Percutaneous Device Closure Research Articles

Right Ventricular Isovolumic Acceleration in Children with Patent Ductus Arteriosus: Short and Mid-term Follow-up after Percutaneous Device Closure

Objective: We aimed to assess the association of right ventricular acceleration during isovolumic contraction (RVIVA) to functional recovery after device closure of patent ductus arteriosus (PDA). Methods: 84(7.5+6.8 year; 49 female ) patients who underwent device closure of PDA were evaluated with conventional and tissue Doppler echocardiography pre closure, at 24 hours and at 6 months post closure to assess RVIVA, myocardial performance index (MPI). Brain natreuretic peptide (BNP) was assessed pre closure and 6 months post closure Results: RVIVA was significantly decreased in children with PDA, while other conventional Echo Doppler parameters were comparable to controls. Following closure of PDA, RVIVA was significantly increased (P 2.4 m/s was the best cutoff value in predicting functional recovery after percutaneous closure of PDA. Conclusion: Measurement of RVIVA in patients with PDA specially those presented late are important to differentiate high- and low-risk groups in terms of prognosis.. RVIVA might be considered a useful indicator for functional recovery after device closure of PDA

Interventional Closure of Secundum Type Atrial Septal Defects in Infants Less Than 10 Kilograms: Indications and Procedural Outcome.

This study set out to assess indications, feasibility, complications, and clinical outcome of percutaneous transcatheter device closure of atrial septal defects (ASDs) in infants with a bodyweight below 10 kg. Retrospective single center chart and echocardiography review study from 8/2005-12/2013. Twenty-eight children with ASD (13 female) with a median age of 1.15 years (0.2-2.8) and a median weight of 7.2 kg (4.5-9.9) were analyzed. Indications for early ASD closure were failure to thrive (n = 15, 54%), bronchopulmonary dysplasia (BPD) with supplemental oxygen dependency (n = 7, 25%), and genetic syndromes with suspected pulmonary hypertension (n = 12, 43%). Device implantation was successful in all patients without any periprocedural mortality or major complication. Clinical outcome after a median follow-up period of 2.1 years (0.25-7.3) revealed no residual shunt and a significant decrease of right ventricular volume load. Patients with pulmonary hypertension experienced a significant reduction of pulmonary artery/RV pressure. Patients also showed decreased supplemental oxygen dependency and less cardiac medications, but no significant "catch-up growth" in those with failure to thrive. Interventional ASD closure in children weighing less than 10 kg can be performed without any additional major risks and shows a favorable outcome, especially in selected patients with significant non cardiac co-morbidities.

Percutaneous Device Closure of a Post-Traumatic Ventricular Septal Rupture.

A 25-year-old male presented to us 3 days after experiencing a stab knife injury to the left third intercostal space. Cardiac computed tomography ([Figures 1A and 1B][1]) showed moderate hemopericardium, autosealed perforation in the right ventricle and a large ventricular septal rupture (VSR).

Delayed spontaneous perforation of polyvinyl alcohol membrane—Covered atrial septal defect closure devices

Percutaneous device closure has become the first choice for secundum atrial septal defect (ASD) closure when feasible in case of favorable anatomy. The Ultrasept II ASD occluder® device (Cardia Inc, Eagan, MN) is made of two nitinol disc frames covered with polyvinyl alcohol membranes, a synthetic polymer with a large application in the biomedical field. Four relatively early malfunctions of the polyvinyl alcohol membrane were observed in a series of six consecutive patients treated with ASD Ultrasept II closure device in our institution. Operators have to be aware of this apparently rare complication that is likely to be underestimated, associated with such devices. © 2016 Wiley Periodicals, Inc.

Multidisciplinary Assessment in Optimising Results of Percutaneous Patent Foramen Ovale Closure.

