percutaneous closure of ruptured sinus of valsalva …summitmd.com/pdf/pdf/6_3_madan.pdf · i, (dr...
TRANSCRIPT
PERCUTANEOUS CLOSURE OF RUPTURED SINUS OF VALSALVA ANEURYSMSINUS OF VALSALVA ANEURYSM(SEALING TOO MANY LEAKS)
DR TARUN MADAN ( MD,DNB,MNAMS)ASST. PROFESSOR (CARDIOLOGY)ASST. PROFESSOR (CARDIOLOGY)
U.N.M INSTITUTE OF CARDIOLOGY & RESEARCH CENTREINDIA
Disclosure Statement of Financial Interest
I, (DR TARUN MADAN) DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.
27/04/2012 TCTAP‐2012 TARUN MADAN
HISTORYHISTORY
• MALE,22 Yrs
• RECENT ONSET PRECORDIAL PAIN F/BRECENT ONSET PRECORDIAL PAIN F/B DYSPNEA, PALPITATION,FATIGABILITY
HYPERDYNAMIC PRECORDIUM• HYPERDYNAMIC PRECORDIUM
• WIDE PULSE PRESSURE
• CONTINUOUS MURMUR ( LEFT PARASTERNAL AREA)PARASTERNAL AREA)
27/04/2012 TCTAP‐2012 TARUN MADAN
INVESTIGATIONSINVESTIGATIONS
• CXR ( CARDIOMEGALY, INCREASED VASCULARITY)
• CBC NORMALCBC NORMAL
• NORMAL RENAL FUNCTIONS ( UREA,CREAT)
• MILD ALTERATION OF LIVER FUNCTIONS
• COAGULATION PROFILE ( WNL)COAGULATION PROFILE ( WNL)
27/04/2012 TCTAP‐2012 TARUN MADAN
ECHOCARDIOGRAPHYECHOCARDIOGRAPHY
( )• RUPTURED SINUS OF VALSALVA (RCS) TO RVOT,RV INFLOW ( MULTIPLE LEAKS)
• DILATED RIGHT VENTRICLE• MODERATE PAHMODERATE PAH • INCREASED Qp/Qs• No AORTIC REGURGITATION, NO VSD• NO EFFUSION• GOOD LV FUNCTION, NO MR
27/04/2012 TCTAP‐2012 TARUN MADAN
• RELATIVES REFUSED FOR SURGICAL CORRECTION
• AFTER INFORMED CONSENT PERCUTANEOUS TREATMENT WAS PLANNED ( DEVICETREATMENT WAS PLANNED ( DEVICE CLOSURE)
27/04/2012 TCTAP‐2012 TARUN MADAN
• RIGHT FEMORAL ARTERY AND VENOUS ACCESS , 6F
• LEFT FEMORAL ARTERY ACCESS , 6F
27/04/2012 TCTAP‐2012 TARUN MADAN
RIGHT CORONARY SINUS RUPTURE( MULTIPLE EXITS)
27/04/2012 TCTAP‐2012 TARUN MADAN
DEFECT CROSSED ANDWIRE SNAREDDEFECT CROSSED AND WIRE SNARED
• TERUMO 0.035” J TIP WIRE
• GOOSE NECK SNARE
• JUDKIN RT. 6FJUDKIN RT. 6F CATHETER
27/04/2012 TCTAP‐2012 TARUN MADAN
ADVANCING THE DELIVERY SHEATH (COOK)ADVANCING THE DELIVERY SHEATH (COOK)
27/04/2012 TCTAP‐2012 TARUN MADAN
1st DEVICE ( 14/12 mm DUCT OCCLUDER)1st DEVICE ( 14/12 mm DUCT OCCLUDER)
27/04/2012 TCTAP‐2012 TARUN MADAN
LATERAL PROJECTIONLATERAL PROJECTION
27/04/2012 TCTAP‐2012 TARUN MADAN
RELEASING THE DEVICERELEASING THE DEVICE
27/04/2012 TCTAP‐2012 TARUN MADAN
OTHER RUPTURE POINTS DEFINEDOTHER RUPTURE POINTS DEFINED
27/04/2012 TCTAP‐2012 TARUN MADAN
DEFECT CROSSED (2nd LEAK)DEFECT CROSSED (2nd LEAK)
27/04/2012 TCTAP‐2012 TARUN MADAN
DEPLOYMENT OF DEVICEDEPLOYMENT OF DEVICE
27/04/2012 TCTAP‐2012 TARUN MADAN
2nd DEVICE (16/14 mm DUCT OCCLUDER )2nd DEVICE (16/14 mm DUCT OCCLUDER )
27/04/2012 TCTAP‐2012 TARUN MADAN
• PATIENT IMPROVED MARKEDLY AND WAS DISCHARGED
• SYMPTOMS OF HEARTSYMPTOMS OF HEART FAILURE DISAPPERED
• REMAINING LEAK WAS• REMAINING LEAK WAS CLSOED IN A STAGED PROCEDUREPROCEDURE
27/04/2012 TCTAP‐2012 TARUN MADAN
STAGED CLOSURE OF THIRD LEAK AFTER FEWWEEKSSTAGED CLOSURE OF THIRD LEAK AFTER FEW WEEKS
27/04/2012 TCTAP‐2012 TARUN MADAN
3rd LEAK DEFINED & ANGIO SHOWING WELL PLACED EARLIER DEVICES
27/04/2012 TCTAP‐2012 TARUN MADAN
DEFECT CROSSED &WIRE SNAREDDEFECT CROSSED & WIRE SNARED
27/04/2012 TCTAP‐2012 TARUN MADAN
ADVANCING DELIVERY SHEATH & DEPLOYMENT OF 3rd
DEVICE
27/04/2012 TCTAP‐2012 TARUN MADAN
3rd DEVICE (12/10 mm DUCT OCCLUDER)3rd DEVICE (12/10 mm DUCT OCCLUDER)
27/04/2012 TCTAP‐2012 TARUN MADAN
FINAL ANGIOGRAMFINAL ANGIOGRAM
27/04/2012 TCTAP‐2012 TARUN MADAN
F/UP CT ANGIO AFTER 7 MTHSF/UP CT ANGIO AFTER 7 MTHS
27/04/2012 TCTAP‐2012 TARUN MADAN
• PT DOING WELL
• NO SYMPTOMSNO SYMPTOMS
• GOOD FUNCTIONAL CAPACITY
27/04/2012 TCTAP‐2012 TARUN MADAN