Speaker’s name: Dr Ramachandra Barik, Assistant professor Department of cardiology Nizam’s Institute of Medical science. Hyderabad INDIA.

I do not have any potential conflict of interest

Device Closure Of Ventricular Septal Defect after 3 Weeks of Coronary Angioplasty.

HAPPY NEW YEAR 2012

Dr Barik.

CLINICAL HISTORY

60 YR/M, SMOKER, NON-DM, NON-HTN AWMI +STK+ ON 1.8.2011 WITHIN WINDOW

PERIOD OF 4 HRS AT A DISTRICT HOSPITAL SOB AT REST ON DAY 3-(3.8.2011)- PSM ECG –AWMI 2D ECHO- VSD ; MODERATE LV DYSFUNCTION REFERRED TO OUR HOSPITAL FOR FURTHER

MANAGEMENT

ON EXAMINATION-

KILLIP II & ANGINA AT REST

BP: 100/70 MMHG, PULSE :109/MIN, RR: 22/MIN, AFEBRILE

JVP: NORMAL, LV – S3+, PSM IV/VI

ROOM AIR ARTERIAL SAT. 95%

OTHER SYSTEMS : B/L BASILLIAR CREPTS

12 LEAD ECG12 LEAD ECG: TACHYCARDIA; Q – V1-V4

RWMA + ( LAD TERRITORY HYPOKINETIC), ANTERO-APICAL VSD OF SIZE 10 mm, LVEF-35%, DIASTOLIC DYSFUNCTION +, NO PE, NO CLOT.

2D/3D-ECHO -04.08.2011

2D ECHO –APICAL 4C

VSD -1.8CM FROM APEX TOWARDS BASE

COLOUR DOPPLER – 4C :VSD

COLOUR COMPARISION

COLOUR COMPARISION

CAG + CATH (4.8.2011): Hb-14gm%, with BMI- 22.03kg/m2; O2 CONS-200/MT

SVC - 50 %IVC - 76%

MVO2 - 56.5%RA - 62%

RV - 83%PA - 80%FA - 92%

RA – 2 MM HGRV – 20/0-4PA – 20/12 ,15PCWP - 17LV -100/0-8FA – 100/70

Qp/Qs - 1.86:1

LAD -LESION

RCA NORMAL

LV ANGIO-SINGLE MUSCULAR VSD

PLAN:Follow Guidelines?

PTCA TO LAD ? PTCA+VSD CLOSURE ? STAGED PROCEDURE ? SURGERY ?

PTCA TO LADENDEAVOR RESOLUTE 3X15 MM

SHARE YOUR IDEAS

PLEASE-IDEAL VSD

CLOSING TIME

Amplatzer VSD Occluder-FAD APPROVED Cardi-O-Fix from Starway

Medical Technology,Inc.

DEVICE OPTION

DELIVERY SYSTEM

Cardi-O-Fix 10mm device through 9 Fr sheath

ARTERIO-VENOUS LOOP

TERUMO- J -TIPPED- 0.35” X 260 CM

SNARING IN PA

AMPLATZER GOOSE-NECK 10MM SNARE;MICROVENA CORPO.

DELIVERY SHEATH ACROSS VSD

12 Fr x1800 CURVE STARWAY MEDICAL TECH.

VSD OCCLUDER

CARDIO-O-FIX14 M.[STARWAY MEDICAL].

AFTER RELEASE

ECHO AFTER 3MONTHS

REVIEW OF LITERATURE

1. Crenshaw BS, Granger CB, Birnbaum Y, Pieper KS, Morris DC, Kleiman NS, et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation 2000;101:27-32.2. Labrousse L, Choukroun E, Chevalier JM, Madonna F, Robertie F, Merlico F, et al. Surgery for post infarction ventricular septal defect (VSD): risk factors for hospital death and long term results. Eur J Cardiothorac Surg 2002;21:725-31.3. Butera G, Chessa M, Carminati M. Percutaneous closure of ventricular septal defects. State of the art. J Cardiovasc Med 2007;8:39-45.4. Ahmed J, Ruygrok PN, Wilson NJ, Webster MW, Greaves S, Gerber I. Percutaneous closure of post-myocardial infarction ventricular septal defects: a single centre experience. Heart Lung Circ 2008;17:119-23.5. Martinez MW, Mookadam F, Sun Y, Hagler DJ. Transcatheter closure of ischemic and post-traumatic ventricular septal ruptures. Catheter Cardiovasc Interv 2007; 69:403-7.

6. Goldstein JA, Casserly IP, Balzer DT, Lee R, Lasala JM. Transcatheter closure of recurrent postmyocardial infarction ventricular septal defects utilizing the Amplatzer postinfarction VSD device: a case series. Catheter Cardiovasc Interv 2003;59:238-43.7. Caputo M, Wilde P, Angelini GD. Management of postinfarction ventricular septal defect. Br J Hosp Med 1995;54:562-6.8. Hachida M, Nakano H, Hirai M, Shi CY. Percutaneous transaortic closure of postinfarctional ventricular septal rupture. Ann Thorac Surg 1991;51:655-7.9. Thiele H, Kaulfersch C, Daehnert I, Schoenauer M, Eitel I, Borger M, et al. Immediate primary transcatheter closure of postinfarction ventricular septal defects. Eur Heart J 2009; 30:81-8.10. Lee EM, Roberts DH, Walsh KP. Transcatheter closure of a residual postmyocardial infarction ventricular septal defect with the Amplatzer septal occluder. Heart 1998; 80:522-4.

CASE REPORT

A 61-year-old male, hypertensive and diabetic for the past 20 years, was brought to

coronary care unit in CCF. He had sustained an anterior wall MI the previous day and was

thrombolyzed with streptokinase. On admission, pulse rate was 110/min and BP was

130/90 mm Hg. Auscultation revealed ……………….. Ajit S. Mullasari,*

MD,et.al.MMM,Chenai.

Catheterization and Cardiovascular Interventions 54:484–487 (2001)

Between Sep.2003 and Feb. 2008, 29 consecutive patients underwent primary transcatheter VSD closure. Clinical, procedural, and outcome data were collected. Patients were divided into those with and those without cardiogenic shock at presentation for risk stratification. The median follow-up time of surviving patients was 730 days. The median time between VSD occurrence and closure was 1 day [interquartile range (IQR) 1–3] the initial procedural success rate was 86%. The shunt (Qp:Qs) could be reduced from 3.3 (IQR 2.3–3.8) to 1.4 (IQR 1.2–1.7; P , 0.001) Procedure-related complications such as major residual shunting, LV rupture, and device embolization occurred in 41%. The overall 30-day survival rate was 35%. Mortality was higher for cardiogenic shock in comparison to non-shock patients (88 vs. 38%, P , 0.001).Holger Thiele1*,et.al

TAKE HOME MESSAGE

USE OF CARDIO-O-FIX DEVICE INITIAL PTCAGAP OF 3 WEEKSVSD CLOSURE AVOIDANCE OF GA,TEE,BALLOON SIZING. NOT USED ANY STIFF GUIDE WIRE

MAKE THE PROCEDURE AS SIMPLE AS POSSIBLE WITH LEAST EXPENDITURE

THANK U GIVING ME THIS OPPORTUNITY TO TO SHARE.