Retrograde transcatheter aortic valve closure in an infant with failing Norwood stage I palliation: a case report
Abstract 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, ventri...
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doaj-fc7dc6c1509c418e824363483524dcbf2020-11-25T03:02:23ZengBMCJournal of Medical Case Reports1752-19472019-07-011311410.1186/s13256-019-2141-5Retrograde transcatheter aortic valve closure in an infant with failing Norwood stage I palliation: a case reportHannah E. Fürniss0Rouven Kubicki1Brigitte Stiller2Katja Reineker3Matthias Siepe4Jochen Grohmann5Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg – Bad Krozingen, Medical Center – University of Freiburg, Faculty of MedicineDepartment of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg – Bad Krozingen, Medical Center – University of Freiburg, Faculty of MedicineDepartment of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg – Bad Krozingen, Medical Center – University of Freiburg, Faculty of MedicineDepartment of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg – Bad Krozingen, Medical Center – University of Freiburg, Faculty of MedicineDepartment of Cardiovascular Surgery, University Heart Center Freiburg – Bad Krozingen, Medical Center – University of Freiburg, Faculty of MedicineDepartment of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg – Bad Krozingen, Medical Center – University of Freiburg, Faculty of MedicineAbstract 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.http://link.springer.com/article/10.1186/s13256-019-2141-5Hypoplastic left heart syndromeTranscatheterDevice implantationAortic regurgitationInfant |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hannah E. Fürniss Rouven Kubicki Brigitte Stiller Katja Reineker Matthias Siepe Jochen Grohmann |
spellingShingle |
Hannah E. Fürniss Rouven Kubicki Brigitte Stiller Katja Reineker Matthias Siepe Jochen Grohmann Retrograde transcatheter aortic valve closure in an infant with failing Norwood stage I palliation: a case report Journal of Medical Case Reports Hypoplastic left heart syndrome Transcatheter Device implantation Aortic regurgitation Infant |
author_facet |
Hannah E. Fürniss Rouven Kubicki Brigitte Stiller Katja Reineker Matthias Siepe Jochen Grohmann |
author_sort |
Hannah E. Fürniss |
title |
Retrograde transcatheter aortic valve closure in an infant with failing Norwood stage I palliation: a case report |
title_short |
Retrograde transcatheter aortic valve closure in an infant with failing Norwood stage I palliation: a case report |
title_full |
Retrograde transcatheter aortic valve closure in an infant with failing Norwood stage I palliation: a case report |
title_fullStr |
Retrograde transcatheter aortic valve closure in an infant with failing Norwood stage I palliation: a case report |
title_full_unstemmed |
Retrograde transcatheter aortic valve closure in an infant with failing Norwood stage I palliation: a case report |
title_sort |
retrograde transcatheter aortic valve closure in an infant with failing norwood stage i palliation: a case report |
publisher |
BMC |
series |
Journal of Medical Case Reports |
issn |
1752-1947 |
publishDate |
2019-07-01 |
description |
Abstract 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. |
topic |
Hypoplastic left heart syndrome Transcatheter Device implantation Aortic regurgitation Infant |
url |
http://link.springer.com/article/10.1186/s13256-019-2141-5 |
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