Transcatheter Ventricular Septal Defect (VSD) Creation for Restrictive VSD in Double-Outlet Right Ventricle
Open Access
- 12 May 2012
- journal article
- case report
- Published by Springer Science and Business Media LLC in Pediatric Cardiology
- Vol. 34 (3), 743-747
- https://doi.org/10.1007/s00246-012-0337-1
Abstract
Double-outlet right ventricle (DORV) with a restrictive ventricular septum is a rare but highly morbid phenomenon that can be complicated by progressive left ventricular hypertrophy, arrhythmias, aneurysm formation, severe pulmonary hypertension, and death in the newborn. Surgical creation or enlargement of a ventricular septal defect (VSD) is palliative but may damage the conduction system or the atrioventricular valves in the newborn. This report presents a transcatheter approach to palliation for a newborn that had DORV with a restrictive ventricular septum. A full-term infant girl (2.9 kg) referred for hypoxia (80 % with room air) and murmur was found to have DORV, interrupted inferior vena cava, and restrictive VSD (95-mmHg gradient). Transhepatic access was performed, and an internal mammary (IM) catheter was advanced through the atrial septal defect and into the left ventricle. By transesophageal echocardiographic guidance, a Baylis radiofrequency perforation wire was used to cross the ventricular septum, and the defect was enlarged using a 4-mm cutting balloon. A bare metal stent then was deployed to maintain the newly created VSD. The patient did well after the procedure but required pulmonary artery banding 4 days later. She returned 5 months later with cyanosis and the development of obstructing right ventricle muscle bundles, requiring further surgical palliation. This report describes the first transcatheter creation of VSD in DORV with a restrictive ventricular septum in a newborn infant. Use of the radiofrequency catheter in combination with cutting balloon dilation and stent implantation is an efficient method for creating a VSD in such a patient.Keywords
This publication has 10 references indexed in Scilit:
- Transcatheter creation and enlargement of ventricular septal defects for relief of ventricular hypertensionThe Journal of Thoracic and Cardiovascular Surgery, 2007
- Surgical management of double outlet right ventricle with intact ventricular septumThe Annals of Thoracic Surgery, 2003
- Surgical repair for double outlet right ventricle and intact ventricular septumThe Annals of Thoracic Surgery, 2001
- Double Outlet Right Ventricle with Intact Atrial Septum and Restrictive Ventricular Septal Defect: An Analysis of Two CasesPediatric Cardiology, 1998
- Spontaneous closure of ventricular septal defect in a case of double outlet right ventricle.Heart, 1983
- Double-outlet right ventricle with restrictive ventricular septal defectThe Journal of Thoracic and Cardiovascular Surgery, 1978
- Double outlet right ventricle with left ventricular outflow tract obstruction due to small ventricular septal defectAmerican Heart Journal, 1971
- Spontaneous Closure of Physiologically Advantageous Ventricular Septal DefectsCirculation, 1971
- Obstructive ventricular septal defect in double outlet right ventricleThe American Journal of Cardiology, 1967
- Congenital malformation of the heart; origin of transposed great vessels from the right ventricle associated with atresia of the left ventricular outlet, double orifice of the mitral valve, and single coronary artery.1952