SUCCESSFUL CLOSURE OF AN APICAL MUSCULAR VSD USING AMPLATZER DUCT OCCLUDER II DEVICE ON POSTOPERATIVE PATIENT ON ECMO


Saltık İ. L. , Dedeoglu R.

The Pediatric & Adult Interventional Cardiac Symposium (PICS/AICS) 19th Annual Meeting, Las Vegas, September 18-21, 2015 , Nevada, United States Of America, 18 - 21 September 2015, vol.1, pp.86

  • Publication Type: Conference Paper / Summary Text
  • Volume: 1
  • Doi Number: 10.12945/j.jshd.2015.0004-15
  • City: Nevada
  • Country: United States Of America
  • Page Numbers: pp.86

Abstract

SUCCESSFUL CLOSURE OF AN APICAL MUSCULAR VSD USING AMPLATZER DUCT OCCLUDER II DEVICE ON POSTOPERATIVE PATIENT ON ECMO Levent Saltik2 , Reyhan Dedeoglu1 1 Department of Pediatric Cardiology, Istanbul University, Cerrahpasa Medical Faculty, istanbul, Turkey 2 Anadolu Medical Center, istanbul, Turkey Residual ventricular septal defects (VSDs) following cardiac surgery are not uncommon and were defined as haemodynamically significant and surgically remediable lesions present after surgeryVenoarterial extracorporeal membrane oxygenation (ECMO) is the most potent form of acute cardiorespiratory support available and enables complete relief of cardiac workload. We describe the successful closure of an apical muscular VSD using Amplatzer Duct Occluder II (ADO II) device on postoperative patient on ECMO A 5year-old patient, weighing 12 kg, had presented with having diffuculties in weaning from cardiopulmonary by-pass after surgery for VSD closure and pulmonary conduit attached to the sistemic ventricule. Preoperative Echocardiography revealed mesocardia, corrected transposition, multipl VSDs, mitral valve insufficiency, pulmonary valve stenosis. At operation VSDs were closed and conduit placed between pulmonary artery and the left ventricle (LV). After surgery child could not be weaned off bypass and ECMO was initiated for cardiac support Echocardiogram revealed one moderate apical VSD.There was a significant systemic ventricule volume overload. Because of the apical location of the VSD, the patient was taken up for a device closure on ECMO.Cardiac catheterization was performed from left femoral artery and vein. A left ventricular angiogram and transesophageal echocardiogram were done. We chose to use the 6/6 ADO II device for VSD closure. Echocardiography showed the device optimally placed with minimal residual flow. The child could be extubated in 36 hours and was discharged in a stable condition at 1 week. The aim of cardiac ECMO is to profoundly unload the heart and decrease its work, Significant residual leaks may occur after repair of any type of VSD. Postoperative patients with residual VSD will not recover until these defects are addressed surgically or percutaneously. Percutaneous closure is less invasive and may be preferable. Hence, we thought of ADO II because of its better profile.