CASE20220531_001

ASD with floating device

By Thanawat Suesat
like off

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 
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

Relevant 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
   Heart team  conference 
  -    CVT surgeon
  -    Ped cardiologist(as adult congenital heart disease  
        consultant)
  -    Adult cardiologist/ Interventionist 
  plan   : Transcatheter closure  for ASD 

Relevant 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  

Interventional 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

Case 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