ASD Device Closure

Double Intervention in Single Setting in a Girl with Atrial Septal Defect and Patent Ductus Arteriosus

Indication:

Atrial Septal Defect with Patent ductus arteriosus.

Equipments:

1. 6 Fr catheter introducer sheath,
2. 5 Fr catheter introducer sheath,
3. 5 Fr Torcon catheter, 0.038
4. Terumo wire, 0.035 super stiff wire,
5. 5 Fr GL catheter, pigtail catheter,
6. 5 Fr NIH catheter,
7. PDA Cook coil 5×3 mm,
8. PDA coil delivery System 80 cm.
9. Cera ASD occluder,
10. ASD device delivery system,
11. Touhy brost adaptor, sizing plate, sizing
balloon and normal Pediatric drape.
12. (Source: Amplatzer Septal Occluder and Delivery System, Instructions for used. AGA Medical Corporation, 682 Golden valley, MN 55427 USA).

Drugs: Injection Ketamine 2 mg/kg, Inj. Midazolam 0.1 mg/kg.

Procedure:

The sedate patient initially with Inj. Ketamine and Midazolam and secure to the table with leucoplast, connect to ECG and pulse oximetry and record baseline readings. Clean and drape both femoral areas after exposure. The groins are anaesthesised with 1% Lignocaine. Introduce a 5 Fr sheath in the right femoral artery and a 6 Fr sheath into the right femoral vein. Perform saturation and pressure run in all the chamber of the right heart and left atrium with 6 Fr NIH catheter. Perform an aortogram with pigtail catheter and identify PDA. Measure PDA size, select appropriate coil or device, attach to the delivery system and introduce through RFA with the help of Torcon catheter or delivery system, which is previously placed in the main pulmonary artery/aorta through PDA. Delivery cable is then forwarded to MPA for a coil, two loops are Cardiac Interventions, Hardware and Implants released and then the delivery cable is withdrawn to aorta and rest of the coil loops are released. For a device, aortic end released first to an aorta and pulled to ampulla followed by further pulling and release of a pulmonary end. Do an aortogram after 10 minutes to check complete occlusion. Place a GL catheter in the left upper pulmonary vein and pass a supper stiff wire secure in a branch vein preferably right upper pulmonary vein. Remove the catheter and sheath afterward, measure ASD size with a sizing balloon forwarding over the wire and inflate with a contrast of 1:8 dilution. Take both echo & fluoroscopy guide to see complete occlusion of ASD with sizing balloon. Measure balloon size in sizing plate with dye withdrawn previously. Select device same or 2 mm more. Introduce ASD device delivery sheath through guide wire to left atrium (LA) and remove dilator with wire. Attach ASD device to delivery cable through loader and then load. Connect loader to delivery sheath through a Touhy boost adaptor and forward device to LA. Release left atrial (LA) disc first followed by subsequent release of right atrial (RA) disc. The whole procedure is performed under echo and fluoroscopy guide and obstruction to surrounding structure overruled. Tug test should be performed then release device from delivery cable. Echocardiography should be repeated on the next day to see the result of an intervention.

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