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