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CASE20191031_038
| STRUCTURAL HEART DISEASE - Congenital Heart Disease (ASD, PDA, PFO, VSD) | |
| Successful Percutaneous Closure of a Ruptured Sinus of Valsalva Aneurysm Under Heart Navigator Using the Amplatzer MVSD Occluder | |
| Igor V. Buzaev1, Alexander Grigoryevich Osiev2, Vladimir V. Plechev3, Irina Evgenievna Nikolaeva3, Gulchachak Khalikova1, Azamat R. Ismagilov3, Ramil Ildusovich Izhbuldin4, Ilina Ramilovna Yalaletdinova4 | |
| Bashkir State Medical University, Russian Federation1, MEDSI Clinical and Diagnostic Centre, Russian Federation2, Republican Cardiology Center, Russian Federation3, Republic Heart Centre, Russian Federation4, | |
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[Clinical Information]
- Patient initials or identifier number:
kh6279
-Relevant clinical history and physical exam:
35 years old female patient arrived to our clinic in August 2019 suffering from dyspnea during light physical activity. She felt ill in December 2018 when these symptoms appeared. The symptoms became worse last months. The systolic-diastolic murmur has been found during the physical examination.
   -Relevant test results prior to catheterization:
ECG: heart rate 104, signs of right chambers dilatation. The echocardiography showed a moderate dilation of right chambers and left ventricle, a bag-shape deformation of the non-coronary sinus wall with shunt from aorta to the right atrium. The diagnosis has been confirmed with multislice contrast CT scan. This scan was used to select the shape and size of the occlusion device.
  fig3_heartnavi planning.jpeg- Relevant catheterization findings:
We used Philips Heart navigator prior to the operation to plan the intervention, access, and choice of the device as well as to receive a better understanding of the anatomy. The software creates an automatic segmentation of the heart CT scan and helps to choose the fluoroscopy agents, and shows if the catheter can pass the target zone. On the aortography the shunt diameter was 4,7 mm.
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[Interventional Management]
- Procedural step:
Local anesthesia was applied. The femoral vein and femoral artery were used as access points with 6F sheaths. Multipurpose catheter from arterial side was passed to the right atrium from aorta under fluoroscopy via rupture. The Heart Navigator helped to understand the location for the shunt using the 3d model layered over the real-time fluoro. We passed Amplatz guidewire 260 cm 0,35 to the inferior vena cava. Then we captured the venous tip of the wire with the loop. The wire has been withdrawn from vein sheath. The heart segment of the wire was covered with MPA catheter during manipulation. 6F delivery system passed to the aorta from femoral vein side touching the MPA catheter to preventing the possible damage to the heart structures caused by the metallic wire. Then the wire was withdrawn. 6 mm Memopart MVSD was passed to the aorta and the first disk was opened. The delivery system moved back a little bit to let the disk touch the sinus and aortography was performed to check its position. The echocardiography and aortography control were performed after positioning the device and then the device was detached. The symptoms significantly receded after the procedure and the patient was discharged without any troubles on the third day. We provided a follow-up in October 2019 (in 1 month). There were no device related problems, symptoms were resolved and the chambers enlargement was reduced to normal.    - Case Summary:
Percutaneous closure of a ruptured sinus of Valsalva aneurysm is a good treatment option. The shape of the Memopart MVSD occluder fitted perfectly the purpose of closure in our case. HeartNavigator system is useful during the planning and performing stage of treatment.
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