1. Speaker’s name: Dr Ramachandra Barik,
Assistant professor
Department of cardiology
Nizam’s Institute of Medical science.
Hyderabad
INDIA.
I do not have any potential conflict of interest

2. Device Closure Of Ventricular Septal Defect after 3 Weeks of Coronary Angioplasty.

3. HAPPY NEW YEAR 2012
Dr Barik.

4. CLINICAL HISTORY
60 YR/M, smoker, non-dm, non-htn
AWMI +stk+ on within WINDOW Period OF 4 HRS at a district hospital
SOB AT REST
On day 3-( )- PSM
Ecg –AWMI
2d echo- VSD ; moderate lv dysfunction
referred to our hospital for further management

5. ON EXAMINATION-
Killip ii & angina at rest
BP: 100/70 mmHg, pulse :109/min, RR: 22/min, afebrile
JVP: normal, lv – S3+, psm iv/vi
Room air arterial sat. 95%
Other systems : B/L basIlliar crepts

6. 12 LEAD ECG
12 LEAD ECG: TACHYCARDIA; Q – V1-V4

7. 2D/3D-ECHO
RWMA + ( LAD TERRITORY HYPOKINETIC),
ANTERO-APICAL VSD OF SIZE 10 mm,
LVEF-35%,
DIASTOLIC DYSFUNCTION +,
NO PE, NO CLOT.

8. 2D ECHO –APICAL 4C
VSD -1.8CM FROM APEX
TOWARDS BASE

9. COLOUR DOPPLER – 4C :VSD

10. COLOUR COMPARISION

11. COLOUR COMPARISION

12. CAG + CATH ( ):
Hb-14gm%, with BMI kg/m2; O2 CONS-200/MT
SVC %
IVC %
MVO %
RA %
RV %
PA %
FA %
RA – 2 MM HG
RV – 20/0-4
PA – 20/12 ,15
PCWP - 17
LV -100/0-8
FA – 100/70
Qp/Qs :1

13. LAD -LESION

14. RCA NORMAL

15. LV ANGIO-SINGLE MUSCULAR VSD

16. PLAN:Follow Guidelines?
PTCA TO LAD ?
PTCA+VSD CLOSURE ?
STAGED PROCEDURE ?
SURGERY ?

17. PTCA TO LAD
ENDEAVOR RESOLUTE 3X15 MM

18. SHARE YOUR IDEAS PLEASE-IDEAL VSD CLOSING TIME

19. DEVICE OPTION
Amplatzer VSD Occluder-
FAD APPROVED
Cardi-O-Fix from Starway
Medical Technology,Inc.

20. DELIVERY SYSTEM

22. Cardi-O-Fix 10mm device through 9 Fr sheath

24. ARTERIO-VENOUS LOOP
TERUMO- J -TIPPED ” X 260 CM

25. SNARING IN PA
AMPLATZER GOOSE-NECK 10MM SNARE;MICROVENA CORPO.

26. DELIVERY SHEATH ACROSS VSD
12 Fr x1800 CURVE STARWAY MEDICAL TECH.

27. VSD OCCLUDER
CARDIO-O-FIX
14 M.[STARWAY MEDICAL].

28. AFTER RELEASE

29. ECHO AFTER 3MONTHS

30. REVIEW OF LITERATURE

31. 1. Crenshaw BS, Granger CB, Birnbaum Y, Pieper KS, Morris DC, Kleiman NS, et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation 2000;101: Labrousse L, Choukroun E, Chevalier JM, Madonna F, Robertie F, Merlico F, et al. Surgery for post infarction ventricular septal defect (VSD): risk factors for hospital death and long term results. Eur J Cardiothorac Surg 2002;21: Butera G, Chessa M, Carminati M. Percutaneous closure of ventricular septal defects. State of the art. J Cardiovasc Med 2007;8: Ahmed J, Ruygrok PN, Wilson NJ, Webster MW, Greaves S, Gerber I. Percutaneous closure of post-myocardial infarction ventricular septal defects: a single centre experience. Heart Lung Circ 2008;17: Martinez MW, Mookadam F, Sun Y, Hagler DJ. Transcatheter closure of ischemic and post-traumatic ventricular septal ruptures. Catheter Cardiovasc Interv 2007; 69:403-7.

32. 6. Goldstein JA, Casserly IP, Balzer DT, Lee R, Lasala JM
6. Goldstein JA, Casserly IP, Balzer DT, Lee R, Lasala JM. Transcatheter closure of recurrent postmyocardial infarction ventricular septal defects utilizing the Amplatzer postinfarction VSD device: a case series. Catheter Cardiovasc Interv 2003;59: Caputo M, Wilde P, Angelini GD. Management of postinfarction ventricular septal defect. Br J Hosp Med 1995;54: Hachida M, Nakano H, Hirai M, Shi CY. Percutaneous transaortic closure of postinfarctional ventricular septal rupture. Ann Thorac Surg 1991;51: Thiele H, Kaulfersch C, Daehnert I, Schoenauer M, Eitel I, Borger M, et al. Immediate primary transcatheter closure of postinfarction ventricular septal defects. Eur Heart J 2009; 30: Lee EM, Roberts DH, Walsh KP. Transcatheter closure of a residual postmyocardial infarction ventricular septal defect with the Amplatzer septal occluder. Heart 1998; 80:522-4.

33. CASE REPORT
A 61-year-old male, hypertensive and diabetic for the past 20 years, was brought to coronary care unit in CCF. He had sustained an anterior wall MI the previous day and was thrombolyzed with streptokinase. On admission, pulse rate was 110/min and BP was 130/90 mm Hg. Auscultation revealed ……………….. Ajit S. Mullasari,* MD,et.al.MMM,Chenai.
Catheterization and Cardiovascular Interventions 54:484–487 (2001)

34. Between Sep.2003 and Feb. 2008, 29 consecutive patients underwent primary transcatheter VSD closure. Clinical, procedural, and outcome data were collected. Patients were divided into those with and those without cardiogenic shock at presentation for risk stratification.
The median follow-up time of surviving patients was 730 days. The median time between VSD occurrence and closure was 1 day [interquartile range (IQR) 1–3]
the initial procedural success rate was 86%.
The shunt (Qp:Qs) could be reduced from 3.3 (IQR 2.3–3.8) to 1.4 (IQR 1.2–1.7; P , 0.001)
Procedure-related complications such as major residual shunting, LV rupture, and device embolization occurred in 41%. The overall 30-day survival rate was 35%.
Mortality was higher for cardiogenic shock in comparison to non-shock patients (88 vs. 38%, P , 0.001).
Holger Thiele1*,et.al

36. TAKE HOME MESSAGE USE OF CARDIO-O-FIX DEVICE
INITIAL PTCAGAP OF 3 WEEKSVSD CLOSURE
AVOIDANCE OF GA,TEE,BALLOON SIZING.
NOT USED ANY STIFF GUIDE WIRE
MAKE THE PROCEDURE AS SIMPLE AS POSSIBLE WITH LEAST EXPENDITURE

37. THANK U GIVING ME THIS OPPORTUNITYTO
TO SHARE.