# Unconventional Ductal Flow Restriction and Iatrogenic Pseudoaneurysm Plug Closure in Pulmonary Atresia With Intact Septum

## TL;DR

This paper describes a complex case of a neonate with a rare heart condition managed using innovative catheter-based techniques to balance blood flow and prevent complications.

## Contribution

The paper introduces unconventional transcatheter strategies for managing pulmonary atresia with intact septum in neonates.

## Key findings

- A modified Medtronic Microvascular Plug was used to restrict pulmonary overcirculation in a neonate with PA/IVS.
- A Konar-A vascular plug successfully closed an iatrogenic pseudoaneurysm in the left external iliac artery.
- Creative transcatheter solutions are essential for managing high-risk neonates with complex congenital heart disease.

## Abstract

Pulmonary atresia with intact ventricular septum (PA/IVS) and right ventricular–dependent coronary circulation pose management challenges requiring creative transcatheter solutions when surgery is unfeasible.

A small-for-gestational-age term neonate with PA/IVS and right ventricular–dependent coronary circulation developed hemodynamic instability after patent ductus arteriosus stenting, requiring deployment of a modified Medtronic Microvascular Plug within the patent ductus arteriosus stent to restrict pulmonary overcirculation. A left external iliac artery pseudoaneurysm was subsequently closed using a 4-mm Konar-A vascular plug.

This case underscores the delicate balance between management of pulmonary over- and undercirculation in neonates with PA/IVS and highlights creative transcatheter strategies used to address these dual hemodynamic dilemmas. Early recognition of at-risk anatomy, and consideration for cardiac transplantation, are essential for survival in these high-risk patients.

Unconventional transcatheter strategies may be essential in managing high-risk neonates with congenital heart disease.