EchoNavigator (registered 3D TEE images) Guided fenestrated VSD closure to help relieve volume load and pulmonary vascular damage

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EchoNavigator (registered 3D TEE images) Guided fenestrated VSD closure to help relieve volume load and pulmonary vascular damage

By Pediatric and Adult Interventional Cardiac Symposium FEATURING John Carroll, Thomas Fagan

299 views

March 16, 2014

History:

• 9 year old female with a history of PA/VSD, discontinuous PA’s, and right ...
read more ↘ aortic arch. The RPA is diminutive and multiple attempts at unifocalization have failed. In 3/03 she underwent RV transannular patch and left BT shunt, 3/27/03 she had direct aorta to LPA shunt. In 11/03 RV to LPA conduit and takedown of BT shunt. On 2/2/05 RV to LPA conduit revision with pulmonary homograft and fenestrated VSD closure (5mm). 12/06 she had LPA stent placement. Cardiac
cath 10/15/12 revealed systemic RV pressure with bidirectional flow at fenestration and baseline Qp:Qs 0.75; conduit and LPA (fractured LPA stent) stenosis; post conduit and LPA stent – RV pressure decreased to 66% systemic and Qp:Qs increased to 1.5.

Physical Findings:

• Wt: 23 kg; RA Sat: increased from 85% to 95%; Grade III/VI medium pitched holosystolic murmum LLSB; Grade III/VI medium pitched systolic murmur LUSB radiating throughout precordium; Grade II/VI medium pitched decrescendo diastolic murmur LLSB.

Pertinent Tests:

EKG:

• Sinus rhythm with RBBB.

Echo:

• Estimated RV pressure 60 mmHg; Gradient across RV-PA conduit of 55 mmHg; Left-to-right shunt at fenestrated VSD with gradient of 50 mmHg.

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