Abstract 11712: Transcatheter Reconstruction of Right Ventricular Outflow Tract After Severe External Compression by a Pseudoaneurysm in an Adult With Tetralogy of Fallot

Abstract

Introduction: Increased survival of adults with tetralogy of Fallot (TOF) has led to the recognition of unanticipated complications. A rare complication after TOF repair is a right ventricle pseudoaneurysm (RV PSA). Often asymptomatic and incidentally found on imaging, the few reports of clinically significant RV PSA were mostly treated surgically. We present an adult with RV PSA after TOF repair treated by a novel transcatheter approach. Case Presentation: A 41 year old male with TOF and a valved right ventricle to pulmonary artery conduit presented with right ventricular failure due to right ventricular outflow tract obstruction (RVOTO) from an anterior RV PSA compressing the conduit (Figure 1). His case was further complicated by HFrEF, severe pulmonary regurgitation, and refractory atrial fibrillation requiring anticoagulation. Surgical intervention was not offered due to five prior sternotomies; he was not a transplant candidate due to substance abuse. CT imaging was used to create a virtual 3D model for interventional planning (Figure 1). A Covered CP Stent™ (B. Braun, Bethlehem, PA) on top of a Palmaz™ XL 5010 stent (Cordis Corp, Miami Lakes, FL) was anchored in the pulmonary valve ring and extended proximally to seal the PSA leak in the RVOTO, followed by Sapien S3 valve (Edwards, Irvine, CA) implantation in the proximal end of the stents (Figure 2). Right ventricular systolic pressure acutely decreased with improved systolic function. Conclusion: Adults with congenital heart disease often require unique approaches to intervention for managing the unnatural history of their conditions. 3D modeling of complex structures is a vital tool to plan these interventions.