Transcatheter aortic valve closure to treat severe aortic regurgitation in a patient failing stage I palliation for hypoplastic left heart syndrome

Abstract

We present a patient with borderline left ventricle, in whom significant aortic regurgitation after failed attempt of biventricular repair with balloon valvuloplasty and consecutive Norwood stage 1 procedure substantially contributed to persisting hemodynamic instability. Transcatheter closure of the aortic valve using an Amplatzer(R) septal occluder was performed and led to clinical stabilization. At medium-term follow-up, there was neither residual aortic regurgitation nor obstruction of the coronary artery origins.

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

“…Our case did not have any coronary sinusoids. Elimination of AR after stage 1 palliation in HLHS using device closure of LV outflow tract have also been described . To our knowledge, LV obliteration to eliminate aortic regurgitation using coils has not been previously reported, and is worthy of consideration in rare cases of problematic native aortic valve insufficiency in HLHS patients.…”

“…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 .…”

Trans-catheter closure of the native aortic valve with an Amplatzer® Occluder to treat progressive aortic regurgitation after implantation of a left-ventricular assist device

“…Due to the infant's size, the smallest Amplatzer W Septal Occluder was chosen, and implanted via an antegrade transvenous approach with an excellent result [7,8]. However, to our knowledge, the case we present here is the first report on trans-catheter closure of the aortic valve in an adult on LVAD support.…”

“…Our strategy was to close the aortic valve percutaneously by implanting an Amplatzer W device with self-expanding double discs and its connecting waist, which usually acts to stent septal defects [7]. This stabilising-stent principle was a priority while considering the patient's need for the device.…”

Transcatheter device occlusion of the left ventricular outflow tract as treatment for severe aortic regurgitation in hypoplastic left heart syndrome

“…Surgical occlusion of the insufficient native aortic valve has been reported together with Norwood Stage I palliation . More recently, also interventional approaches have been proven to be successful for similar conditions: Riede et al published the interventional closure of the aortic valve with an Amplatzer TM septal occluder in the setting of a borderline sized left ventricle , and stenting of the LVOT was performed by another group as alternative approach to ductal stenting or a Blalock–Taussig shunt in HLHS . To the best of our knowledge, we are the first to report the interventional occlusion of the LVOT in a pediatric patient.…”