LEGENDS
Fig. 1. A: Selective angiography for residual MBT shunt (white asterisk) in a patient after Fallot tetralogy repair, patient developed heart failure symptoms due to significant left to right shunt.B: The same patient after occlusion of the MBT shunt with vascular plug (yellow arrow) with no residual flow is seen after aortic angiography. C: Significant LPA stenosis (yellow arrow) with decreased left lung vascularity in another patient after Glenn surgery, patient developed significant desaturation (68-73%) after surgery.D: The same patient after LPA stenting (yellow arrow) with improvement of left lung vascularity and patient saturation increased to 85%.MBT shunt: Modified Blalock-Taussig shunt, LPA left pulmonary artery.
Fig. 2. Cardiac catheterization performed for a six months old baby presented late with DORV, subpulmonic VSD, Intramural left coronary artery and hypoplastic aortic arch after arterial switch operation on ECMO support. Patient developed an iatrogenic AO to RV fistula that led to severe coronary steal, severe cardiac dysfunction and inability to wean from ECMO support. A : Contrast injection in the neo-aorta revealed a large AO-RV fistula (white asterisk) with coronary steal (coronary arteries are not seen with neo-aortic injection). B : Selective injection of the AO-RV fistula (white asterisk).C-D:Neo-aortic injection after fistula is occluded with vascular plugs showed no residual fistula and no more coronary steal as coronary arteries are seen well after neo-aortic injection ( yellow arrows). Three days later patient was successfully disconnected from ECMO and contractility progressively improved and patient discharged home. DORV: double outlet right ventricle, VSD: ventricular septal defect, VC: venous cannula, AC: arterial cannula, AO aorta, RV: right ventricle, ECMO: extracorporeal membrane oxygenation.
Fig. 3. Kaplan Meier survival curve : Demonstrating less survival among patients performed cardiac catheterization on ECMO support. ECMO: Extracorporeal membrane oxygenation.