Ventricular septal rupture following nonsurgical septal reduction for hypertrophic cardiomyopathy: treatment with percutaneous closure.

An 82-year-old woman with severe symptomatic hypertrophic obstructive cardiomyopathy undergoes nonsurgical septal reduction, leading to immediate hemodynamic and functional improvement. Five weeks later, she presents with severe biventricular failure due to a large septal rupture with marked left-to-right shunting. The rupture is closed with an Amplatzer post-MI ventricular septal defect occluding device. Residual shunting through the device and a small residual shunt at its superior rim lead to severe hemolysis, which resolves spontaneously after 10 days of supportive therapy. A further self-limiting episode of hemolysis recurred 3 months later following a period of excessive anticoagulation.

Successful stenting for Budd-Chiari syndrome after pediatric liver transplantation: a case series and review of the literature.

Hepatic venous outflow obstruction, known as Budd-Chiari syndrome, is a rare but serious complication of orthotopic liver transplantation and may lead to graft loss. Our aim was to describe a single center experience of percutaneous interventional management of hepatic outflow obstruction post liver transplantation in children. Three children with post-transplant hepatic venous outflow obstruction were treated successfully with percutaneous stent placement. This resulted in long-term resolution of symptoms and was superior to balloon angioplasty both in our series and in cases reported in the literature. Stenting may be the treatment of choice for hepatic venous obstruction after pediatric liver transplantation, particularly if there is a recurrence of stenosis after balloon dilatation.