[III-JCKAP7-2-2] Transjugular Closure of Complex Muscular Ventricular Septal Defect in A Small Baby
キーワード：ventricular septal defect, transcatheter closure, transjugular
Objective: Transcatheter closure of muscular ventricular septal defect (VSD) is an optimal alternative option compare to open heart surgery, especially in small children with complex multiple holes. In addition, small baby also have technical issue challenges and potential complications. Transfemoral venous approach is more common but transjugular venous approach may be considered in selective cases. Methods: Clinical case report. Results: A 1 year-old girl was admitted to the hospital because of severe malnutrition with only 5 kg in weight. TTE showed at least two holes of muscular VSD which diameter was 4 to 6 mm and a 3mm type A PDA. Interventions: Firstly, the PDA was closed by 6x4 ADOI device. Left ventriculography showed many holes of muscular VSD from the middle of ventricular septum to the apex, with total diameter was 14 to 16 mm in LV side and 10 mm in RV side. An AV loop was created in SVC. A 12x10 mm MFO device was deployed by antegrade approach. However, a significant residual shunt near the apex was detected. A 2.4F microcatheter and 0.014 guidewire was used to cross through VSD. AV loop was created in IVC. A 10x8 mm MFO device was deployed to close the residual shunt. Left ventriculography showed all the holes were closed totally. Conclusion: Transjugular venous approach to create AV loop may be easier and more helpful than transfemoral venous for advancing delivery in antegrade closure to avoid complication such as bradycadia. Residual shunt is also a challenge in technical issue. Microcatheter may be helpful to find and cross through this shunt.