A 7-year-old child was referred with the main symptom of shortness of breath one year prior to admission. She started experiencing repeated respiratory tract infections, feeding issues, and failure to thrive at the age of six months, although she was not bluish. She received a pulmonary TB diagnosis and had 9 months of therapy. She continued to report having dyspnea, and an echocardiogram showed that she had multiple muscular VSDs with a left-to-right shunt and pulmonary hypertension with a total diameter of 1-1.4 cm. The results of a physical examination revealed a heart rate of 115 beats per minute, a respiratory rate of 21 breaths per minute, and a room air oxygen saturation of 98%. Her height was 122 cm, and her body weight was 18 kg. Regular first and second heart sounds were audible during auscultation, as well as a loud intensity holosystolic murmur grade 3/6 in the lower left sternal border. The patient had a D-shaped LV and severe PH with a TVG of 69 mmHg and a transVSD gradient of 15 mmHg.
We chose to use the jugular vein approach to accomplish percutaneous transcatheter VSD closure. Preprocedural 98%; patient underwent general anesthesia. The patient was intubated using ETT No. 5.5% and 30% FiO2. 100% post-intubation saturation TEE revealed several muscular VSD with 2-3 mm and 12 mm diameters, 3 mm spacing between VSD, L to R shunt, AR (-), and TR mild with septal leaflet tricuspid prolapse. (Figure 1A). The decision was made to catheterize the right heart. The right femoral artery of the patient was punctured, and the patient then inserted a 4F sheath, heparin 1.000 IU, and MP sidehole 5F catheter. The right jugular vein was punctured; the MP sidehole was 5F and the sheath 6F was used. Following right cardiac catheterization (Qp:Qs 3.5, PVRi 5.23WUmsq, PVR 4.55 WU, PVR/SVR 0.16), we made the decision to correct the defect using an Amplatzer Septal Occluder (AGA) No. 16 mm using transjugular method. Through the muscular VSD, a 5F MP sidehole diagnostic catheter was introduced under the direction of transesophageal echocardiography (TEE). A 5F MP sidehole diagnostic catheter was introduced under the direction of transesophageal echocardiography (TEE) from SVC, RA, RV and LV through muscular VSD (Figures 1B-D). Using 0.035'' Amplatzer stiff wire, we change to 8F delivery sheath (Figure 1E). Full device deployment was successfully performed with several episodes of PVC storm and severe bradycardia (Figures 1F-H). Echocardiography evaluation showed no complications before, during, and after deployment of the occluder device (Figure 1H). Her symptoms and appetite steadily improved a week after the operation. She was able to engage in moderately intensive activities three months after the treatment without experiencing any discomfort.
Her TVG was 60 mmHg and 50 mmHg six months and one year after the procedure, respectively, with still visible evidence of PH. However, 1.5 years after the procedure, her TVG dropped to only 18 mmHg, her visible indicators of PH subsided, and the PA dilator treatment was discontinued. Her body weight had increased to 28 kg, and she had no complaints. The patient's ECG showed sinus rhythm during our most recent clinic visit.