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Outside the South Carolina Children’s Heart Center, 40 year old Amy Abbernathy underwent surgery for the most common form of congenital heart disease, a bicuspid aortic valve, where there the valve has only 2 leaflets rather than the typical 3. Although often asymptomatic, she developed a damaged aortic valve and enlarged aorta which was at risk for dilation and rupture.  Her postoperative course was complicated by an infection and the rare complication of a pseudo-aneurysm (a ballon like outpouching of the heart muscle wall). Serial evaluations revealed progressive enlargement of the pseudo-aneurysm impinging on the left main coronary artery, putting her at risk for a heart attack or even death.  Given her high risk for re-operation, she was referred to the interventional specialists in the South Carolina Children’s Heart Center for catheter based occlusion of the pseudo-aneurysm.  A device was placed in this pseudo-aneurysm through a catheter in the femoral artery, the first reported case of this procedure in the world, allowing her to avoid surgery.  Her recovery was excellent and she went home the following morning without complications.  Three years later she continues to do great with complete occlusion of the pseudo-aneurysm and a now normal course of the left coronary artery.
 

The procedure
Our congenital cardiac interventionalists have vast experience with correcting several common forms of congenital heart disease that until recently could only be corrected using surgery. Holes in the heart such as atrial septal defects and some ventricular septal defects as well as abnormal vascular connections such as patent ductus arteriosus are now routinely managed in the pediatric cardiac catheterization laboratory. Typically performed with catheters in the artery and veins in the leg, these procedures avoid surgery and typically require no more than an overnight stay in the hospital.  Our program was one of only 7 in the country invited to participate recently in a trial of an investigational device to close membranous ventricular septal defects. The expertise gained in treating more common congenital defects has now been expanded to uncommon problems with often life saving results.