Transcatheter occlusion of the neoaorta to augment mechanical circulatory support after stage 1 single ventricle palliation

Abstract

Aortic insufficiency can be a complication of continuous mechanical circulatory support that leads to inefficient circulation and decreased coronary perfusion. In adults, this has been addressed through both surgical and transcatheter approaches. However, this has rarely been reported in children with congenital heart disease. We present the case of a neonate who developed severe neoaortic insufficiency after stage one single ventricle palliation while on central veno-arterial extracorporeal membrane oxygenation (VA-ECMO) that was managed with transcatheter neoaortic occlusion. We used an Amplatzer Vascular Plug II 10 mm device (Abbott Cardiovascular) to successfully improve neoaortic insufficiency and overall hemodynamics. This procedure was technically feasible and may be considered in rare cases to address aortic insufficiency while on mechanical circulatory support.