Successful percutaneous treatment with the Konar MF™-VSD Occluder in an infant with Abernethy syndrome-case report

A rare presentation of type II Abernethy malformation and nephrotic syndrome: Case report and review

Type II Abernethy malformation is an extremely reported congenital extrahepatic portosystemic shunt in complication with nephrotic syndrome. We present the case of an 8-year-old boy who presented with symptoms of type II Abernethy malformation and nephrotic syndrome. This diagnosis of this type II Abernethy malformation was based on physical examination, blood tests, urinalysis, nephrotic and hepatic function tests, routine clinical lipid measurements, abdominal ultrasonography, and computed tomographic angiography. A kidney biopsy revealed the pathological features of nephrotic syndrome. This is the second reported patient diagnosed with type II Abernethy malformation and nephrotic syndrome. Captopril treatment was effective in improving the symptoms of this case. A patient with type II Abernethy malformation related to immune complex-mediated glomerular injury was effectively improved with medication. Type II Abernethy malformation is a causative factor of immune complex-mediated glomerular injury in nephrotic syndrome. Captopril treatment significantly improved the symptoms in this case.

Off-label use of Lifetech KONAR-MF™ ventricular septal defect occluder for large patent ductus arteriosus closure in <6 ​kg infants

Background

Device PDA closure is increasingly used in smaller patients. Major safety concerns remain when applied to <6 ​kg infants with large PDA and challenging anatomy. We aimed to report our experience with the new Konar-MF™ ventricular septal defect (VSD) occluder for transcatheter closure of large patent ductus arteriosus (PDA) in infants <6 ​kg.

Methods

Infants <6 ​kg in whom PDA occlusion was attempted using the Konar-MF™ VSD occluder were analyzed to review procedural characteristics and outcomes. Prospective follow-up was achieved until August 2021.

Results

A total of 9 implantations were performed in 7 infants [age: 5.3 ​± ​3.4 (1.7-10.1) months, weight: 4.1 ​± ​0.8 (2.9-5.8) kg]. All PDAs were large and short [minimal ductal diameter: 5.6 ​± ​1.0 (4.5-7.0) mm, ductal length: 4.3 ​± ​0.6 (3.5-5) mm]. Successful device implantation was achieved in all cases without major complication. Early device embolization occurred in 1 case with safe percutaneous device removal. Late percutaneous device retrieval was achieved 5 weeks after implantation because of symptomatic residual shunt. In both cases a second Konar-MF™ VSD occluder was implanted with excellent outcome. Over a median follow-up of 12 (6-25) months, 1 patient died from a device-unrelated cause; all remaining patients are asymptomatic, with complete occlusion and no delayed device-related complication.

Conclusions

Transcatheter closure of large PDA using the Konar-MF™ VSD occluder appears to be feasible, effective and safe in <6 ​kg infants. This approach might be an alternative to surgical ligation in carefully selected infants, although that remains to be confirmed by extensive experience and long-term outcomes data.

A case of two shunts in the endovascular treatment of type II Abernethy syndrome

Background

Abernethy malformation is a rare condition defined by a congenital extrahepatic portosystemic shunt, often leading to absence or hypoplasia of the intrahepatic portal venous system. Although there are no consensus treatment guidelines, interventional techniques now offer minimally invasive treatment options for Abernethy malformations. This case report describes a case of Abernethy Syndrome Type II where the patient had two separate extrahepatic portosystemic shunts treated with endovascular occlusion with two Amplatzer plugs and demonstrates the feasibility of this treatment for this rare condition. This case was in a young adult, adding to the scarce literature of treatment for Abernethy syndrome in the adult population.

Case presentation

We report a case of a 20-year-old female patient with neurocognitive behavioral difficulty, voracious appetite, and chronic encephalopathy secondary to type II Abernethy malformation with not one, but two extrahepatic portosystemic shunts. The patient had failed medical management and was not a liver transplant candidate. Therefore, she presented to us for an endovascular treatment option. The two shunts were treated with endovascular occlusion using Amplatzer vascular plugs. Following embolization, flow into the hypoplastic portal vein improved with near complete occlusion of flow into the portosystemic shunts, thus restoring blood flow into the native portal system. At 3 month follow up, a CT demonstrated complete occlusion of the two portosystemic shunts, and a portal vein diminutive in caliber. The portal vein measured 7 mm in diameter on both pre and post-procedure CT scans. The total volume of the liver was found to be 843 cm3 on pre-procedure CT & 1191 cm3 on post-procedure CT.

Conclusions

This report demonstrates the feasibility of using endovascular embolization to treat Abernethy II malformations. The management strategy of Type II Abernethy Syndrome should be to redirect blood flow into the hypoplastic native portal system, allowing for physiologic hepatic metabolism of splanchnic blood, hypertrophy of the portal system, and growth of the liver from the increased trophic flow.