CASE20220531_001
ASD with floating device
By Thanawat Suesat
0
Presenter
Thanawat Suesat
Authors
Thanawat Suesat1
Affiliation
Khon Kaen Hospital, Thailand1
Structural Heart Disease - Congenital Heart Disease (ASD, PDA, VSD)
ASD with floating device
Thanawat Suesat1
Khon Kaen Hospital, Thailand1
Clinical Information
Patient initials or Identifier Number
P J , 60 year old Thai female
Relevant Clinical History and Physical Exam
CC : Dyspnea and leg edema for 6 months PI : 6 month PTA leg edema and dypnea No PND , orthopnea No chest pain FC III Dx. AF + Right sideHF Rx with digoxin & diuraticPH : No DM, HT , Dyslipidemia PE : RV heaving . Fixed split S2 ,SEM 2/5 at LPSM pitting edema 2 + both legLAB : normal kidney & Liver function
Media1.mp4
TTE : RV dilatation , LVEF = 56 % , ASD secundum 2.2 cm with LtoR shunt RVSP = 42 mmHg Qp/Qs = 2.2
TEE : 2 ASD , 13 and 10 mm No anomalous pulmonary veins
Media1.mp4Relevant Test Results Prior to Catheterization
CAG : non signifcant coronary stenosis
O2 step up at RA mean PA = 31 mmHg Qp/Qs = 2.44 Pulmonary resistance ( Rp) = 2.67 W.U.m2 Rp/Rs = 0.13
Media2.mp4
Media3.mp4
O2 step up at RA mean PA = 31 mmHg Qp/Qs = 2.44 Pulmonary resistance ( Rp) = 2.67 W.U.m2 Rp/Rs = 0.13
Heart team conference
- CVT surgeon
- Ped cardiologist(as adult congenital heart disease
consultant)
- Adult cardiologist/ Interventionist
plan : Transcatheter closure for ASD
Media2.mp4 Media3.mp4Relevant Catheterization Findings
Balloon Sizing A= 15.2 mm and B = 10.3mmASD “ 15 mm =A” was closed with Amplatzer multifenestrated septal occluder “cribrifrom” size 35 mm( 9F) ASD “ 10 mm=B” closed with Amplatzer septal occluder Size 10 mm ( 6F) with “ interleaving” technique
1 minute ….after device A released, B was embolized to LA and to LV just few minutes , Device B was migrated to ascending aorta and abdominal aorta
Media6.mp4
Media8.mp4
1 minute ….after device A released, B was embolized to LA and to LV just few minutes , Device B was migrated to ascending aorta and abdominal aorta
Media6.mp4 Media8.mp4Interventional Management
Procedural Step
CAG : non signifcant coronary stenosis
O2 step up at RA mean PA = 31 mmHg Qp/Qs = 2.44 Pulmonary resistance ( Rp) = 2.67 W.U.m2 Rp/Rs = 0.13
Balloon Sizing A= 15.2 mm and B = 10.3mm
ASD “ 15 mm =A” was closed with Amplatzer multifenestrated septal occluder “cribrifrom” size 35 mm( 9F)
ASD “ 10 mm=B” closed with Amplatzer septal occluder Size 10 mm ( 6F)
with “ interleaving” technique
1 minute ….after device A released, B was embolized to LA and to LV
just few minutes , Device B was migrated to ascending aorta and abdominal aorta
Multi-snare 15 mm + Sheath 8 F via RFA --> failedthen …..change to 10 F sheath -->success
Media7.mp4
Media9.mp4
Media10.mp4
O2 step up at RA mean PA = 31 mmHg Qp/Qs = 2.44 Pulmonary resistance ( Rp) = 2.67 W.U.m2 Rp/Rs = 0.13
ASD “ 15 mm =A” was closed with Amplatzer multifenestrated septal occluder “cribrifrom” size 35 mm( 9F)
ASD “ 10 mm=B” closed with Amplatzer septal occluder Size 10 mm ( 6F)
with “ interleaving” technique
1 minute ….after device A released, B was embolized to LA and to LV
just few minutes , Device B was migrated to ascending aorta and abdominal aorta
Multi-snare 15 mm + Sheath 8 F via RFA --> failedthen …..change to 10 F sheath -->success
Media7.mp4 Media9.mp4 Media10.mp4Case Summary
conclusion
Percutaneous transcatheter closure of multiple/ fenestrated ASD may be more complicated than closure of single ASD Multiple device is important risk factor for device embolization Snare is common instrument for retrieval device
Percutaneous transcatheter closure of multiple/ fenestrated ASD may be more complicated than closure of single ASD Multiple device is important risk factor for device embolization Snare is common instrument for retrieval device