Percutaneous patent foramen ovale (PFO) closure is a therapeutic option to prevent recurrent cerebral ischaemia in patients with cryptogenic stroke and transient cerebral ischaemia (TIA). The apparent lack of benefit seen in previous randomised trials has, in part, reflected inclusion of patients with alternate mechanisms of stroke. The role of formal neurology involvement in accurately delineating the likely aetiology of stroke or TIA is crucial in appropriate identification of patients for device closure. Furthermore, as the benefits of device closure may accrue over time, long-term follow-up is essential to define the role of device closure in management of presumed cryptogenic stroke. We retrospectively reviewed our experience with percutaneous PFO device closure since 2005. All subjects who underwent PFO closure at John Hunter and Lake Macquarie Private Hospitals were included in the study. All patients referred for device closure following cryptogenic stroke or TIA had first undergone formal neurology review with appropriate imaging and exclusion of paroxysmal atrial arrhythmia. Patients with a history of transient ischaemic attack (TIA) are frequently referred to a specialised clinic, aimed to identify patients with conditions not referable to cerebral ischaemia, with investigations initiated by the specialist clinic to elucidate an underlying aetiology. Outcome data was derived from the Hunter New England Area Local Health District Cardiac and Stroke Outcomes Unit, in addition to review of the medical record. The Cardiac and Stroke Outcomes Unit prospectively identified all patients presenting with stroke, TIA and atrial fibrillation. One hundred and twelve consecutive patients undergoing percutaneous patent foramen ovale closure between 2005 and 2015 were identified. The average age was 42.7 years and 57 (50.9%) patients were male. Cryptogenic stroke (68.8%) and transient cerebral ischaemia (23.2%) were the most common indications for PFO closure, with the Amplatzer device used in 83 cases (74.1%). Early residual shunting was visible in seven patients (6.3%), however on follow-up agitated saline study only two patients had residual shunt (1.8%). The annual risk of recurrent stroke or TIA was 0.21%. Percutaneous patent foramen ovale closure can be performed safely and effectively in patients with paradoxical embolism. In selected patients, following appropriate multidisciplinary specialist pre-procedural assessment, excellent long-term results with low incidence of recurrent events may be achieved.

Minimally Invasive Peratrial Device Closure of Perimembranous Ventricular Septal Defect Through a Right Infraaxillary Route: Clinical Experience and Preliminary Results

Both percutaneous and perventricular device closures of perimembranous ventricular septal defects (PmVSD) present certain drawbacks. We report our experiences with a new, minimally invasive surgery using a peratrial device closure of PmVSD through a right infraaxillary route. Between January 2014 and October 2015, 145 patients (71 male, 74 female) with PmVSD, aged 0.5 to 9.7 years (mean 2.8 ± 2.2) and weighing between 6.1 kg and 43 kg (mean 14.0 ± 6.6 kg) were included in this study. In patients with left lateral position, a 2- to 3-cm incision was made along the right midaxillary line. The thoracic cavity was entered through the fourth intercostal space. With the help of transesophageal echocardiography guidance, a specially designed hollow probe was inserted into the right atrium. The probe was passed through the tricuspid valve into the right ventricle. The tip of the probe was adjusted to point to or cross the defect. A flexible guidewire was inserted into the left ventricle through the channel of the probe to establish a delivery pathway. Then, the device was deployed to close the defect. A total of 142 cases (97.9%) were successfully occluded, whereas 3 cases failed and were converted to cardiopulmonary bypass operation through the original incision. The device size ranged from 4.0 to 10.0 mm (mean 5.1 ± 1.4 mm), and all devices were concentric. Follow-up in all patients ranged from 1.0 to 22.8 months (mean 9.9 ± 5.6) and revealed no evident valve regurgitation, no complete atrioventricular block, and no device dislocation. This new minimally invasive technique of peratrial device closure through a right infraaxillary route under transesophageal echocardiography guidance was shown to be a safe, effective, feasible, and cosmetically superior treatment for PmVSD.

Obturator foramen bypass for infective groin caused by closure device

A 69-year-old man underwent carotid artery stenting through the right femoral artery with a percutaneous vascular closure device for hemostasis. Eleven days later, an infective femoral artery pseudoaneurysm was diagnosed by computed tomography. At surgery, a defect in the femoral artery was observed, corresponding to the remnants of the closure device. Removal of the foreign material, debridement, wound irrigation, and arterial patch plasty were performed, but the infection and leg ischemia did not improve. After several failed attempts to revascularize and control the infection, obturator foramen bypass was performed. The postoperative course was uneventful, indicating the usefulness of this procedure.

