Potency of Non-fluoroscopy Guided Patent Ductus Arteriosus Closure: a Case Report

Mendel, Brian; Amin, Bany Faris; Prakoso, Radityo

doi:10.1007/s42399-021-01062-4

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…Even though ALARA (as low as reasonably achievable) principle is used, it would be preferable to completely eliminate radiation exposure risks for both the operators and the patient. In our facility, the technique would be carried out initially without any fluoroscopy, or if the echocardiography window was insufficient intraprocedurally, the technique would be converted to the standardized fluoroscopy process ( 1 , 3 , 10 , 11 ).…”

Section: Discussionmentioning

confidence: 99%

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Transesophageal echocardiography-guided percutaneous closure of multiple muscular ventricular septal defects with pulmonary hypertension using single device: A case report

Siagian

Prakoso

Mendel

et al. 2023

Front. Cardiovasc. Med.

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BackgroundSurgery is typically used to correct challenging ventricular septal defects (VSDs), such as VSD with pulmonary hypertension and multiple defects. In this case report, we would like to highlight the feasibility of multiple defects VSD closure with single device percutaneously using zero-fluoroscopy technique.Case presentationA 7-year-old child was referred with the main symptom of shortness of breath. She started experiencing repeated respiratory tract infections, feeding issues, and failure to thrive at the age of six months. Her body weight was only 18 kg. TEE revealed several muscular VSD with 2–3 mm and 12 mm diameters, 3 mm spacing between VSD, L to R shunt, AR (-), and TR mild with septal leaflet tricuspid prolapse. Following right heart catheterization (Qp:Qs 3.5, PVRi 5.23WUmsq, PVR 4.55 WU, PVR/SVR 0.16), we made the decision to correct the defect using an Amplatzer Septal Occluder (AGA) No. 16 mm using transjugular method. Full device deployment was successfully performed with several episodes of PVC storm and severe bradycardia. One and a half years after the procedure, her TVG dropped to only 18 mmHg, her visible indicators of PH subsided, and the PA dilator treatment was discontinued. Her body weight had increased to 28 kg, and she had no complaints.ConclusionsOur experience demonstrated that percutaneous closure of multiple VSD with a single device is possible, even with pulmonary hypertension.

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Section: Discussionmentioning

confidence: 99%

“…The shape and diameter of the VSD may be estimated with precision using TEE. When employing TEE, the danger of oesophageal trauma and erosion should be taken into account ( 1 , 3 , 10 , 11 ).…”

Section: Discussionmentioning

confidence: 99%

Transesophageal echocardiography-guided percutaneous closure of multiple muscular ventricular septal defects with pulmonary hypertension using single device: A case report

Siagian

Prakoso

Mendel

et al. 2023

Front. Cardiovasc. Med.

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“…When severe pulmonary hypertension is present, there is a very significant risk of maternal (up to 50%) and fetal (up to 60%) mortality. 1 , 5 , 10 Invasive RHC is advised in accordance with the ESC 2018 guidelines if there is diagnostic uncertainty and to support significant therapeutic decisions. 4 However, no RHC procedure was performed prior to ASD closure in our patient.…”

Section: Discussionmentioning

confidence: 99%

Transoesophageal echocardiography-guided balloon-assisted percutaneous closure of a large secundum atrial septal defect in a pregnant woman: a case report

Prakoso,

Ariani,

Mendel

et al. 2023

European Heart Journal - Case Reports

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Structured Abstract Background According to 2018 European Society of Cardiology (ESC) guidelines, atrial septal defect (ASD) closure can be performed during pregnancy but is rarely indicated. In this case, we demonstrate the viability of percutaneous balloon-assisted ASD closure without fluoroscopy in a pregnant woman. Case summary A 23-year-old G3P2A0 woman who was 20 weeks pregnant had primary complaints of breathlessness (New York Heart Association functional class (NYHA) fc III-IV for one week prior to admission. Transthoracic echocardiography (TTE) showed dilatation of right atrium, dilated right ventricle, dilated main pulmonary artery (28.1 mm), and an oval-shaped 22x33 mm-sized secundum ASD with left-to-right (L-to-R) shunt. Despite optimal pharmacological treatment, the NYHA fc did not improve. Under transoesophageal echocardiography (TEE) monitoring only, we introduced a 40 mm CeraTM ASD Occluder (Lifetech, China) via the delivery sheath. The device was deployed as usual, however despite numerous placement adjustments, the LA disc keeps being dislodged to RA and could not engage correctly. Therefore, we decided to use balloon-assisted approach using sizing balloon No.34 mm. The device was successfully positioned, a wiggle test was conducted to make sure the device was stable. The patient was able to give birth to the child normally several months later. Discussion Despite the fact that pregnant women with ASD receive a very low dose of radiation, it is nevertheless recommended to avoid radiation because this demographic is particularly vulnerable to it. It is possible to treat large ASD in pregnant women with a successful balloon-assisted approach.

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“…[1][2][3] Recent studies have demonstrated favorable outcomes with device closure of acyanotic CHDs, including atrial septal defect (ASD), ventricular septal defect (VSD), and patent ductus arteriosus (PDA). [4][5][6][7] Concerns over radiation exposure, especially in children and pregnant women, have led to the adoption of non-fluoroscopy techniques for defect closure, with comparable efficacy and safety to traditional methods. In our effort to mitigate radiation exposure during transcatheter closure procedures for congenital heart defects, we have implemented a policy promoting non-fluoroscopy techniques, even in challenging cases such as multiple ventricular septal defects (VSDs) and in pregnant women with atrial septal defect (ASD) with pulmonary hypertension.…”

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confidence: 99%

The Current Strategy in Managing Congenital and Structural Heart Disease: Find and Treat Them Appropriately

Prakoso

2024

HSJ

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Significant progress has been made in diagnosing and treating congenital heart defects (CHDs) over the past five decades. Notable advancements include pulse oximetry screening for critical CHDs in newborns and percutaneous, catheter-based procedures, improving outcomes even in developing nations. Recent studies demonstrate favorable outcomes with device closure of acyanotic CHDs, with non-fluoroscopy techniques adopted to minimize radiation risks. Positive results are observed with right ventricular outflow tract (RVOT) stent palliation for late-presenting cyanotic congenital heart diseases such as tetralogy of Fallot (TOF). Novel interventions like reverse Potts shunt anastomosis show promise in managing pediatric pulmonary arterial hypertension (PAH), while prophylactic treatments effectively reduce postoperative arrhythmias. Fontan procedure significantly enhances survival rates for individuals with single functional ventricles, although challenges arise with aging populations. In developed countries, fetal cardiac interventions utilizing advanced imaging techniques allow for early detection and preventive interventions, reducing secondary complications. Keyword: Fetal Intervention, Fontan, Non-Fluoroscopy, Percutaneous, Reverse Potts, Rheumatic Heart Disease, RVOT Stenting.

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Potency of Non-fluoroscopy Guided Patent Ductus Arteriosus Closure: a Case Report

Cited by 3 publications

References 16 publications

Transesophageal echocardiography-guided percutaneous closure of multiple muscular ventricular septal defects with pulmonary hypertension using single device: A case report

Transesophageal echocardiography-guided percutaneous closure of multiple muscular ventricular septal defects with pulmonary hypertension using single device: A case report

Transoesophageal echocardiography-guided balloon-assisted percutaneous closure of a large secundum atrial septal defect in a pregnant woman: a case report

The Current Strategy in Managing Congenital and Structural Heart Disease: Find and Treat Them Appropriately

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