VSD Device Closure
Device Closure of Ventricular Septal Defect with Muscular Occluder
Indication:
Muscular VSD Device.
Equipment:
1. Muscular VSD device
2. VSD device delivery system with sheath.
3. Terumo exchange wire
4. Arterial and venous sheath
5. JR catheter
6. Pigtail catheter
7. Snare catheter
8. Echocardiography machine with TFE probe.
9. Standard Pediatric drape.
Procedure:
A 6F sheath should be introduced in right Jugular vein, 5F sheath to right femoral vein and 4F sheath to right femoral artery. A pigtail angiogram of the left ventricle (LV) to be performed to see the size of VSD. AJR 4 catheter then passed from RFA to LV and VSD should be crossed with Terumo wire and JR catheter. Terumo wire should be placed to the main pulmonary artery (MPA) and snared with a snare catheter passed through the right Jugular vein to MPA. Terumo wire should then be withdrawn through the right Jugular vein with the help of snare. A long transseptal sheath or delivery system of appropriate size should be forwarded over terumo guide to RA to RV to LV. A VSD mid muscular device should be loaded in the loader with the help of the delivery cable. The loader then attached to long sheath and cable forwarded through the sheath to LV. LV disc should be released under TEE/TTE and Fluoroscopy guide. Delivery cable with sheath then withdrawn to RV and RV disc should be released. A pigtail angiogram of LV should be done to confirm complete closure. Sheath and pigtail should be removed. A patient should be heparinized during a procedure and injectable antibiotic (e.g Cefuroxime 15-mg/kg body weight 8 hourly) is given IV after deployment of the device and continued for 24 hours. Echocardiography on next morning should be done. A patient may be discharged 3 days after the procedure. Follow up appointment should be given at 1, 3, 6, 9, 12, 18, 24, months and yearly thereafter.
Animation
Real-time Video
Device Closure of Perimembranous Ventricular Septal Defect (VSD) with PM VSD Occluder
Indication: Large Perimembranous VSD.
Equipment’s required:
1. Perimembranous VSD device
2. Torque delivery system
3. Terumo exchange wire
4. Noodle’s wire
5. Arterial and venous sheath.
6. JR-4 catheter
7. Pigtail catheter
8. Snare catheter
9. Standard pediatric drape
10. Echocardiography machine with TEE probe.
Procedure:
A 6 Fr sheath should be introduced to right femoral vein and a 5 Fr sheath to right femoral artery. A pigtail angiography of left ventricle (LV) should be performed to locate VSD and measure the size of it. A JR-4 catheter should be used with Terumo wire guide to cross VSD. JR-4 then forwarded to main pulmonary (MPA) and terumo wire should be changed with noodle wire. Noodle wire later snared from MPA with the help of snare catheter and pulled out through right femoral vein. Amplatzer torque delivery sheath of required size should be introduced through right femoral vein over the noodle wire. Delivery sheath should be advanced to aorta, then dilator should be withdrawn for a short distance and sheath was rotated clockwise and withdrawn backwards to drop it to LV facing towards apex. An appropriate device should be selected for the particular case and should be loaded to loader with the help of delivery cable and Pusher catheter. Delivery system should be forwarded to LV. LV disc to be released first then whole system should be withdrawn to RV and RV disc should be released. Both fluoroscopy and TEE/ TTE guide should be taken during deployment then Pusher catheter is withdrawn backwards and device released by counter clockwise rotation of delivery cable. A pigtail LV graphy should be done to confirm complete occlusion of VSD. Patient should be heparinized with 100 unit/ Kg heparin before deployment of device. Injectable antibiotic (e.g Cefuroxime 15-mg/kg body weight 8 hourly) is given IV and continued for 24 hours. Echocardiography should be repeated on next morning. Patient should be discharged three days after the procedure and follow up appointment should be given at 1, 3, 6, 9, 12, 18, 24 months and yearly thereafter.
Animation
https://youtu.be/2WvZ0nlFNnA
