Percutaneous Closure of the Acquired Gerbode Shunt Using the Amplatzer Duct Occluder in a 3-Month Old Patient
A 1-month old male with a large perimembranous VSD, secundum atrial septal defect (ASD), and patent ductus arteriosus (PDA), and diagnosed as having 18 trisomy by chromosome analysis underwent a patch closure of a VSD, a primary closure of an ASD, and a ligation of the PDA. The post-operative course was smooth and the extubation was uneventful. One month later, he was presented with progressive dyspnea and tachypnea, and grade 3 of a holosystolic murmur was detected. His chest X-ray showed moderate cardiomegaly that had changed from before, and a large amount of shunt from the left ventricle to the right atrium with a dilated left ventricular dimension was identified by a two dimensional echocardiography (). The amount of shunt (Qp/Qs) was measured as above 2.0 by radioisotope cardiac scan. He required ventilator care due to congestive heart failure for 1 month and the medical treatment was not effective. When he turned 3 months old and his body weighed 3.0 kilograms, we decided to close the shunt using the transcatheter technique with an Amplatzer duct occluder because his parents did not want a correction by sternotomy. The longest dimension of the defect on a two-dimensional echocardiogram was 2.5 mm. After we examined the left ventriculogram on the four-chamber image (), 5 Fr Judkins right catheter was approached to the left ventricle retrogradely. A 0.035 mm Terumo guide wire was introduced inside the Judkins right catheter and selected the Gerbode defect. After Terumo guide wire passed through the defect and was located in the superior vena cava, we snared it with a snaring catheter successfully. Thereafter, a 5 Fr introducing catheter for a 5-4 mm Amplatzer duct occluder was passed through the defect on the wire into the femoral vein and located in the ascending aorta, and the Amplatzer duct occluder was positioned successfully in the defect under the guidance of the transthoracic echocardiography (). Even though a small residual leak was found immediately in transthoracic echocardiography, a complete closure was confirmed 2 weeks later. The cardiomegaly decreased and extubation was successful 2 weeks after the procedure ().\nWe reported the closure of the Gerbode shunt in a 3-months old patient by a transcatheter technique using the Amplatzer duct occluder.