KC

29 years, male, BMI of 18, no co-morbiditiesPresented with sudden onset of worsening breathlessness and palpitations  of  2 days durationOn examination, patient was dyspnoec, BP – 100/60 with a regular pulse rate of 100/min. He had  pitting oedema of both his lower limbs,  with a raised JVP– very high a and v waves with a steep y descent., and a continuous murmur over the precordium.

A transthorasicecho was performed which showed rupture of the non coronary sinus of Valsalva intothe Right Atrium.A detailed TEE evaluation was doneA CT aortogram confirmed the rupture of the sinus of Valsalva. Patient was started on non-invasive ventilation,and managed in the ICCU.
His creatininewas 5.2 and rising rapidly, with a decreased urine output.As he was highrisk for surgery, with a narrow mouth at the aortic end he was taken up fortrans-catheter device closure .

Right heart cath showed severe PVH with PAH and a Qp/Qs of 4:3

Procedure was done while the patient was on non invasive ventilation.RSOV was crossed with JR and exchange length terumo.Terumo was snared from SVC with a 25 mm gooseneck snare and AV loop was established.After multiple views and TEE RSOV at the aortic end was determined to be 13-14 mm , Lifetech occluder 16/18 mm device was deployed after confirming position in TEE and aortic root angiogram.procedure was unevetful Patient was stableRepeat Catheterization showed the PA pressure and PCWP had settled. 

Post closurecath study –RA -10RV -45/10PA – 45/24/34PCWP – 24  Post procedure patient stabalised, his urine output improved and renal parameters settled.His breathlessness decreased and JVP stabalised
Trans catheter closure of RSOV is a feasible and can be life saving, if done by experienced operators.