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.