A little boy found solace after expert doctors’ intervention
THE CASE
A 7 year old boy from Uzbekistan, weighing 21 kg was admitted with
pain and discomfort in both lower limbs. The boy was experiencing
fatiguability for a long time while walking. Transthoracic
Echocardiography showed severe Coarctation of Aorta (COA) with
pandiastolic spill with moderate sized outlet muscular Ventricular
Septal Defect (VSD) shunting left to right.
Family was counselled regarding treatment options either surgically or
by intervention methods. As patient weight was not suitable for stenting
of Coarctation of Aorta so ballooning of Coarctation along with device
closure of VSD was planned.
THE PROCEDURE
Procedure was done in conscious sedation. Right femoral Vein and
Artery was taken and secured with 6F and 5F shorts sheaths
respectively. Pre balloon COA pressure gradient was 40 mm Hg.
Ballooning of COA segment was done with Tyshak II 8*40 mm followed
by 10*40 mm balloons.
There was a significant step up in saturation from SVC to Pulmonary
Artery. LV Angiogram was done which showed 4.9 mm outlet muscular
VSD with good separation from aortic valve. VSD device closure was
done with Amplatzer Duct Occlude II (6*4 mm) from retrograde route
(Femoral Artery) under fluoroscopic guidance. Device position was
confirmed on Echocardiography and then released.
THE RESULT
Post ballooning of COA segment, there was an insignificant pressure
gradient along with well opened COA segment. Post VSD device closure,
there was no residual shunt across the device with no aortic
regurgitation and the cardiac rhythm was normal in ECG. Patient was
discharged after 48 hours in haemodynamically stable state.