Dr. Padmanabhan MD,DM,MD,DM

KIMS Hospital HyderabadKIMS Hospital, Hyderabad

19 yr old/Female19 yr old/FemaleAcyanotic CHD - RSOV rupture in RV, VSD with Severe ARwith Severe ARPost ICR + AVR (26/11/08) 27 St. Judes ProstheticProstheticSevere Paravalvular leakH l ti iHaemolytic anaemia

Present History :Present History :C/o SOB FC II x 6 months.Palpitations since 6 monthsPalpitations since - 6 months.Giddiness during sitting position

P HiPast History :K/C/O CHD - RSOV, VSD, Severe AR.

Patient was admitted with SOB & Palpitation and evaluated.and evaluated.2D Echo & TEE done which showed large paravalvular leak at two sites pAfter workup Device closure of paravalvular leak planned, patient was electively intubated

d l dand ventilated.

Approach :Right Femoral & Left Femoral arterialarterial

Pressures :Femoral Art –170/60 (96) Sheath Used:6F 7F sheath & 9F Long sheathSheath Used:6F, 7F sheath & 9F Long sheathDevice Used:10 -12mm Lifetech PDA occluder

& 6 8mm Cardi O Fix (Lifetech) PDA& 6 - 8mm Cardi-O-Fix (Lifetech) PDA occluder

A l t k 25 6F (EV3)Amplatzer gooseneck snare 25mm,6F (EV3)

Aortic root angiogram-paravalvular leak Crossing of paravalvular leak with sheath

10-12 PDA deployed Recrossing thru second leak

Second 6-8 PDA device deployed Embolization of second PDA device

Retrival of embolized PDA device with snare Device trapping in aorta bifurcation

Chop stick technique to retreive device for aorta bifurcation

Better to use VSD muscular device/ ADO IIBetter to use VSD muscular device/ ADO II or vascular plug Type II or Type III in aortic paravalvular leaksparavalvular leaksAlways little oversize the defect as these defects are not circulardefects are not circularBe ready for snaring whenever necessary