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

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Apr 07, 2023 44 likes •200 views

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

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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 l F l i Eld l F l in a Elderly Fem ale in a Elderly Fem ale

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

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Case Case

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

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

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ECG ECG

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CAG & PCI

LCA #6; 90% #11; 75% RCA RCA #4PL; 90% #4PD; 90%

but still in NYHA class III NYHA class III

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2 D TTE im age 2 D TTE im age

multiple ASDs RA RV dil t ti RA, RV dilatation moderate degree of TR

ASD1 ASD2 ASD3

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3 DTEE im age of atrial septum 3 DTEE im age of atrial septum

ASD1 17mm ASD2 11mm from LA side from LA side

S P A

ASD3 21mm

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Schem atic illustration of ASDs

SVC

ASD1 (anterosuperior): 17mm ASD2 (posterosuperior): 11mm ASD3 (inferoanterior): 21mm 1 2 ASD3 (inferoanterior): 21mm

3 2

RV CS

3

IVC

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Schem atic illustration of ASDs continued

SVC

19mm 16mm 8mm 8mm 7mm 17mm

24mm 14mm

21mm 11mm

RV CS

4mm 9mm 21mm

IVC

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Sim ultaneous balloon sizing of ASDs g

< strech balloon diameter > ASD1 (superio-anterior): 18mm ASD2 (superio-posterior): 15mm ASD3 (infero-anterior): 24mm PA view

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ASO devices deploym ent

P-A view

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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 P A I P A

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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

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TTE im ages before and 1 m after ASD closure

before 1 M after TRPG: 52 ⇒ 39mmHg

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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.