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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
×
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
.
Diseases
Validation
Diseases presenting
"perimembranous ventricular septal defect"
symptom
hirschsprung disease
kabuki syndrome
This symptom has already been validated