Coil‐occlusion of the left ventricle as emergency treatment in failing stage I palliation for hypoplastic left heart syndrome with sinusoids

The phenomenon of coronary steal is well known in the setting of HLHS (Hypoplastic Left Heart Syndrome) early after the Classical Norwood Operation. We report a rare case of an infant with HLHS [Severe Aortic Stenosis (AS), Mitral Stenosis (MS) and small Left Ventricle (LV)], who developed aortic regurgitation and presumed coronary steal late after the Sano Modification of the Norwood Procedure. Coronary steal developed secondary to progressive aortic and mitral regurgitation and resulted in poor right ventricular function and severe tricuspid regurgitation. We describe a novel interventional approach for obliteration of the LV cavity by using hydrogel coils. LV obliteration eliminated the presumed steal and resulted in improvement in ventricular function, tricuspid regurgitation and clinical course.

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“…Coil occlusion of the LV in the setting of coronary sinusoids has been previously described . Our case did not have any coronary sinusoids.…”

Section: Discussionsupporting

confidence: 50%

“…This problem is usually corrected by balancing the pulmonary and systemic circulations post‐operatively in the cardiac intensive care unit . One solution that has been utilized in patients with HLHS and presumed coronary steal due to AR or coronary sinusoids has been obliteration of the LV cavity with transcatheter devices .…”

Section: Introductionmentioning

confidence: 99%

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

El‐Said

Pockett

Moore

2017

Cathet Cardio Intervent

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“…Some techniques and material for interventional closure of CAF have been described previously and these vary according to the patient's size, anatomy and size of the coronary vascular bed, size, length, location, origin, course and distal orifice of the CAF, the accompanying structures (side branches) and the estimated location of the electric cardiac conduction system. Controlled‐release devices were used in all patients to reduce the risk of device embolization, migration, maladjustment or of an unforeseeable size mismatch.…”

Section: Methodsmentioning

confidence: 99%

Coronary Interventions in Congenital Heart Diseases: From Preterm to Young Adult Patients

Schneider

Wiebe

Hraška

et al. 2013

J Interven Cardiology

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Congenital and post-procedural coronary obstructive lesions can be considered for effective treatment with balloon dilation at any age as a salvage procedure. In coronaries impaired by external compression, stent implantation can restore perfusion, but long-term results are missing. Interventional closure of coronary fistulae has shown improvement of coronary arterial perfusion. The latter techniques can be used to close right ventricular to CA connections in patients with pulmonary atresia to prepare for biventricular repair, but bail-out strategies should be planned in all coronary interventions.

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“…Severe native or acquired AR leading to impaired coronary perfusion is a rare but potentially life-threatening complication in HLHS. Additional anatomical features promoting LV decompression during diastole, such as a VSD, can aggravate the steal effect [4].…”

Section: Discussionmentioning

confidence: 99%

Retrograde transcatheter aortic valve closure in an infant with failing Norwood stage I palliation: a case report

et al. 2019

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Background Aortic valve regurgitation leading to coronary steal phenomenon can severely impair cardiac function in hypoplastic left heart syndrome, thus worsening long-term outcome. Case presentation A German infant with borderline aortic and mitral valve, hypoplastic left ventricle, ventricular septal defect, and hypoplastic aortic arch with critical coarctation initially underwent aortic arch reconstruction and aortic valve dilation with the aim of biventricular correction later on. Unfortunately, severe cardiac dysfunction necessitated a change in strategy entailing modified stage I Norwood palliation. Increasing aortic regurgitation with coronary steal was revealed postoperatively, which required redo surgery to oversew the valve. However, pronounced aortic regurgitation recurred, causing severe cardiac decompensation with repeated resuscitation. As a bailout strategy, we performed aortic valve closure via transfemoral retrograde implantation of an Amplatzer Duct Occluder II device. This led to the patient’s rapid stabilization while circumventing highly risky renewed surgery in such a critically ill infant. Conclusions Retrograde transcatheter aortic valve closure may be considered a feasible alternative in infants with a failing single ventricle due to aortic regurgitation, with critical device evaluation being crucial for successful device implantation in this young age group. Electronic supplementary material The online version of this article (10.1186/s13256-019-2141-5) contains supplementary material, which is available to authorized users.

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Coil‐occlusion of the left ventricle as emergency treatment in failing stage I palliation for hypoplastic left heart syndrome with sinusoids

Cited by 6 publications

References 39 publications

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

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

Coronary Interventions in Congenital Heart Diseases: From Preterm to Young Adult Patients

Retrograde transcatheter aortic valve closure in an infant with failing Norwood stage I palliation: a case report

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