Deepak Talreja, MD, FACC, FSCAI

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Presentation transcript:

Deepak Talreja, MD, FACC, FSCAI Nurses Week Celebration CRT 2013 Source of Embolus? Deepak Talreja, MD, FACC, FSCAI

Deepak Talreja, MD Honoraria: Abbott Vascular GlaxoSmithKline Bristol-Myers Squibb Sanofi Pharmaceuticals Partnership AstraZeneca Merck and Company, Inc. Sanofi-Aventis St. Jude Medical, Inc.

History 70 yo female transferred from OSH with sudden onset complete bilateral blindness.

History (cont) 70 yo female transferred from OSH with sudden onset complete bilateral blindness. Head CT scan – multiple areas of cortical infarct bilaterally and encephalopmalasia

Source of Embolus?

Past Medical History Hypertension Diabetes Mellitus on insulin Dyslipidemia Hypothyroidism Obesity

Past History H/O Syncope with 3rd degree CHB treated with PPM (2007, OSH) Two separate prior CVA: Cryptogenic ischemic CVA 2006 Postoperative CVA (2007) with hemorrhagic transformation – left frontal lobe infarct with hemiparesis; SNF rehab.

PPM Implant 2007 Complicated procedure (5 hours) Initial question of arterial access – venograms performed by implanting EP and surgeon called in consultation Transient asystole Two atrial leads failed to capture with severe TR, question of crossing PFO entertained; but third lead did capture with good thresholds

CXR

CT Chest

Echocardiogram Normal EF 45-50% without WMA C/w Left sided implant with leads seen in Ao and LV Moderate AI around LV lead

Cardiac Catheterization

DX: Left sided PPM Implant via Left Subclavian artery with LV apical Lead and atrial lead inserted in distal LM/LCX So what now?

Options On-Pump, Lead and device extraction and repair Minimally invasive options?

1. New Pacer Implant on R given CHB

2. Operation: Draped in OR – ready to crack chest – pacer pocket opened and left sided PPM explanted. Vasc Surgery obtained brachial access with cutdown. Balloon used to tamponade while pacer leads extracted. Covered stent deployed in LSCA to cover access site Repeat angiography showed patent cors