Cases

ASD Device closure and Trans-Radial PCI in Same Hospital admission

By: AQM Reza, MBBS, MD(Card), FACC, FSCAI; AHM Waliul Islam, MBBS, PhD., FACC, FSCAI, FAPSIC, Atique Bin Siddique, MBBS, D.Card.(London)

Submitted: 03/07/2012

Operator(s):
AQM Reza, MBBS, MD(Card), FACC, FSCAI; AHM Waliul Islam, MBBS, PhD., FACC, FSCAI, FAPSIC, Atique Bin Siddique, MBBS, D.Card.(London)

Affiliation(s):
Dept of Invasive and Interventional Cardiology, Apollo Hospitals Dhaka.

Facility/Institution
Apollo Heart Center of Apollo Hospitals Dhaka, Bangladesh

Clinical History
56yr old /M Bangladeshi patient. Known case of ASD Secundum and SVD-DG lesion. He was recommended elsewhere, for ASD repair and Single vessel grafting at the same time by sternotomy. CAD Risk factor: DM, Dyslipidemia. Admitted for ASD Device closure and PCI to DG at our facilities

Angiography
LM: Normal. LAD: Good size artery. Mild changes. No flow limiting problem. Diagonal (DG) is a good size branch with 75-80% proximal plaque (Fig. 7) LCX: Normal. RCA: Normal

Procedure
Percutaneous ASD Device closure was done via TF approach(19/5/2012). Atrial Septal defect was located (Fig 1.). Sizing of the ASD was done by a balloon (Fig. 2). By using a 24 mm Fibulla (STX Flex) ASD Device was positioned (Fig. 3) and released from the connector (Fig 4). Final cine shows well apposed ASD device covering the defect.(Fig.5 and Fig. 6). PCI to Proximal segment of good caliber DG was done in the next sitting on (22/5/2012). Ballooning of culprit lesion by a 2.0 x 10 mm Avita balloon. (Fig.8). PCI to DG lesion in its proximal segment was done by using a Integrity 2.5 x 18 mm stent and deployed at 10-12ATM (Fig. 9). Final cine shows TIMI- III distal flow with no residual stenosis (Fig 10.)

Conclusion(s)/Result(s)
ASD Secundum and associated CAD is an uncommon clinical entity. Percutaneous ASD Device closure and subsequent PCI could be a good option instead of sternotomy. Thus, Surgery can be avoided

Comment(s)/Lesson(s)
Trans-thoracic echocardiography (TTE) and Trans-esophageal echocardiography (TEE) is routinely done in our protocol for all patient. Correlation of Cine angiographic balloon sizing and both TTE and TEE findings help the operator to select and implant correct size ASD device.

Conflict(s) of Interest
None

Figure:1