Transcatheter coil closure of a right pulmonary artery to left atrial fistula in an ill neonate

Slack, Michael; Jedeikin, Roy; Jones, John S.

doi:10.1002/1522-726x(200007)50:3<330::aid-ccd12>3.0.co;2-t

Cited by 34 publications

(45 citation statements)

References 9 publications

(5 reference statements)

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“…This is seen more frequently in males than in females, with a reported frequency of 3:1 9. Although a few patients have been diagnosed at infancy,2 the majority are identified following delayed onset of cyanosis at adolescence or even adulthood. Symptoms at presentation include progressive cyanosis, effort intolerance, embolic manifestations, endarteritis, hyperviscosity symptoms and even fatal rupture 9.…”

Section: Discussionmentioning

confidence: 99%

“…Surgery was the only treatment available for these patients until the first transcatheter coil closure was performed in 2000 2. The surgical approach depends on the anatomy, with an off-pump ligation preferred whenever feasible, although alternative surgeries such as ligation and division, and excision and intracardiac repair, have been performed in a minority of patients, with excellent results 9.…”

Section: Discussionmentioning

confidence: 99%

“…Recent advances in the catheter-based techniques brought this condition into the realm of treatment by interventionists. The first reported transcatheter closure was performed by Slack et al 2 in a sick neonate, using Gianturco coils. Subsequently, six more patients underwent device closure successfully, using either an Amplatzer septal occluder,4 8 a muscular ventricular septal defect occluder6 or a duct occluder 3 5 7.…”

Section: Discussionmentioning

confidence: 99%

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Transcatheter closure of direct right pulmonary artery to left atrial communication using vascular plug

2015

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A direct right pulmonary artery to left atrial fistula is a rare congenital condition in which patients usually present with isolated cyanosis in the absence of abnormal cardiovascular findings. We report the percutaneous closure of such a defect in a young woman who presented with severe cyanosis. This was achieved without making a conventional venovenous loop and was performed using an Amplatzer vascular plug. We believe, in patients with a suitable anatomy, closure with vascular plug without a venovenous loop should be the method of choice for treating this malady in view of the technical ease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Transcatheter closure of direct right pulmonary artery to left atrial communication using vascular plug

2015

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“…The communication can be addressed successfully by means of percutaneous catheter-based interventional device closure in neonates and older children [10].…”

Section: Discussionmentioning

confidence: 99%

Catheter Interventional Closure of a Large Right Pulmonary Artery–to–Left Atrial Communication in a Neonate

Burkamp

Ghisla²,

Knirsch

et al. 2012

Pediatr Cardiol

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Right pulmonary artery-to-left atrial communication is a rare congenital vascular malformation that results in a right-to-left shunting. This report describes the case history of a neonate with a large right pulmonary artery-to-left atrial connection resulting in cyanosis and severe heart failure who underwent successful early catheter interventional therapy. In the neonate, this lesion can be diagnosed accurately using transthoracic echocardiography. Closure of the communication can be achieved even in infants via percutaneous interventional catheterization with a low procedure-related risk and a good midterm follow-up result.Keywords Catheter interventional therapy Á Congenital heart defect Á Pulmonary artery-to-left atrium communication Á Neonate One-third of neonatal cyanosis cases are caused by congenital heart defects and it is important to differentiate them from pulmonary disease or persistent fetal circulation [5]. Right pulmonary artery (RPA)-to-left atrium (LA) communication involves a direct connection between the pulmonary artery and the pulmonary vein or LA [11] and is a very uncommon cause of right-to-left shunting. This pathologic vascular communication results in a large shunting of venous blood to the arterial side, leading to both cyanosis and volume overload. Case ReportA female term neonate with a birth weight of 3 kg and 620 g presented 14 h postnatally with central cyanosis and clinical signs of respiratory distress. An echocardiogram showed a large RPA-LA communication from the proximal RPA to the roof of the LA (Fig. 1). The LA and the left ventricle were dilated, and left ventricular function was impaired (ejection fraction, 33%).The patient's condition improved and stabilized after initiation of continuous epinephrine and milrinone administered intravenously. After 6 days, cardiac catheterization was performed with the patient under general anesthesia via a transfemoral venous approach using a 5-Fr introducer sheath. The size and anatomy of the fistula were identified and measured by a selective pulmonary angiogram (Fig. 2).Due to the shunt volume, the diameter of the proximal RPA was double that of the left pulmonary artery. The fistula itself measured 9-mm at the pulmonary end, narrowed to 2.2-mm, and widened again to 9-mm at the atrial end at the roof of the LA.The communication was entered from the pulmonary arterial side with an 0.018 in. wire. Through the 5-Fr sheath and across the wire, a flexible introducer catheter was advanced into the fistula. Successful closure then was performed with a detachable patent arterial duct (PDA) coil (7 9 6-mm, Nit-Occlud; pfm, Cologne, Germany) from the pulmonary arterial side. Three loops of the coil were placed into the LA, and the remaining loops were placed into the fistula and the RPA.After confirmation that the positioning of the device was stable and the flow of the RPA and LA was unimpaired (via a contrast injection through the introducer catheter and a transthoracic echocardiography), the coil was released. A final angiogram s...

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“…Surgery or transcatheter closures are the definitive treatment modalities. (5,6) Case Report A 3-year old Caucasian boy living in an urban area was directed to our hospital for suspected cat scratch disease. On examination, extreme cyanosis of the skin and mucous membranes as well as finger clubbing were apparent.…”

mentioning

confidence: 99%

Overt yet unrecognized cyanosis in a 3-year old boy with right pulmonary artery-to-left atrium communication: malpractice or ignorance?

Čače

Ovuka

Čače

et al. 2012

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Transcatheter coil closure of a right pulmonary artery to left atrial fistula in an ill neonate

Cited by 34 publications

References 9 publications

Transcatheter closure of direct right pulmonary artery to left atrial communication using vascular plug

Transcatheter closure of direct right pulmonary artery to left atrial communication using vascular plug

Catheter Interventional Closure of a Large Right Pulmonary Artery–to–Left Atrial Communication in a Neonate

Overt yet unrecognized cyanosis in a 3-year old boy with right pulmonary artery-to-left atrium communication: malpractice or ignorance?

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