Closure of a large perimembranous ventricular septal defect in a 4.8Â kg baby with Down syndrome using a duct occluder.

[hirschsprung disease]

A 9 .5 -month -old boy with Down syndrome , weighing 4 .8 Â kg , presented with history of failure to thrive . Clinically , he had symptoms and signs of congestive heart failure . His echocardiogram showed a large perimembranous ventricular septal defect (pmVSD ) with some inlet extension covered by a large aneurysmal tissue with multiple right ventricular (RV ) exits . Additionally , he had hypothyroidism and Hirschsprung disease . Instead of closing the VSD surgically , the VSD was successfully closed utilizing an 8 Â Ã—Â 6 Â mm duct occluder . The baby remained in the intensive care unit for one night . The day after the procedure , the infant was stable and showed clinical improvement . Electrocardiogram (ECG ) showed normal sinus rhythm with no evidence of heart block . Twenty -four hours later , echocardiography showed the device was in an excellent position , with a small residual leak . There was normal tricuspid valve inflow and normal aortic valve outflow with no significant valvar insufficiency . The baby was discharged after 3 Â days in stable condition . We believe infants with such co -morbidities which might complicate their post-operative course and prolong the intensive care unit admission , might benefit from such alternative management .