Simultaneous stenting of tightly stenosed patent ductus arteriosus and pulmonary artery bifurcation using two stents (Y stenting): an innovative technique.

Stenting of patent ductus arteriosus (PDA) is a palliative technique that is evolving as an alternative to shunt surgery. Patients with duct-dependant pulmonary circulation and branch pulmonary artery stenosis are often palliated by shunt surgery with repair of branch pulmonary arteries under cardiopulmonary bypass. We present here an 8-month-old male child with duct-dependant pulmonary circulation with bifurcation stenosis who was palliated successfully by transcatheter means. He had stenosed PDA with tight pulmonary artery bifurcation stenosis and underwent successful "Y" stenting of PDA with simultaneous deployment of two stents. He successfully underwent bidirectional Glenn surgery 8 months after the procedure. Simultaneous stenting of bifurcation stenosis of branch pulmonary arteries with two stents has not been described in the literature.

Transcatheter closure of ruptured sinus of valsalva aneurysm into the left ventricle: a retrograde approach.

Aneurysms of sinuses of Valsalva (ASOV) are thin-walled saccular or tubular outpouchings of the aortic sinuses, which can be either congenital or acquired. They can rupture into heart chambers, the pulmonary artery, or the pericardial space (Perloff, Clinical recognition of congenital heart disease, [8]). This report presents a rare case of a patient with treated infective endocarditis who had a patent ductus arteriosus (PDA), a coronary cameral fistula, and a ruptured ASOV (RASOV) into the left ventricle (LV). Successful transcatheter closure of the ruptured ASOV and the other two lesions was performed using three Amplatzer duct occluders (AGA Medical Corporation, Golden Valley, MN, USA).

Tracheal bronchus: a cause of unexplained prolonged hypoxemia during ventilation.

The spectrum of disorders involving the tracheobronchial tree is diverse, with some of the conditions unique to the pediatric population. Despite the "airway first" maxim, many such disorders are missed initially. Tracheal bronchus is one such condition that comes to notice by persistent right upper lobe atelectasis, pneumothorax, recurrent pneumonia, chronic bronchitis, and prolonged ventilation. This anatomic variant in a patient with cyanotic congenital heart disease is reported. For this patient, timely identification of tracheal bronchus allowed appropriate changes in airway management and was life saving.

Transcatheter device closure of patent ductus arteriosus without arterial access--single institution experience.

OBJECTIVE: Retrospective analysis of feasibility, safety and advantages of device closure of patent ductus arteriosus (PDA) using only venous access. BACKGROUND: Arterial access for transcatheter device closure of PDA has been a standard practice, but has inherent complications, especially in infants. METHOD: Records of patients who underwent PDA device closure from 2004 to 2012 were reviewed. Echocardiography was used for patient selection and for assessment of procedural outcome. RESULT: 151 out of 179 patients underwent PDA device closure with venous access alone, weighing 2.2-58 kg with half <10 kg and follow up of 6 months-8 years. Fluoroscopic time ranged from 2.2 to 16 min. Immediate closure was achieved in 146 patients. Two patients had new-onset left pulmonary artery turbulence and one had residual flow. CONCLUSION: PDA device closure without arterial access can be accomplished safely and effectively in vast majority of patients including infants.

Transcatheter closure of a large aortopulmonary window with severe pulmonary arterial hypertension beyond infancy.

A patient presented with a large aortopulmonary window and significant pulmonary hypertension, and underwent successful closure with muscular ventricular septal occluder (Shen-Zhen Lifetech Scientific Inc.) without complications in short-term follow-up.

Exclusion of infected pseudoaneurysm of modified Blalock Taussig shunt using a covered stent.

A pseudoaneurysm due to infection after a modified Blalock-Taussig shunt is a rare but potentially fatal complication that can rupture, compress mediastinal structures, produce shunt occlusion, and bacteremia. In these patients, medical management of endocarditis is often incomplete because of the presence of prosthetic material and requires the take down of the shunt, most often by surgery, which can be technically challenging. We outline the use of a covered stent to exclude pseudoaneurysm from circulation.

Right pulmonary artery to left atrium fistula: transcatheter closure without conventional venovenous loop.

Right pulmonary artery to left atrium fistula is a rare anatomic variation of pulmonary arteriovenous malformation in which the initial connection exists between a pulmonary artery and a pulmonary vein, but during vascular development the pulmonary vein gets incorporated into the left atrium. Though nearly 60 such cases have been reported in literature, only 6 cases have been tackled by transcatheter technique with various types of devices and coils. This is a case where we demonstrate that large fistulae can be closed successfully with an atrial septal occluder without a conventional method of transseptal puncture and venovenous loop formation.

Transcatheter perimembranous ventricular septal defect closure with atrial septal occluder.

We report a patient with hemodynamically significant perimembranous ventricular septal defect who underwent successful closure with the Amplatzer Atrial Septal Occluder (AGA Medical Corporation, Golden Valley, Minnesota) without complications in short-term follow up.