Percutaneous closure of atrial septal defect via transjugular approach with Blockaid device in a patient with interrupte
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CASE REPORT
Percutaneous closure of atrial septal defect via transjugular approach with Blockaid device in a patient with interrupted inferior vena cava Rao D. Seshagiri • A. N. Patnaik • B. Srinivas
Received: 19 September 2011 / Accepted: 1 June 2012 / Published online: 19 July 2012 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2012
Abstract Percutaneous ASD closure was successfully performed through the internal jugular approach in a 40-year old female with IVC interruption and azygos continuation. This case demonstrates the feasibility of transcatheter ASD closure in a difficult anatomy which precludes the standard transfemoral approach. Keywords Atrial septal defect Venous anomaly Intervention
Introduction Percutaneous closure of ostium secundum atrial septal defect (ASD) is now a well established treatment modality. The route of deployment is through the femoral venous approach and the devices are designed for that route. However, in some rare cases, it may not be possible to deploy through the inferior vena cava (IVC) route, especially if there is an interruption. In such situation, an alternative route like the transjugular approach should be considered.
Case report A 40-year old female patient was evaluated for exertional dyspnea of 2 years duration and diagnosed as having a large ostium secundum ASD. She was referred to our centre for possible device closure. On evaluation she was R. D. Seshagiri A. N. Patnaik B. Srinivas (&) Department of Cardiology, Nizam’s Institute of Medical Sciences, Hyderabad 500 082, Andhra Pradesh, India e-mail: [email protected]
found to have a secundum ASD which was suitable for device closure The defect was measuring 26 mm on transesophageal echocardiography (TEE). IVC interruption with azygos continuation was noted. Hence transjugular device deployment was planned. The procedure was performed under fluoroscopic and transthoracic echocardiographic guidance under local anaesthesia. 6-French(6F) introducers were placed in the right femoral vein and artery. An IVC gram was performed to demonstrate IVC interruption (Fig. 1) with azygos continuation (Fig. 2). A 7-French(7F) introducer (Cordis corporation, Miami, Florida, USA) was introduced through the right internal jugular vein. A 6F internal mammary artery catheter (IMA) catheter was used to cross the ASD with a straight tip guidewire (0.03500 9 150 cm) (RADI FOCUS, TERUMO Corporation, Tokyo, Japan). Difficulty in crossing the ASD was experienced but overcome by advancing the guidewire and IMA catheter directed posteriorly rather than in right to left direction. After crossing the ASD, the guidewire was exchanged with 0.03500 Amplatz extra stiff guidewire (Cook, Indianapolis, USA). Then, a 34 mm AMPLATZER sizing balloon was used to size the ASD. The size of the stretched diameter of the ASD was about 26 mm., done with the help of colour Doppler. A 12F 60 cm single curve delivery sheath (Shanghai shape memory alloy limited, Shanghai, China) was introduced into the left atrium which requ
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