Hybrid management of a large atrial septal defect and a patent ductus arteriosus in an infant with chronic lung disease

Abstract

We report a case wherein a dysmorphic four-month-old infant (weighing 4.5 kgs) with an 8 mm atrial septal defect (ASD), a 1.5 mm patent ductus arteriosus (PDA), a 2 mm mid-muscular ventricular septal defect (VSD) associated with chronic lung disease, and severe pulmonary hypertension, was successfully managed using a hybrid approach, without the use of cardiopulmonary bypass (CPB). Through a median sternotomy, the PDA was ligated and the ASD was closed with a 9 mm Amplatzer septal occluder implanted through peratrial access. The VSD was left untouched. Serial echocardiograms showed complete closure of the ASD and PDA, with progressive normalization of the pulmonary artery (PA) pressures within three months. The child rapidly gained weight and was weaned from sildenafil and oxygen administration. After 12 months, the VSD closed spontaneously and the child remained well, with normal PA pressures. A hybrid approach without the use of CPB should be considered in the management of infants with congenital heart disease, associated with chronic lung disease and pulmonary hypertension.

Experiência inicial no fechamento percutâneo da comunicação interatrial tipo ostium secundum com a prótese Figulla

“…Exceção a essa diretriz seria o encontro de pequenos pacientes com pneumopatias crônicas graves (broncodisplasia da prematuridade, asmáticos perenes) muitas vezes portadores de quadros sindrômicos genéticos associados. 17,18 Nesses subgrupos de risco, concordamos que o fechamento percutâneo oportuno da comunicação interatrial durante os dois primeiros anos de vida resulta em grande melhoria clínica e pulmonar. Por outro lado, próteses maiores vêm sendo utilizadas sem complicações significativas em crianças pequenas nos Estados Unidos e na Europa.…”

Hybrid atrial septal defect closure in a child with positional anomaly of the heart and thoracic wall abnormalities

“…The presented hybrid procedure allowed for successful closure of ASD II with reduction to a minimum of the risk of possible complications and adverse effects related to conventional cardiac surgery in the face of the critical comorbidities [ 2 – 4 ].…”