A Case of A Case of Transcatheter Transcatheter Closure of Closure - PowerPoint PPT Presentation

A Case of A Case of Transcatheter Transcatheter Closure of Closure of Multiple Multiple Atrial Atrial Septal Septal Defects w ith Defects w ith Three Three Am platzer Am platzer Septal Septal Occluder Occluder Devices Devices i Eld i Eld in a Elderly Fem ale in a Elderly Fem ale l F l F l l Koji Nakagawa, Teiji Akagi, Manabu Taniguchi Yasufumi Kijima, Kengo Fukushima Kusano Hiroshi Ito, Shunji Sano Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Dentistry and Pharmaceutical Sciences

Case Case � 82y female diagnosed as ASD at age 75. � repeated CHF � refused surgical closure � in NYHA functional class III despite anti-congestive medication

Chest X-ray Physical findings 141cm, 46kg facial and leg edema irregular heart rate III/VI systolic murmur Catheterization Qp/Qs: 6.4 p PA pressure: 44/17/26mmHg Laboartory data y plasma BNP: 1008 pg/ml

ECG ECG

NYHA class III NYHA class III but still in CAG & PCI #4PD; 90% #4PL; 90% #11; 75% #6; 90% LCA RCA RCA

2 D TTE im age 2 D TTE im age � multiple ASDs � RA RV dil t ti � RA, RV dilatation ASD1 ASD2 � moderate degree of TR ASD3

3 DTEE im age of atrial septum 3 DTEE im age of atrial septum ASD1 ASD2 17mm 11mm from LA side from LA side S ASD3 A P 21mm I

Schem atic illustration of ASDs SVC ASD1 (anterosuperior): 17mm ASD2 (posterosuperior): 11mm ASD3 (inferoanterior): 21mm ASD3 (inferoanterior): 21mm 1 2 2 RV RV 3 3 CS IVC

Schem atic illustration of ASDs continued SVC 16mm 19mm 8mm 8mm 17mm 7mm TV 14mm 11mm 24mm RV RV 21mm 21mm 9mm CS 4mm IVC

Sim ultaneous balloon sizing of ASDs g < strech balloon diameter > ASD1 (superio-anterior): 18mm ASD2 (superio-posterior): 15mm ASD3 (infero-anterior): 24mm PA view

P-A view ASO devices deploym ent

3 DTEE im age of atrial septum before and 3 DTEE im age of atrial septum before and after three ASO devices deploym ent from LA side S A A P P I

Chest X-ray before and 1M after ASD closure Chest X ray before and 1M after ASD closure before 1 M after plasma BNP : 1008 pg/ml ⇒ 466 pg/ml

TTE im ages before and 1 m after ASD closure TRPG: 52 ⇒ 39mmHg 1 M after before

Sam m ary � We could successfully perform transcatheter ASD closure for multiple ASD using three ASO devices, and achieved a good result for management of refractory CHF in complex case. � Live 3D TEE image was useful to assess spatial position and distance between the defects and provided and distance between the defects and provided appropriate device placement in multiple ASDs.