Simultaneous Transcatheter Device Closure of ASD, VSD and PDA in an Infant with Down Syndrome

Abstract

Incidence of congenital heart defects in Down syndrome varies from 40% to 60%. Atrioventricular septal defect is most common defect seen, followed by isolated Ventricular Septal Defect (VSD). Multiple defects can be found in 5% to 10% of Down syndrome babies. Such patient usually presents with Pulmonary Hypertension (PAH) early in life and can develop rapid progression. An infant with Down syndrome weighing 6.5 kg presented with recurrent lower respiratory tract infections. A Transthoracic echocardiogram showed 10 mm secundum Atrial Septal Defect (ASD), 5 mm peri membranous Ventricular Septal Defect (VSD) and 3.5 mm conical shaped Patent Ductus Arteriosus (PDA) with Pulmonary Arterial Hypertension (PAH). As all the defects were suitable for transcatheter closure, patient underwent successful device closure of VSD by 6/4 mm Amplatzer duct occluder II (ADO II) device, PDA closure by 6/4 mm Amplatzer duct occluder (ADO) device and ASD closure by 12 mm Amplatzer septal occluder device. PA pressures of patient reduced significantly after the procedure and possible post-operative morbidity was avoided by transcatheter intervention.

Management of Congenital Heart Diseases Associated with Down Syndrome

“…Transcatheter device closure is the preferred approach for most secundum atrial septal defects.Ventricular septal defects are more often treated surgically, but transcatheter closure is an option in selected cases. [10] Multiple defects in DS are usually treated with surgery, but there is case report of infant with Down's syndrome with ASD, VSD and PDA who was treated with simultaneous transcatheter device closure as all the defects were suitable for interventional procedure 11 .…”