Amplatzer Vascular Plug II for transcatheter closure of an unligated vertical vein after a repair of an infracardiac total anomalous pulmonary venous connection

Kojima Takuro, Kobayashi Toshiki, Yoshiba Shigeki, Sumitomo Naokata

doi:10.20599/jjcic.6.12

In some cases of a repair of a total anomalous pulmonary venous connection (TAPVC), the vertical vein (VV) is left unligated in order to stabilize the postoperative hemodynamics. Because it is speculated that most unligated VVs in infracardiac TAPVCs close spontaneously, transcatheter closure of the VVs in infracardiac TAPVCs are rarely reported. Here, we report an adult case who underwent a transcatheter closure of an unligated VV with an Amplatzer™ Vascular Plug II (AVPII; St. Jude Medical, Saint Paul, MN, USA) after a repair of an infracardiac TAPVC. In an infracardiac TAPVC, migration of the device is of concern after the deployment because of the long VV running across the diaphragm towards the portal vein. Also, because the VV stenosis was mild in this case, we deployed a 20 mm×16 mm AVPII, which was more than 200％ the size of the smallest vessel diameter. Under the guidance of an intracardiac echocardiogram, we performed an interatrial septal puncture by the Brockenbrough method. Then, we approached the VV with a Judkins Left guiding catheter® (Hanako Medical Co., Ltd., Saitama) and 0.035 inch Radifocus® (Terumo Inc., Tokyo) guidewire. Though the insertion of a long sheath into the VV was difficult, we could deploy the device without a protrusion into the left atrium.

Amplatzer Vascular Plug II for transcatheter closure of an unligated vertical vein after a repair of an infracardiac total anomalous pulmonary venous connection

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