Objective: To analyse the results of percutaneous closure of secundum atrial septal defect by using transthoracic or transesophageal echocardiographic guidance.
Transcatheter device closure of secundum atrial septal defect is a well known option since 1974. The procedure is routinely performed through femoral vein approach but rarely inferior venacava (IVC) may be interrupted or blocked so transfemoral approach cannot be an option in these patients. In such rare cases surgical closure can be performed but in cases of percutaneous closure of secundum atrial septal defect the viable options are transjugular and transhepatic routes. We used transhepatic approach in this patient for device closure of secundum atrial septal defect. A 27mm occluder was used for the defect and two flipper free coils were used to seal the tract and there were no major complications. The patient was discharged home after 36 hours of the procedure with normal liver functions and ultrasonography.
Pseudoaneurysm of ascending aorta is potentially fatal but well-recognized and infrequent complication after cardiac surgeries. The presentation can be varied and may develop early as in our case or may develop even after years. Our patient had VSD closure along with RV band Resection four month earlier to the development of pseudoaneurym. Transcatheter device closure was performed with 24mm atrial setal occluder without any procedural complication. To the best of our knowledge this is the largest device ever used for closure of post surgical pseudoaneurysm.
We report a technically difficult retrieval of embolized Atrial Septal Defect device from left atrium. Device was captured after multiple attempts using different types of snares and was brought to inferior vena cava without delivery sheath. As we were unable to slenderize the device into short sheath, it was finally retrieved using an unconventional and innovative technique.We emphasize the importance of safe improvised methods during challenging catheterization procedures resulting in successful outcomes.
Recent increase in deployment of trans-catheter devices such as septal or ductal occluding coils and devices has been a possible risk factor for infective endocarditis, predominantly in the initial post deployment period before endothelialization has ensued. Though a long-term study of trans-catheter Atrial Septal Defect (ASD) closure revealed no cases of Infective Endocarditis, some case reports of endocarditis in trans-catheter device closure of ASD, VSD and Patent ductus arteriosus(PDA) advocate that residual defect after device occlusion may be a factor in the risk for Infective Endocarditis. We herein describe the case of a 9-month-old female patient who underwent device closure for peri-membranous ventricular septal defect (VSD) and developed fungal infective endocarditis in early post occlusion period which was confirmed on blood culture. Despite treatment with appropriate antifungal as per sensitivity, clinical condition of the patient deteriorated and it was decided to manage her with surgical explanation of device and closure of defect.
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