Does this child just have an atrial septal defect? More potentiality of interventional therapy: A rare case report

TL;DR

A rare case shows that interventional therapy can successfully treat a heart defect often requiring surgery, offering new treatment options for children.

Contribution

This is the first reported case of percutaneous closure of ASD and supracardiac PAPVC through a vertical vein in a single procedure.

Findings

Interventional therapy effectively occluded both ASD and PAPVC in a 2-year-old child.

Using a guide wire instead of a catheter helps avoid missing PAPVC during interventional therapy.

PAPVC can be reliably diagnosed using TEE, CMR, or CT before surgery.

Abstract

Partially anomalous pulmonary venous connection (PAPVC) is a rare congenital heart disease, often concomitant with atrial septal defects (ASDs). PAPVC usually tends to be treated by surgery, but the case we report will open up new perspectives for the interventional treatment of PAPVC present with ASD.

We present a case of a 2-year-old 11 kg boy transthoracic echocardiography showed secundum-type ASD. A supracardiac-PAPVC was accidentally detected during cardiac catheterization, and an abnormal pulmonary vein connection was detected with a vertical vein (VV) opening. Ultimately, ASD and VV were both occluded.

Surgical therapy of PAPVC is the first line treatment of most centers in the world. However, the main complications after surgical repair of PAPVC raise our concerns, such as pulmonary stenosis, caval vein stenosis and sinus node dysfunction. Therefore, percutaneous closure of PAPVC can be an alternative method. This case of percutaneous interventional closure of ASD and supracardiac PAPVC through a vertical vein in the same surgery was first reported. Patients with ASD tend to have missed diagnoses of PAPVC. We can evaluate it by transesophageal echocardiography (TEE), cardiac magnetic resonance imaging (CMR) and computed tomography (CT).

This case suggests that the effect of interventional therapy is quite reliable. For children with ASD, attention should be paid to the omission of the presence or absence of PAPVC before surgery. During interventional therapy, a guide wire rather than a catheter should be preferred to explore the atrial septum and pulmonary veins to avoid a missed diagnosis of PAPVC.

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