¿Estamos cerrando muchos forámenes ovales permeables en Colombia? Foramen ovale permeable, aneurisma del septum interauricular y riesgo de ataque cerebrovascular criptogénico recurrente. Revisión sistemática de la literatura

IntroductionPatent foramen ovale and atrial septal aneurysm are frequent findings in the average population. Over the last years multiple studies have suggested there is an association between both entities and cerebrovascular accidents of cryptogenic origin as a consequence of paradoxical embolism, specially among population under age 55, which has stimulated the development of devices for percutaneous closure of these defects with the goal of reducing recurring cerebral ischemic events, without a clear demonstration of their efficacy. MotivationTo perform a systematic review of literature to assess the risk of recurrence and benefits of this surgery. Results1,208 articles were collected for this evaluation, with a total of 11 papers included in the analysis following selection, assessment and application of selection criteria. 3 of them were clinical trial and 8 were systematic reviews or meta-analysis. ConclusionsIn adult patients with cryptogenic cerebrovascular ischemic or transient ischemic attacks with patent foramen ovale documented via transthoracic echocardiogram no decrease has been found in the risk of recurrence of cerebrovascular attacks, transient ischemic accidents or neurological events in comparison with traditional medical therapy.

The Future of Cardiovascular Surgery.

Cardiac surgery has been a vibrant field since the early pioneering procedures were attempted, became successful, and eventually reproducible. From the successful closure of a patent ductus arteriosus in 1938 and the Blalock-Taussig shunt, discovery and innovation have been the hallmarks of cardiac surgery.1 Dr John Gibbon’s first clinical use of the heart lung machine in 1953 opened the door to diverting the circulation and oxygenating the blood, making open heart surgery to repair congenital defects and valvular lesions possible.4 The development of safe myocardial preservation with solutions to protect the heart opened the surgical world to complex prolonged cardiac procedures and made cardiac transplantation feasible. Routine preservation of myocardial structure and function for periods of several hours has been achieved. The future holds dramatic advances that will transform the cardiac surgeon, in part, into an interventionalist with new skills in diagnostic and therapeutic approaches to structural heart disease. The burden of ischemic heart disease in our society challenges the multiple approaches used to treat coronary artery disease. Advances in primary and secondary prevention have finally had an impact; however, current therapy for acute myocardial infarction is primarily culprit vessel percutaneous coronary intervention or occasionally coronary artery bypass surgery. Surgery has been necessary for the mechanical complications of myocardial infarction including mitral regurgitation, ventricular septal defect, or cardiac rupture. However, the future will see the effective use of percutaneous closure devices for postinfarction ventricular septal defect and the use of a variety of devices for acute postinfarction mitral regurgitation. Treatment of unstable angina, chronic stable angina, or left main disease remains a dynamic field with competing interventional and surgical approaches. Data from randomized clinical trials and larger registries have helped define subgroups and have informed us of some of the best treatment strategies for patient subsets. Professional cardiology …

16. Optimal guidance of percutaneous device closure of PDA by transthoracic echocardiography

Patent ductus arteriosus (PDA) is common congenital cardiac lesion and the most accepted way of management is transcatheter occlusion by device which is usually done under fluoroscopy guidance. Transoesophageal echo cardiography and transaortic imaging were used in adult to guide the procedure which is with certain applications in pediatric age group transthoracic echocardiography (TTE) in pediatric population provides excellent images for PDA and may replace the use of fluoroscopy to guide PDA closure at least in special situations. To highlight the feasibility of device closure under guidance of TTE to be applied in sick patients who are not suitable for transfer to cardiac catheter laboratory or those with contraindication to contrast and or radiation application. 18 patients from July 2013 to May 2015 underwent TTE guidance device closure of PDA, 1 patient was excluded after device embolization which necessitate retrieval under fluoroscopy (fluoro.). Conscious sedation was used in 17 patients except 1 who was sick and already ventilated in ICU, there were 11 female and 7 male, antegrade approach was used in 10 patients with partial fluoro and retrograde approach in 8 patients without fluoro. Median age is 7 months, median weight is 8 kg (3.2–11 kg), 2 patients with renal impairment, 2 with Leukemia, median procedure time is 35 min, median fluoro. is 2.2 min, PDA size were small in 13 patients and moderate in 5, immediate closure is achieved in all. The devices were ADOI, ADOS, ADOII, Occlutech, and AVP2. Device embolization in 1 with successful retrieval and second device was used with complete closure percutaneous PDA closure under TTE guidance is feasible, safe and recommended in selected patients with certain situation.

