Transcatheter closure of post-fontan communication between the hepatic vein and left atrium by amplatzer duct occluder: a case report

A 14-year-old boy underwent palliative total cavopulmonary connection [modified Fontan operation] for a single ventricle and pulmonary atresia. At postoperative outpatient clinic follow-up visits progressive cyanosis was noticed. Cardiac catheterization and angiography revealed a hepatic vein draining to the left atrium accounting for the arterial desaturation. The communication was successfully closed by transcatheter method using the Amplatzer duct occluder

Clinical outcome of small ventricular septal defects [VSDs] in children

To assess the clinical outcome of patients with isolated ventricular septal defects small enough not to require surgical closure. Between January 2001 and May 2003 a total of 118 patients who were recently or previously diagnosed to have isolated ventricular septal defects small enough not to require surgical closure were included in this study. Inclusion criteria for the study were single ventricular septal defect with a size less than 5 mm in diameter on a 2-D echo, normal or borderline left ventricular end diastolic diameter [20-44 mm], normal left ventricular fractional shortening [0.30-0.40], normal or slightly raised pulmonary artery pressure [less than 30/15 mmHg, with a mean less than 19 +/- 7 mmHg] and absent ventricular septal defect-related clinical symptoms. Exclusion criteria were symptomatic small ventricular septal defect patients and those who had an additional hemodynamically relevant heart defects. Follow up period was recorded. Mean age of the study population at presentation was 13.3 +/- 1.4 months [range, one week-10 years] and at last follow-up visit 6.0 +/- 0.7 years [range 2.5-12.5 years]. Follow-up was performed for 111 patients [94 percent]. The mean follow up period was 5.5 +/- 0.6 years [pre- and post enrollment]. Spontaneous closure was observed in 12 of perimembranous, and 10 of muscular ventricular septal defects [overall rate of spontaneous closure 19.8 percent], by the end of the study. None of the patients died nor required medical or surgical treatment. Two patients developed mild aortic insufficiency and two patients had infective endocarditis during the follow-up period. None of the patients had definite increasing dimensions or functional deterioration of the left ventricle. Twenty-five patients underwent exercise treadmill testing; 84 percent of those achieved a target heart rate more than 80 percent of age-predicated maximum heart rate. None had a target less than 70 percent of predicated maximum heart rate or any exercise-induced significant arrhythmias. On the other hand 21 percent showed non-significant rhythm abnormalities either at resting electrocardiogram or 24-hour Holter monitoring. The overall clinical outcome of asymptomatic children with small isolated ventricular septal defect is excellent. Spontaneous closure may occur and these children may be allowed to participate freely in physical exercise and engage in competitive sports. Clinical and 2-D echo follow-up are indicated

Transcatheter closure of patent ductus arteriosus using Gianturco coil: Jordanian experience

To assess the immediate and mid-term results of transcatheter closure of patent ductus arteriosus [PDA] less than 4 mm in diameter using single or multiple Gianturco coils. Settings: Queen Alia Heart Institute, a tertiary center for cardiac patients, Amman, Jordan. Patients And From December 1977 to January 2002, 32 patients [21 female, 11 male] underwent a transcatheter closure of a small PDA less than 4 mm in diameter in our institution as an alternative to standard surgical ligation. The patient's mean age was 8.4 years [range 1-27 years]; their mean weight was 26.5 kg [range 8-81 kg]. All patients were asymptomatic. Gianturco stainless steel coils [Cook] with thrombogenic strands attached to them were used for closure. The mean followup period was 2.1 years [range 0.5-4]. The mean narrowest PDAdiameter was 2.8 mm range [1.4-4], the mean pulmonary/systemic flow ratio was 1.57 range [1.22-2.5]. A single coil was used in 24 patients [75%], four patients [12.5%] needed two coils, four patients [12.5%] needed three coils to achieve complete closure of the PDA. The patients who had two or three coils, had larger shunts with PDA's narrowest diameter more than 3.5 mm. There were two incidents of coil migration to the left pulmonary artery, which were retrieved with a gooseneck snare. There was immediate and complete closure in 28 patients out of 32 [87.5%] as confirmed by post-closure descending aortogram. Four patients had residual shunt, which disappeared after 24 hours. All patients were discharged home one day after the procedure. Coil occlusion of PDA less than 4 mm was safe and effective. Immediate success rate was high. Residual shunts were commonly observed immediately following coil occlusion, but spontaneous closure occurs in all patients. The risk of coil embolization was less in PDA less than 4 mm in diameter. No complications have been encountered during the first four years of follow up

Surgical outcome of ventricular septal defect closure in infants and young children. A 7-Year Jordanian experience

To evaluate the surgical outcome of primary closure of ventricular septal defects in children. This retrospective study was carried out between January 1990 and January 1997. One hundred and nine patients with failure to thrive, congestive heart failure or pulmonary hypertension, underwent primary surgical closure of a ventricular septal defect [V.S.D] at Queen Alia Heart Institute. There were 59 males and 50 females. Age ranged from 0.5-13 years and body weight from 4.5-30kg. The mean pulmonary to systemic flow ratio was 2.3:1. The mean systolic pulmonary artery pressure [PAP] was 58.4mmHg, and the mean pulmonary vascular resistance [PVR] was 8.37 units. The basic anomaly was isolated V.S.D in 84 patients. The others had associated patent ductus arteriosus or atrial septal defect. Complete closure of the defect was achieved in 100 patients [91.7%], including two patients who died postoperatively. The residual shunt was large in three, and small in six patients. The hospital mortality rate was 1.8% with no late deaths. Death occurred highest among younger infants with a pre-existing respiratory problem, a large V.S.D and high pulmonary vascular resistance. Follow-up color echo-doppler was done in 95 patients [88.8%], while additional follow-up cardiac catheterization was done in 48 patients [44.8%]. Forty five patients had normal PAP while three patients had large residual shunt and high PAP and needed reoperation. Small insignificant residual leaks were found in six patients. Primary surgical closure of V.S.D during the first two years of life appears to be safe and effective. Reduction of heart size and improved exercise tolerance were the most pertinent follow-up findings. These results are comparable to those already published and encourage efforts at correction before pulmonary vascular resistance rises