Transcatheter closure of an unligated vertical vein with an Amplatzer Vascular Plug-II device

Abstract

: The usual surgical practice after repair of a Total Anomalous Pulmonary Venous Connection (TAPVC) is to ligate the vertical vein (VV). Many surgeons find it expedient to leave the VV unligated to reduce pulmonary arterial pressure, decrease perioperative pulmonary hypertensive crisis, provide better hemodynamics postoperatively (1), and enable the adaptation of cardiac chambers to a new workload. Afterwards, the unligated VV may cause significant left-to-right shunt, likewise an atrial septal defect, mandating later surgical ligation or device closure (2). This report details transcatheter occlusion of a patent VV using a device Amplatzer Vascular Plug II, after TAPVC repair in early infancy. The transcatheter occlusion of an unligated VV after repair of supracardiac TAPVC represents an effective alternative to surgical redo. The device Amplatzer Vascular Plug II achieves great results.

Pulmonary Veins: Not Always Where You Expect Them

“…Recently, transcatheter occlusion of the VV in partial anomalous pulmonary venous connection with dual return to the LA and a VV has begun to gain favor in the congenital cardiology community, as indicated in multiple case studies and our center’s unpublished experience. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 Although TTE remains the initial imaging modality of choice, often further evaluation of posterior structures requires TEE or cross-sectional imaging. In our case, the entry of the VV was severely narrowed as visualized on CCT, with secondary findings of increased Q p /Q s ratio and right-sided chamber dilation on CMR in the absence of an intracardiac shunt.…”

Does this child just have an atrial septal defect? More potentiality of interventional therapy: A rare case report

“…Some scholars suggest oversizing by 30–50 % to the diameter measured at catheterization [ 21 ]. The general choice is 1.6 to 1.8 times the inner diameter of the narrowest part, and some different researchers believe that adding 2 mm to the inner diameter of the narrowest part is also feasible [ 22 , 23 ]. To avoid oversizing the device selection, we chose an occluder size of 1.7 times the inner diameter of the narrowest part, and the results are reliable.…”

Transcatheter closure of patent vertical vein after repair of total anomalous pulmonary venous connection: a case series

“…There have been only a few cases reported in the literature where the vertical vein closure is performed with the Amplatzer vascular plug or duct occluder. [15][16][17][18][19][20] Amoozgar et al reported that vertical vein of two total anomalous pulmonary venous connection patients, whose vertical vein was left open due to high pulmonary artery pressures in the surgery, was closed with a vascular plug type 1 device with a size of 10 mm and 8 mm. 19 Verma et al reported that they closed three unligated vertical vein of patients of two supracardiac total anomalous pulmonary venous connection and one mixed type total anomalous pulmonary venous connection with the device of 22 mm Cera vascular plug.…”

“…17 In addition, unligated vertical veins of patients with supracardiac type of total anomalous pulmonary venous connection have also been closed with 12 or 18 mm Amplatzer vascular Plug II. 15,16 In our article, we describe a case series of successful transcatheter closure of the unligated vertical vein using the Amplatzer vascular plug or duct occluder in patients who underwent surgery of supra-cardiac type of total anomalous pulmonary venous connection . The results of our study have shown that transcatheter closure of the vertical veins is well-tolerated and an effective method.…”