Unconventional Ductal Flow Restriction and Iatrogenic Pseudoaneurysm Plug Closure in Pulmonary Atresia With Intact Septum.

BACKGROUND

Pulmonary atresia with intact ventricular septum (PA/IVS) and right ventricular-dependent coronary circulation pose management challenges requiring creative transcatheter solutions when surgery is unfeasible.

CASE SUMMARY: A small-for-gestational-age term neonate with PA/IVS and right ventricular-dependent coronary circulation developed hemodynamic instability after patent ductus arteriosus stenting, requiring deployment of a modified Medtronic Microvascular Plug within the patent ductus arteriosus stent to restrict pulmonary overcirculation. A left external iliac artery pseudoaneurysm was subsequently closed using a 4-mm Konar-A vascular plug.

CONCLUSIONS

This case underscores the delicate balance between management of pulmonary over- and undercirculation in neonates with PA/IVS and highlights creative transcatheter strategies used to address these dual hemodynamic dilemmas. Early recognition of at-risk anatomy, and consideration for cardiac transplantation, are essential for survival in these high-risk patients.

TAKE-HOME MESSAGE: Unconventional transcatheter strategies may be essential in managing high-risk neonates with congenital heart disease.