Percutaneous transient occlusion of the transtricuspid flow: a new method to evaluate the right ventricle-dependent coronary circulation in pulmonary atresia with intact ventricular septum.

Pulmonary atresia with an intact ventricular septum is characterised by heterogeneity in right ventricle morphology and coronary anatomy. In some cases, the presence of ventriculocoronary connections may promote coronary artery stenosis or interruption, and aortic diastolic pressure may not be sufficient to drive coronary blood flow. This requires a correct evaluation (currently done by angiography) which depends on whether the patient can be offered decompression of the right ventricle. To date, there is no objective method to do so, so we designed a percutaneous, transitory technique with the purpose of occluding the transtricuspid anterograde flow. The manoeuverer was performed in a 25-day-old female with pulmonary atresia with intact ventricular septum, right ventricle at suprasystemic level, and selective coronarography was not conclusive, the anterior descendant with stenosis in its middle third and from this point, thinner with to-fro flow. Occlusion was performed with a balloon catheter. We re-evaluated the coronary flow and the normalised anterior descendant flow. We hope that with this new method, we can give a more accurate diagnosis and determine the cases in which the coronary circulation is truly not right ventricle dependent to offer a greater number of patients biventricular or 1.5 ventricular repairs and thereby improve their quality of life and survival, the ones that turn out to be right ventricular dependant; offer them an early reference for cardiac transplant or in case it is not available to consider univentricular palliation knowing that this probably would not reduce the risk of ischaemia and/or death over time.

Transcatheter resolution of an aneurism of the pulmonary trunk with residual ductus arteriosus after thoracoscopic clipping: a new approach.

Patent ductus arteriosus is the most common cardiac anomaly in our country. In the last few decades, there has been a lot of interest in developing less invasive techniques like video-assisted thoracoscopic clipping; nevertheless, this also has some complications. We present an 8-year-old female, which had been treated with video-assisted thoracoscopic clipping of patent ductus arteriosus. Five years later, she presented with a large aneurysm of the ductus arteriosus extending to the pulmonary trunk and a residual patent ductus arteriosus. A Cardia ASD occluder of 24 mm was placed in the aneurysm, and the residual ductus arteriosus was then closed with an Amplatzer Plug vascular II device of 10 mm, with a good outcome. The development of an aneurysm after video-assisted patent ductus arteriosus closure is apparently a non-reported complication; therefore, there are also no reports for its treatment. That is why we present this case as an option for its resolution.