FT04. “The Vein Is Screwed” Proof of Concept of the VeinScrew: A New Percutaneous Venous Closure Device

FT04. “The Vein Is Screwed” Proof of Concept of the VeinScrew: A New Percutaneous Venous Closure Device

SS10. Advanced Vascular Surgery Surgical Skills and Simulated Assessment Program for Senior Vascular Surgery Trainees

Cognitive competence in vascular surgery is determined by oral and written examinations administered by the Vascular Surgery Board. Technical competence of vascular surgery trainees is determined solely by subjective assessment from faculty members of the trainee's institution. This program represents the first attempt to objectively evaluate the advanced vascular surgical skills of senior vascular trainees using high-fidelity simulation models by an independent faculty proctor. Nineteen senior vascular trainees were evaluated over a 3-day period. Twenty-five board-certified vascular surgeons served as assessment proctors. Assessment stations included thoracic and abdominal aortic aneurysm endograft repair, open abdominal aortic aneurysm repair, carotid endarterectomy, femoral-popliteal bypass, arteriovenous fistula creation, mismatched end-to-side anastomosis at depth, carotid, renal, iliac, and superficial femoral artery angioplasty and stenting, and use of a percutaneous closure device. Trainees were given 1 hour to complete each station. Technical performances were evaluated by a single faculty member using global rating scales, critical task and time assessment metrics, and a global rating summary. Competency was defined as achieving >80% global rating scale score, 100% achievement of all critical task metrics, or attainment of a level 4 (proficient) or level 5 (advanced) global rating summary score. Immediate feedback was provided after each performance. Six simulation stations were videotaped for future assessment metrics validation. A total of 202 skill and simulation assessments were performed. Vascular trainees were graded as being proficient for 83% (global rating scale), 75% (global rating summary), and 49% (critical task metrics) of all surgical skills and simulated performances. Similar patterns of trainee technical and procedural errors were noted to occur for each simulated procedure. The performance results identified a range of technical skills among the trainees. Faculty assessment was inconsistent with reporting errors or omissions occurring in 18%. Endovascular simulator malfunction occurred in just 4% of procedures. No malfunctions occurred in the open vascular simulators. These preliminary results indicate that it is feasible to perform objective assessment of senior vascular trainees by board-certified vascular surgery faculty using multiple objective assessment metrics. Simulation models overall exhibited good durability and consistency, and therefore appear to be useful in the assessment of advanced vascular surgical skills. Data from this initial feasibility study can be used to determine reproducible objective assessment metrics. These metrics, once validated, can than serve as a foundation for a technical competence examination in vascular surgery.

Interventional post-myocardial infarction ventricular septal defect closure: a systematic review of current evidence.

Interventional closure of post-myocardial infarction ventricular septal defects (VSD) is an alternative treatment option to surgical repair. However, only limited evidence exists concerning the interventional closure of a VSD. This review seeks to establish an overview of the existing literature and to carry out a systematic analysis of the success rate and clinical outcome of this procedure. We conducted a comprehensive systematic literature search to evaluate the existing evidence of percutaneous device closure of post-infarction VSD. Patient series with fewer than five reported cases were excluded. In total, 13 series were identified, with an overall inclusion of 273 patients. Mean patient age was 70 years. Cardiogenic shock was present in 48% of cases at the time of intervention. Device closure within the first 14 days (acute phase) after VSD detection was performed in 42% of cases. Technical success rate was high (>75%). Successful device implantation rate was 89%. Overall in-hospital/30-day mortality was 32%. Major complications included device embolisation, ventricular perfora-tion and arrhythmias. Percutaneous device closure of post-myocardial infarction VSD is a valuable alternative to surgical repair, with the advantage of immediate shunt reduction to prevent haemodynamic deterioration. A high rate of technically successful percutaneous procedures can be achieved; however, the mortality rate remains high, especially in cardiogenic shock patients.

Clinical Experience of Transcatheter Closure for Residual Ventricular Septal Defect in Pediatric Patients.

