Percutaneous obliteration of left ventricular cavity to eliminate aortic regurgitation and presumed coronary steal in an infant with hypoplastic left heart syndrome

Left atrial appendage occlusion using hydrogel coils in a child

Left atrial appendage occlusion in young children has not been reported before. Herein, we describe a successful occlusion using hydrogel coils in a toddler. The decision to occlude the appendage was made to mitigate the potential risk of systemic thromboembolism, given the child's unusual anatomy.

Vascular occlusion with 0.035-inch hydrogel expandable coils in congenital heart diseases and vascular anomalies

BACKGROUND

We present our experience with transcatheter vascular occlusion using 0.035-inch hydrogel expandable coils, which has been reported only in a few cases in the pediatric cardiology fields.

METHODS

This study is a retrospective analysis of all patients who underwent transcatheter embolization with 0.035-inch hydrogel coils at the Department of Pediatrics, Okayama University Hospital, between October 2018 and September 2020.

RESULTS

Twenty patients with a median age of 5.1 years (0.05-26.0 years) and a median weight of 13.8 kg (3.0-56.8 kg) were included. A total of fifty-four 0.035-inch hydrogel coils, including 35 Azur 35 and nineteen Azur CX 35 coils (Terumo, Tokyo, Japan), were successfully deployed in 22 target vessels. The target vessels consisted of 10 aortopulmonary collaterals, 8 veno-venous collaterals, and 4 pulmonary arteriovenous malformations. We achieved technical success in all the target vessels. In total, the mean target vessel diameter was 4.4 mm, the mean number of 0.035-inch hydrogel coils was 2.5 per vessel. The mean device to vessel ratio was 1.6 for the anchor coil and 1.2 for the additional coil. Post-implantation angiograms revealed that the primary occlusion rate was 18/22 (82%). There were no periprocedural complications.

CONCLUSIONS

The 0.035-inch hydrogel expandable coils are effective and safe in patients with congenital heart disease and vascular anomalies. These occlusion devices could be valuable options for interventional pediatric cardiologists.

Percutaneous transcatheter occlusion of left atrioventricular valve in a patient with single ventricle and severe atrioventricular valve regurgitation

Many patients with single ventricle physiology suffer from atrioventricular valve (AVV) regurgitation which may worsen their cardiac function and cause symptoms. It has been postulated that elimination of the nondominant hypoplastic AVV regurgitation, might improve the clinical status in patients post-Fontan surgery. We describe a case of hypoplastic left heart variant, post Fontan surgery who had severe left AVV regurgitation and underwent percutaneous transcatheter occlusion of the hypoplastic left AVV, using a VSD occluder device. At 3 months post procedure, the patient is improved. Transcatheter closure of a regurgitant hypoplastic AVV in a patient with single ventricle helps to improve the patient's cardiac function and clinical status.

Coil occlusion of a congenital left ventricular aneurysm in a newborn

We report interventional treatment of a congenital left ventricular aneurysm in a neonate. The aneurysm was detected prenatally at 20 weeks of gestation. Postnatally, the aneurysm increased in size during the first few days of life and therefore we opted for interventional closure to abolish the potential risk of rupture. The aneurysm was entered with a 2.7 French microcatheter, and complete occlusion was achieved by successive placement of three detachable large volume coils (Ruby Coil Penumbra^R , Alameda, California). To the best of our knowledge, this is the first report describing interventional occlusion of a congenital ventricular aneurysm in early infancy. Interventional occlusion with detachable large volume coils appears to be an attractive alternative to surgical resection in patients presenting with ventricular outpouchings and narrow base connection to the ventricle.