperative period. We present here an unusual case with a large residual APC causing refractory low-output state in the early postoperative period. Usual arterial approach failed due to extensive angulation with ostial narrowing. The large residual APC was successfully closed with an Amplatzer duct occluder (ADO) device delivered through the transvenous route.
