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[Simultaneous treatment of pulmonary valve stenosis and patent ductus arterious by interventional catheterization]
C A Pedra1, S R Pedra, C A Esteves
1Instituto Dante Pazzanese de Cardiologia, São Paulo.
Insights
Pediatric interventional cardiology successfully treated two rare cases of pulmonary valve stenosis and patent ductus arteriosus in a single procedure, demonstrating effective management of complex congenital heart defects.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Pulmonary valve stenosis (PVS) and patent ductus arteriosus (PDA) are infrequently diagnosed together in pediatric cardiology.
- This report details two pediatric cases presenting with this uncommon dual diagnosis.
Observation:
- A 14-month-old boy with PVS underwent successful percutaneous pulmonary valvuloplasty, reducing the RV-pulmonary artery systolic gradient from 71 to 3 mmHg.
- A 20-month-old girl with PVS had her RV-pulmonary artery systolic gradient reduced from 60 to 5 mmHg via percutaneous pulmonary valvuloplasty.
- The PDA in the first case was occluded with a 38-5-5 coil; the second case experienced coil embolization requiring retrieval and subsequent closure with a Rashkind umbrella.
Findings:
- Both patients with PVS and PDA underwent successful, simultaneous interventional procedures.
- Percutaneous pulmonary valvuloplasty effectively reduced pressure gradients in both cases.
- PDA occlusion was achieved, with one case requiring device retrieval and alternative closure strategy.
Implications:
- This study highlights the feasibility and success of combined percutaneous interventions for PVS and PDA in pediatric patients.
- It provides valuable insights into technical considerations and management of potential complications during these procedures.
- The findings support a single-stage interventional approach for this rare combination of congenital heart defects.
Abstract:
The association of pulmonary valve stenosis and patent ductus arteriosus is uncommonly found in clinical practice of pediatric cardiology. The authors describe 2 patients with this association that were successfully treated in the same procedure by interventional cardiology: first case, a 14 month old boy was submitted to percutaneous pulmonary valvoplasty with reduction of systolic gradient between pulmonary artery and right ventricle from 71 to 3 mmHg. The 2.0 mm of diameter and conical shape duct was successfully occluded using a 38-5-5 coil; second case, a 20 month old girl was submitted to percutaneous pulmonary valvoplasty with reduction of systolic gradient between pulmonary artery and right ventricle from 60 to 5 mmHg. An attempt to close the 3.5 mm of diameter and concial shape duct using coil was performed, but the device embolized into the pulmonary artery. After immediate retrieval, a 12 mm Rashkind umbrella was implanted. Indication of treatment of both conditions, technical aspects and complications related to the procedures, and patients follow up are also discussed.