Open cardiac surgery has traditionally been the gold standard for repair of ventricular septal defect (VSD). The inherent risks and complications associated with open surgery and the incidence of postoperative residual VSD are significant disadvantages of the open surgical approach. To evaluate the methodology and efficacy of transcatheter closure of postoperative residual VSD in children. Patients with postoperative VSD who underwent percutaneous device closure in the period from August 2010 and February 2014 in our center were analyzed retrospectively. Twelve children, including 8 males and 4 females, with mean age of 8.13 ± 5.39 years (range 0.67-17 years) and mean weight of 29.63 ± 20.86 kg (range 5.5-66 kg) were included in the study. Ten cases had residual shunts situated at the margin of the patches while the other two had residual shunts because of multiple muscular VSD. The mean VSD diameter was 3.84 ± 1.86 mm (range 2.3-8.7 mm). On cardiac catheterization, the reported mean pulmonary circulatory blood volume/systemic circulation volume (Qp/Qs) ratio was 1.86 ± 0.91 (range 1.1-4.25) and the mean pulmonary artery pressure was 25.92 ± 12.42 mm Hg (range 7-52 mm Hg). Successful transcatheter closure was obtained in all twelve patients with postsurgery residual VSD. Two cases with residual muscular VSD underwent retrograde catheterization via the femoral artery while one case with residual VSD located at the lower margin of the patch was accessed via the internal jugular vein. The mean procedure time was 81.25 ± 25.86 minutes (range 40-120 minutes). There was no evidence of residual VSD, and no instances of new-onset valvular regurgitation were reported, with the only two exceptions being patients who had multiple muscular VSDs where clinically insignificant residual shunts were detected. Our retrospective study highlights the potential safety and therapeutic efficacy of transcatheter approach for closing postoperative residual VSD in children. More robust studies with longer-term follow-up of outcomes are required to firmly establish the safety profile and respective indications for use of various occluder devices for treating different categories of residual VSD.

Percutaneous closure of pseudoaneurysm in the left ventricle in a young child

Pseudoaneurysm in the left ventricular outflow tract is a rare complication occurring after cardiac surgery. We report on the successful percutaneous device closure of a pseudoaneurysm in the left ventricular outflow tract, which developed in a 23-month-old girl after resection of a subaortic ridge. The pseudoaneurysm was closed using an Amplatzer Vascular Plug II.

Percutaneous removal using Perclose ProGlide closure devices versus surgical removal for weaning after percutaneous cannulation for venoarterial extracorporeal membrane oxygenation

The removal of arterial cannulas using a Perclose device (Abbott Vascular, Clonmel, Tipperary, Ireland) has not been reported in patients undergoing venoarterial extracorporeal membrane oxygenation (ECMO). We investigated the procedural outcomes and complications of percutaneous device closure vs surgical repair for hemostatic control of the arterial access site in weaning from venoarterial ECMO. Between September 2012 and December 2014, 115 patients with ECMO weaned by percutaneous or surgical access were enrolled. The percutaneous technique used two ProGlide devices (Abbott Vascular) by direct puncture of an arterial cannula at the time of weaning off ECMO. The primary outcomes were composite complications of open repair at the insertion site, limb ischemia after removal of the arterial cannula, removal site infection, pseudoaneurysm, distal part embolization, and 10minutes or more manual compression at the weaning site. The percutaneous technique was performed on 56 patients, and the surgical exposure technique was performed on 59. Technical success was not significantly different between the percutaneous and surgical groups (85.7% vs 86.4%; P=1.0) although the procedure duration (17.15± 9.38minutes vs 64.33± 31.67minutes; P< .001) was shorter in the percutaneous access group. A composite of procedure-related complications and length of stay in the intensive care unit after weaning was not significantly different between groups (17.9% vs 28.8%; P= .19 and 16.82± 38.53days vs 19.69± 21.40days; P= .62). Percutaneous access using two Perclose ProGlide devices was a feasible and safe strategy for weaning from ECMO.

Transesophageal echocardiography guided transseptal puncture for atrial fibrillation ablation in a patient with a 30 mm atrial septal closure device.

