Author + information
- Received October 17, 2016
- Revision received November 29, 2016
- Accepted December 5, 2016
- Published online February 15, 2017.
- Elena K. Grant, MBChBa,b,∗ (, )
- Dennis W. Kim, MDa,b,
- William L. Border, MBChB, MPHa,b,
- Stamatios Lerakis, MDc,
- Vasilis Babaliaros, MDc and
- Robert N. Vincent, MDa,b
- aDivision of Pediatric Cardiology, Children’s Healthcare of Atlanta, Atlanta, Georgia
- bDepartment of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- cDivision of Cardiology, Emory University Hospital, Atlanta, Georgia
- ↵∗Address for correspondence:
Dr. Elena K. Grant, Children’s Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, Georgia 30322.
A 15-year-old post-neonatal repair of truncus arteriosus sustained an anterior leaflet mitral valve injury during elective aortic root replacement and aortic valve repair, resulting in severe mitral regurgitation (Figure 1, Online Video 1). He was deemed not to be a surgical candidate in the setting of multiorgan failure on extracorporeal membrane oxygenation 1 month post–valve injury. Amplatzer septal occluders (10 mm, then 12 mm) (St. Jude Medical, Minneapolis, Minnesota), a 25-mm Gore Cardioform septal occluder (Gore Medical, Flagstaff, Arizona) and a 22-mm Amplatzer vascular plug type II (St. Jude Medical) pulled through the defect during attempted device deployment. A 22-mm Amplatzer vascular plug type II was successfully deployed across both the atrial septum and the mitral valve defect, thus slightly suspending the anterior mitral valve leaflet and reducing tension on the defect rims (Figures 2 and 3, Online Video 1). Mitral regurgitation (Figure 3, Online Video 1) and clinical status improved including successful extracorporeal membrane oxygenation decannulation. Sadly, the patient suffered a cerebral hemorrhage and care was withdrawn 8 days post-intervention. Although the length of device follow-up in this case is too limited to assess this strategy for long-term management, transcatheter closure using a transseptal anchor technique for challenging defects may at least provide acute hemodynamic improvement as a bridge to surgery for high-risk patients.
For a supplemental video and its legend, please see the online version of this article.
Dr. Kim has served as a consultant for B Braun Medical and Edwards Lifesciences. Dr. Babaliaros has served as a consultant for Abbott Vascular and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 17, 2016.
- Revision received November 29, 2016.
- Accepted December 5, 2016.
- American College of Cardiology Foundation