Structural Heart Disease - Others (Structural Heart Disease)
Siddharth Bajaj1, Rajeev V. Menon2
Apollo Hospitals, India1, AIG Hospitals, India2
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 done
A 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 –
PA – 45/24/34
PCWP – 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.