Percutaneous device closure is a well-established treatment of atrial septal defects (ASD) and the method of stroke prevention in a selected group of patients with patent foramen ovale (PFO). However, in case of drug-refractory atrial fibrillation (AF), when catheter ablation of pulmonary veins (PV) is required, the access to the left atrium is more difficult due to the ASD/PFO closure device. We report a case of a 58-year-old man with PFO closure performed due to recurrent stroke (Nit-Occlud PFO device 30 mm in diameter). 3.8 years after the successful procedure the patient suffered from frequent, symptomatic episodes of drug-refractory AF. Before the pulmonary vein isolation (PVI) procedure a computed tomography scan was obtained to access the PV anatomy and to visualize the device position (Figure 1 A). Figure 1 A – Computed tomography scan merged with CARTO map of left atrium (LA) indicating relation of the device (green arrows) to the anatomical structures and ablation line (red dots). Projections shown in Figure 1: right anterior oblique (RAO) 46o ... During PVI four venous accesses were obtained: two in the right and two in the left femoral veins. Diagnostic catheters were placed in coronary sinus and His bundle position. Left atrial access was obtained with a double transseptal puncture under both fluoroscopic and transesophageal echocardiography (TEE) guidance (Vivid q). Two 8.5-Fr transseptal sheaths were advanced over a guide wire to the superior vena cava. Then a transseptal needle was introduced into the sheath, and the whole unit was withdrawn under the fluoroscopic antero-posterior view and TEE guidance. The typical “jump” of the needle could not be observed due to device presence. The optimal site of the transseptal puncture was determined mostly on TEE guidance. In the bicaval view the correct position in the vertical axis was fixed. In the short axis view the position of the puncture needle was corrected in the anterior-posterior (A-P) axis (Figure 1 B). The transseptal system was positioned in relation to the interatrial septum, visualized by TEE and directed to the thinner part of the septum, below and posterior to the occluder device. When the transseptal unit was placed in the desired location, the position was confirmed by the typical tenting of the septum caused by the transseptal unit, and the needle was advanced through the septum. Effectiveness of the puncture was confirmed by saline injection to the left atrium and assessed by TEE (Figure 1 C). Finally, the transseptal sheath was advanced over the wire to the left atrium. A second transseptal puncture was performed using a similar technique, slightly inferior to the first access. The ablation strategy consisted of PVI with two wide antral circumferential RF ablations around ipsilateral PV using an electroanatomical mapping system (CARTO 3), a 3.5-mm irrigated-tip catheter and a circular mapping catheter. All four PV were isolated with confirmed entrance and exit block (Figure 1 A). There were no procedure-related complications. More and more patients after device PFO/ASD closure will undergo procedures requiring transseptal access. As described in this case and several previous reports [1–4], transseptal access in a patient with an atrial septal occluder device can be performed successfully and allow pulmonary vein isolation. The TEE is an effective method to guide transseptal puncture in this group of patients.

Platypnea-Orthodeoxia Syndrome after Transcatheter Aortic Valve Implantation.

Progressive dyspnea and hypoxaemia in the subacute phase after transcatheter aortic valve implantation (TAVI) are uncommon and warrant immediate assessment of valve and prosthesis leaflet function to exclude thrombosis, as well as investigation for other causes related to the procedure, such as left ventricular dysfunction, pulmonary embolism, and respiratory sepsis. In this case, we report the observation of a patient presenting two weeks after TAVI with arterial hypoxaemia in an upright position, relieved by lying flat, and coupled with an intracardiac shunt detected on echocardiography in the absence of pulmonary hypertension, raising the suspicion of Platypnea-Orthodeoxia Syndrome (POS). Invasive intracardiac haemodynamic assessment showed a significant right-to-left shunt (Qp/Qs = 0.74), which confirmed the diagnosis, with subsequent closure of the intracardiac defect resulting in immediate relief of symptoms and hypoxaemia. To our knowledge, this is the first reported case of an interatrial defect and shunt causing Platypnea-Orthodeoxia Syndrome after transcatheter aortic valve implantation, resolved by percutaneous device closure.

Device closure in adults with atrial septal defect in Shiraz, a single center registry.

Introduction: Successful closure of atrial septal defect (ASD) improves patients’ functional class and exercise capacity. In this study we evaluate the safety and feasibility of percutaneous device closure of ASDs. Methods: Two hundred fifty six patients with significant ASD according to our criteria were enrolled. The patients were treated using nitinol wire mesh transcatheter devices. Complications were followed for a median of 2.5 years. Results: Success rate was 98.4% with 3 unsuccessful cases and a mean hospital stay of 1.007 ± 0.0004 days. Complication rate was 7.42%. Size of the right ventricle (RV) annulus was significantly decreased 24 hours after intervention (P = 0.005). Conclusion: The present report demonstrates that transcatheter closure of ASD is safe and effective.

Successful Transcatheter Closure of Patent Ductus Arteriosus in Isolated Levocardia with Situs Inversus

Isolated levocardia with situs inversus is an extremely rare type of situs anomaly with an estimated incidence of 1 per 22,000 in the general population. This autosomal recessive situs anomaly has been described as normal levo position of the heart with dextro position of the abdominal viscera. In this case report, we describe accidental diagnosis of isolated levocardia with situs inversus in pediatric patient while evaluating for heart murmur. Systematic examination of the patient identified the presence of patent ductus arteriosus, anomalous course of inferior vena cava and bovine aortic arch. We shared our experience of successful transcatheter closure of patent ductus arteriosus. This case report is worth reporting both, for demonstrating the possibility of the percutaneous device closure of the patent ductus arteriosus in patient with this unusual situs anomaly to interventional cardiologists and because of scanty of literature.