Percutaneous obliteration of the right ventricle to avoid coronary damage by sinusoids in patients with pulmonary atresia intact ventricular septum during staged single ventricle palliation

Abstract

Background and Aims Suprasystemic pressure waves can damage the coronary arteries resulting in myocardial ischemia and excess early mortality. We aimed to reduce the coronary pressure wave through the sinusoids by abolishing RV volume with percutaneous devices. Methods and Results Four patients with PA‐IVS and coronary sinusoids from the hypertensive rudimentary RV were evaluated at a median age 26.6 months (range: 2.7–51.7). Right ventricle coronary dependent flow to the left ventricular myocardium was excluded. All four patients had dual perfusion with competitive flow from the RV through the sinusoids to the coronary arteries. Devices used were: Amplatzer vascular plug II of 10–16 mm; 27 coils (diameter 5–15 mm) in the oldest patient. Right ventricular angiography after cavity obliteration showed no more significant coronary perfusion through the sinusoids. There were no complications or deaths. Only minor and transient changes in the levels of troponin were observed. Coronary angiography at pre‐Fontan evaluation showed no progress of coronary abnormalities in two patients. Conclusion In selected patients with functionally single left ventricle, obliteration of the hypertensive RV cavity by percutaneous devices is safe and abolishes the systolic pressure wave in coronary sinusoids. When performed early, this may halt coronary damage and avoid excess mortality.

Percutaneous transcatheter occlusion of left atrioventricular valve in a patient with single ventricle and severe atrioventricular valve regurgitation

“…Similarly, Hummel et al 14 also reported the emergency coil occlusion of the hypoplastic left ventricle in a critically sick infant with ventriculocoronary connections causing coronary steal and myocardial ischemia. Several studies also detailed the occlusion of the right ventricle in patients with pulmonary atresia, intact ventricular septum and large coronary sinusoids to the right ventricle; which may halt the coronary damage caused by the systolic pressure waves, and thus allow for staged single ventricle palliation in this difficult substrate 15,16 …”