Transcatheter closure of a rare congenital left ventricle to right atrium shunt using the amplatzer duct occluder II

RATIONALE: Left ventricle-right atrium (LV-RA) shunt is a rare case and surgical repair has been the routine procedure to correct this defect. With the rapid development of transcatheter technology, some of the cases can be closed with transcatheter technique. Here, we would like to report a congenital LV-RA case who received transcatheter closure using the Amplazter duct occluder II (ADO II) and the short-term outcomes of this procedure. PATIENT CONCERNS: A 2-year-old female presented a systolic murmur between the 2 to 3 sternal rib during the routine examination before kindergarten administration. DIAGNOSIS: The patient denied any cardiac surgery, endocarditis, trauma or cardiomyopathy. The echocardiography confirmed an abnormal shunt between left ventricle and right atrium located in the superior part of ventricular septum which is closed to septal tricuspid valve and anterior mitral valve, and the diameter of this shunt is 2 mm. Besides, the dilation of right atrium (40 mm) has been identified which was not a common clinical manifestation of typical ventricular septal defect. Angiography demonstrated the shunt driven from left ventricle to right atrium. INTERVENTION: An AGA ADO II device had been delivered to close the defect. OUTCOME: Follow-up kept for 3 months. Echocardiography revealed completed closure of the shunt with normal movement and function valves. And no complication of arrhythmia has been recorded. LESSONS: This case report highlighted the administration of ADO II in some ventricular septal defect with superior location, and provided an essential experience of using ADO II to close long tunnel type LV-RA shunt.