conference presentation of your reseach

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Cardi o-fix device for post mi vsd singapur

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conference presentation of your reseach

  1. 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. 2. Device Closure Of Ventricular Septal Defect after 3 Weeks of Coronary Angioplasty.
  3. 3. HAPPY NEWYEAR 2012 Dr Barik.
  4. 4. CLINICAL HISTORY  60 YR/M, SMOKER, NON-DM, NON-HTN  AWMI +STK+ ON 1.8.2011 WITHIN WINDOW PERIOD OF 4 HRS AT A DISTRICT HOSPITAL  SOB AT REST  ON DAY 3-(3.8.2011)- PSM  ECG –AWMI  2D ECHO- VSD ; MODERATE LV DYSFUNCTION  REFERRED TO OUR HOSPITAL FOR FURTHER MANAGEMENT
  5. 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. 6. 12 LEAD ECG12 LEAD ECG: TACHYCARDIA; Q – V1-V4
  7. 7. 2D/3D-ECHO -04.08.2011 RWMA + ( LAD TERRITORY HYPOKINETIC), ANTERO-APICAL VSD OF SIZE 10 mm, LVEF-35%, DIASTOLIC DYSFUNCTION +, NO PE, NO CLOT.
  8. 8. 2D ECHO –APICAL 4CVSD -1.8CMFROM APEXTOWARDS BASE
  9. 9. COLOUR DOPPLER – 4C :VSD
  10. 10. COLOUR COMPARISION
  11. 11. COLOUR COMPARISION
  12. 12. CAG + CATH (4.8.2011): Hb-14gm%, with BMI- 22.03kg/m2; O2 CONS-200/MT SVC - 50 % RA – 2 MM HG IVC - 76% RV – 20/0-4 MVO2 - 56.5% PA – 20/12 ,15 RA - 62% PCWP - 17 RV - 83% LV -100/0-8 PA - 80% FA – 100/70 FA - 92%  Qp/Qs - 1.86:1
  13. 13. LAD -LESION
  14. 14. RCA NORMAL
  15. 15. LV ANGIO-SINGLE MUSCULAR VSD
  16. 16. PLAN:Follow Guidelines? PTCA TO LAD ? PTCA+VSD CLOSURE ? STAGED PROCEDURE ? SURGERY ?
  17. 17. PTCA TO LADENDEAVORRESOLUTE 3X15MM
  18. 18. SSH ARE YOUR IDEA DPL EASE-IDEAL VSCLOSING TIME
  19. 19. DEVICE OPTIONAmplatzer VSD Occluder-FAD APPROVED Cardi-O-Fix from Starway Medical Technology,Inc.
  20. 20. DELIVERY SYSTEM
  21. 21. Cardi-O-Fix 10mm device through 9 Fr sheath
  22. 22. ARTERIO-VENOUS LOOPTERUMO- J-TIPPED- 0.35”X 260 CM
  23. 23. SNARING IN PAAMPLATZERGOOSE-NECK10MMSNARE;MICROVENA CORPO.
  24. 24. DELIVERY SHEATH ACROSS VSD12 Fr x1800 CURVESTARWAY MEDICALTECH.
  25. 25. VSD OCCLUDERCARDIO-O-FIX14 M.[STARWAYMEDICAL].
  26. 26. AFTER RELEASE
  27. 27. ECHO AFTER 3MONTHS
  28. 28. REVIEW OF LITERATURE
  29. 29. 1. Crenshaw BS, Granger CB, Birnbaum Y, Pieper KS, Morris DC, Kleiman NS, et al. Riskfactors, angiographic patterns, and outcomes in patients with ventricular septal defectcomplicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinaseand TPA for Occluded Coronary Arteries) Trial Investigators. Circulation 2000;101:27-32.2. 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 deathand long term results. Eur J Cardiothorac Surg 2002;21:725-31.3. Butera G, Chessa M, Carminati M. Percutaneous closure of ventricular septal defects.State of the art. J Cardiovasc Med 2007;8:39-45.4. Ahmed J, Ruygrok PN, Wilson NJ, Webster MW, Greaves S, Gerber I. Percutaneousclosure of post-myocardial infarction ventricular septal defects: a single centre experience.Heart Lung Circ 2008;17:119-23.5. Martinez MW, Mookadam F, Sun Y, Hagler DJ. Transcatheter closure of ischemic andpost-traumatic ventricular septal ruptures. Catheter Cardiovasc Interv 2007; 69:403-7.
  30. 30. 6. Goldstein JA, Casserly IP, Balzer DT, Lee R, Lasala JM. Transcatheter closure ofrecurrent postmyocardial infarction ventricular septal defects utilizing the Amplatzerpostinfarction VSD device: a case series. Catheter Cardiovasc Interv 2003;59:238-43.7. Caputo M, Wilde P, Angelini GD. Management of postinfarction ventricular septal defect.Br J Hosp Med 1995;54:562-6.8. Hachida M, Nakano H, Hirai M, Shi CY. Percutaneous transaortic closure ofpostinfarctional ventricular septal rupture. Ann Thorac Surg 1991;51:655-7.9. Thiele H, Kaulfersch C, Daehnert I, Schoenauer M, Eitel I, Borger M, et al. Immediateprimary transcatheter closure of postinfarction ventricular septal defects. Eur Heart J 2009;30:81-8.10. Lee EM, Roberts DH, Walsh KP. Transcatheter closure of a residual postmyocardialinfarction ventricular septal defect with the Amplatzer septal occluder. Heart 1998; 80:522-4.
  31. 31. CASE REPORTA 61-year-old male, hypertensive and diabetic for the past 20 years, was brought tocoronary care unit in CCF. He had sustained an anterior wall MI the previous day and wasthrombolyzed with streptokinase. On admission, pulse rate was 110/min and BP was130/90 mm Hg. Auscultation revealed ……………….. Ajit S. Mullasari,*MD,et.al.MMM,Chenai.Catheterization and Cardiovascular Interventions 54:484–487 (2001)
  32. 32. Between Sep.2003 and Feb. 2008, 29 consecutive patients underwent primarytranscatheter VSD closure. Clinical, procedural, and outcome data were collected.Patients were divided into those with and those without cardiogenic shock atpresentation for risk stratification. The median follow-up time of surviving patients was 730 days. The median timebetween 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 deviceembolization 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
  33. 33. 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
  34. 34. THANK U GIVING ME THIS OPPORTUNITY TO TO SHARE.

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