RESUMO
Abernethy malformations are a rare collection of congenital hepatic portosystemic shunts. Our 19-year-old patient is with a type 2 Abernethy malformation elected permanent shunt closure following worsening dyspnea. This report details a single stage endovascular technique wherein shunt closure was achieved immediately by placement of an aortic endograft. At 5-month follow-up, the patient reported decreased shortness of breath. Furthermore, ultrasound investigation demonstrated a patent portal vein and right heart catheterization 6 months after procedure revealed decreased pulmonary hypertension relative to preprocedure values. This one step method may serve as an alternative treatment strategy to multistage endovascular closure techniques of type 2 Abernethy malformations.
RESUMO
This report details a method of percutaneous, transluminal retrieval of an intracardiac foreign body using fluoroscopy in combination with intracardiac echocardiography. During retrieval, intracardiac echocardiography (ICE) provided real-time anatomic localization of a constantly moving, almost radiolucent micropuncture coaxial dilator fragment with respect to the tricuspid and pulmonary valves. This method may serve as a crucial aid in retrieval of intracardiac foreign bodies that are difficult to see with fluoroscopy and which may be adjacent to cardiac valves.
RESUMO
Infants with tracheoesophageal fistulas may present with complex cardiac disease that may obviate or disrupt a safe operative repair. Here we present a case of an infant who developed cardiac instability during esophageal atresia repair, precluding formal anastomosis after approximation of the distal and proximal esophageal segments. Postoperatively, anastomosis of the esophagus was achieved using an image-guided technique with subsequent dilation. This approach may provide an alternative approach for establishment of esophageal continuity in patients who are high-risk operative candidates.