CASE20220613_002

How Timely Intervention Saved a Precious Life.

By Siddharth Bajaj, Rajeev V. Menon
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Presenter

Siddharth Bajaj

Authors

Siddharth Bajaj1, Rajeev V. Menon2

Affiliation

Apollo Hospitals, India1, AIG Hospitals, India2
Structural Heart Disease - Others (Structural Heart Disease)

How Timely Intervention Saved a Precious Life.

Siddharth Bajaj1, Rajeev V. Menon2

Apollo Hospitals, India1, AIG Hospitals, India2

Clinical Information

Patient initials or Identifier Number

KC

Relevant Clinical History and Physical Exam

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.

Relevant Test Results Prior to Catheterization

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 .

Relevant Catheterization Findings

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

Interventional Management

Procedural Step

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. 

Case Summary

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.