|
ABSTRACT 36
ACUTE POSTINFARCTION VENTRICULAR SEPTAL DEFECT
CLOSURE FOLLOWING PRIMARY PTCA
A.S. Bortone, S. Schena, D. DAgostino, M. Sciascia,
E. De Cillis, M. Carminati*, L. de Luca Tupputi Schinosa
Division of Cardiovascular Surgery, University of Bari and
*Division of Cardiology-G.Pasquinucci Hospital, Milan, Italy.
A 77 year-old man was admitted for AMI. He underwent primary
PTCA on LAD with two balloons (Rocket 2.0´20 and Tacker 3.5´20
mm) introduced through a previously advanced Shinobi guide wire.
In order to optimize the result, a Cross-flex 3.5´10 mm stent
was inserted and a final TIMI flow 3 was achieved. A new catheterization
was performed three months later, in order to allow the formation
of a fibrous ring around the wall defect and then the engagement
of the device. The angiography showed a persistent patency of
LAD with a VSD located in the midportion of the septum, as confirmed
by TEE. The VSD was accessed with a multipurpose catheter from
femoral artery. After having advanced an exchange wire into the
right ventricle (RV) throughout the VSD, a central venous catheter
was inserted into the right internal jugular vein in order to
snare and pull the one previously positioned in RV and establish
an artero-venous circuit. A sizing balloon was then advanced from
the venous wire and across the defect that was estimated to be
14-mm wide. The balloon was removed and replaced with a 10F Mullins
sheath with the tip located in the left ventricle (LV). A 14 mm
VSD Amplatzer device was advanced within the sheath until the
distal disk was opened and slowly retracted to achieve an optimal
contact with the septum. Before the device was released, its central
waist was engaged within the defect and the proximal disk deployed.
In order to evaluate both the correct performance and devices
stability, each step of the procedure was monitored by TEE. Confirmation
of an optimal closure of the defect was obtained by LV angiography.
In conclusion, VSD closure can be safely and non invasively performed
after primary PTCA in ventricles severely damaged during AMI whenever
a fibrous territory allows the hooking of the device.
|
