Sasikumar Navaneetha, Rajasekar Premsekar, Suramanyan Raghavan
Department of Pediatric Cardiology, Frontier Lifeline Hospital, R-30/C, Ambattur Industrial Estate Road, Mogappair, Chennai 600101, Tamil Nadu, India.
Indian Heart J. 2013 May-Jun;65(3):283-5. doi: 10.1016/j.ihj.2013.04.020. Epub 2013 Apr 10.
A 21-year-old male presented with severe aortic paravalvular leak. He had undergone three cardiac surgeries and also had chronic kidney disease. It was decided for a trans-catheter closure owing to the risks of a fourth surgery and co-morbidity. The device was sized based on angiogram, balloon sizing and two dimensional transesophageal echo. There was significant residual leak after deployment of first device. Hence the defect was re-crossed and two duct occluder devices were positioned across the leak from two arterial access. After confirming position and satisfactory reduction in paravalvular leak, the devices were released in tandem. There was near abolition of leak. The patient is asymptomatic at three months follow up. Larger paravalvular leaks are better addressed with two devices of smaller size rather than a single large device. Technical considerations while deploying multiple devices are discussed.
一名21岁男性因严重主动脉瓣周漏就诊。他曾接受过三次心脏手术，且患有慢性肾脏病。鉴于第四次手术的风险及合并症，决定行经导管封堵术。根据血管造影、球囊扩张测量及二维经食管超声确定封堵器尺寸。首次置入封堵器后仍有明显残余漏。因此，再次穿过缺损部位，从两个动脉入路置入两个动脉导管封堵器横跨漏口。确认位置并证实瓣周漏明显减少后，依次释放封堵器。漏口几乎消失。患者在三个月随访时无症状。较大的瓣周漏使用两个较小尺寸的封堵器比使用单个大尺寸封堵器处理效果更好。文中讨论了置入多个封堵器时的技术要点。
