This document discusses the percutaneous closure of a residual aortopulmonary window in a 2-year-old boy using a second occlusion device. The boy was originally treated for an aortopulmonary window at 2 months of age, but follow up showed a residual 4mm window. A second device, an ADO-II 6x6, was successfully deployed above the original device with no residual shunt seen. The boy was discharged the next day with both devices in position and no complications. The summary demonstrates the feasibility of using a second occlusion device to treat residual defects after an initial device closure procedure.

1. MURTAZA KAMAL
DEPARTMENT OF FETAL, PEDIATRIC AND STRUCTURAL
CARDIOLOGY
ASTER RAMESH HOSPITALS, VIJAYAWADA, INDIA
PERCUTANEOUS DEVICE CLOSURE OF
RESIDUAL (POST-DEVICE CLOSURE)
AORTO- PULMONARY WINDOW
DEVICE ON DEVICE
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BACKGROUND
▸Conotruncal anomaly, abnormal communication between aorta- PA
▸Rare, 0.1-0.2% of all CHDs
▸Surgery in the initial days: Mostly large, excellent results
▸Transcatheter closure: Technical complexity of APW closure: Small,
midway, away from coronary artery origin and aortic valve (10%)
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CLINICAL PROFILE
▸2y 8m, boy
▸Diagnosed to have an aortopulmonary window (4.5 mm) with PAH
and dilated left heart at 2 months of age in view of the inability to gain
weight (3.5kg) and heart failure symptoms
▸Planned for device closure
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APW CONVERTED VIDEOS 2ND DEVICE
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▸Successfully occluded with ADO-II 6 X4
▸Small residual flow across
▸No AR, No supravalvular stenosis
▸Discharged on D3rd of procedure
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FURTHER COURSE
▸Further course: Gaining weight
▸O/E: Continuous murmur in the left precordium
▸2D ECHO: Residual APW 4 mm, the previous device in situ, dilated
left heart, flow reversal in descending aorta
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THE PROCEDURE
▸Planned for closure: Significant shunt
▸IV sedation, RFA/ RFV access
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ASCENDING AORTOGRAM (AP, RAO 30): RESIDUAL
APW ABOVE PREVIOUS DEVICE
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6F- JR GUIDE PARKED IN ASCENDING AORTA,
ADO-II 6 X 6 DEVICE
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ANGIOGRAPHIC CONFIRMATION OF NO RESIDUAL
SHUNT
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DEVICE RELEASE
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BOTH DEVICES SITTING IN HARMONY
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FURTHER COURSE
▸ Discharged next day
▸ Good weight gain, devices in harmony
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LITERATURE REVIEW
▸ Device preference:
▸ ADO-II:
▸ Low profile- smaller-sized delivery system (4F/5F JR Guide), greater
flexibility, lesser vascular complications
▸ Double disk profile may cause PA turbulence
▸ Septal occluder, ADO-I, Perimembranous VSD device
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TAKE HOME MESSAGE
‣ Transcatheter closure of APW: Feasible choice in specific anatomic
subsets
‣ Several occluder devices are designed to achieve an effective closure
according to the anatomy of the defect
‣ ADO-II: Low profile and a lesser risk of vascular complications
‣ Residuals can be safely occluded by transcutaneous devices
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17. THANK YOU…
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