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.
Annals of Pediatric Cardiology
|April 5, 2014
Summary
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.
