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

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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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