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Is mesocardia with left-sided caval vein draining to coronary sinus a contraindication for a percutaneous pulmonary valve implantation? A case description

Published online by Cambridge University Press:  04 October 2017

Marinos Kantzis*
Affiliation:
Centre for Congenital Heart Disease, Heart and Diabetes Centre, Bad Oeynhausen, Ruhr University of Bochum, North Rhine Westphalia, Germany
Christoph M. Happel
Affiliation:
Centre for Congenital Heart Disease, Heart and Diabetes Centre, Bad Oeynhausen, Ruhr University of Bochum, North Rhine Westphalia, Germany Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover, Germany
Nikolaus A. Haas
Affiliation:
Centre for Congenital Heart Disease, Heart and Diabetes Centre, Bad Oeynhausen, Ruhr University of Bochum, North Rhine Westphalia, Germany Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximillians University, Grossharden Clinic, Munich, Germany
*
Correspondence to: M. Kantzis, Department of Congenital Heart Defects, Heart and Diabetes Centre, Ruhr University Bochum, North Rhine Westphalia, Georgstrasse 11, D-32545 Bad Oeynhausen, Germany. Tel: +49 5731 973626; Fax: +49 5731 972300; E-mail: marinos.kantzis@gmail.com, mkantzis@hdz-nrw.de

Abstract

Introduction

Although the right jugular vein approach for percutaneous pulmonary valve implantation is well described, there are no reports that describe a percutaneous pulmonary valve implantation through a left superior caval vein to coronary sinus pathway.

Case

A 14-year-old female with tetralogy of Fallot, mesocardia, left superior caval vein draining into the coronary sinus, and hemiazygos continuation of the inferior caval vein underwent ventricular septal defect closure, with homograft insertion from the right ventricle to the pulmonary artery, patch augmentation of the left pulmonary artery, and creation of an atrial communication. Thereafter followed numerous catheterisations and interventions with stent implantation for stenosis of the left pulmonary artery and the homograft, as did device closure of the atrial communication. When she was a 12-year-old, the indications for a percutaneous pulmonary valve implantation were fulfilled and she underwent implantation of a 22 mm Melody® valve through the left superior caval vein. The extra-stiff exchange wire was pre-formed into a “U-spiral”-type configuration, according to the underlying anatomy, in order to provide a smooth route for the delivery of stents, to create the landing zone, and for the implantation of the Melody “ensemble”. The procedure was performed under deep sedation according to our standard protocol. The duration of the procedure was 172 min and the radiation time was 24.9 min.

Conclusion

On the basis of this unique experience, percutaneous pulmonary valve implantation is safe and feasible even in patients with unusual anatomy. Crucial is the “U-spiral” shaped configuration of the guide wire.

Type
Original Articles
Copyright
© Cambridge University Press 2017 

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