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ASD procedure.pptx
- 3. Procedure • Patient Selection • Cath lab • Sedation/Anaesthesia • Echo Guidance • Access • Hardware • Delivery system • Other considerations
- 4. Other consideration • Hemodynamic assessment • Qp/qs, PVR/SVR, PVR • mPAP • LVEDP • Balloon sizing
- 5. Cath lab • Single plane cath lab • Furnished with all necessary equipment • May have to deal with unexpected technical challenges and complications • Device stock • Retrieval equipment: snares, bioptomes • Surgical backup
- 6. Sedation/Anaesthesia • In Children usually general anaesthesia (GA) or Total Intraventous anesthesia (TIVA) • Also depends on use of TTE, TEE or ICE (not available in Nepal) • In adolescents and adults, local anaesthesia (LA) is good enough if the procedure is under TTE guidance
- 7. Intraprocedural Echo • TTE or TEE in our scenario (@ SGNHC) • Mostly we use TTE (>90% cases) • TEE is useful where TTE image is suboptimal or when you are in doubt or for doing complex ASDs • Echo shows • Device position and stability • Capture of rims • Behaviour of device during wiggling • Adjacent struture like SVC, IVC and pulmonary veins • AV valve regurgitation • Pericardial Effusion
- 8. Access • Usually femoral venous access is sufficient (e.g., 6 Fr. RFV sheath). • Arterial access if arterial pressure needs to be monitored or for hemodynamic evaluation • Heparin 100 U/kg • IV antibiotics – e.g. Cefazolin
- 9. Hardware • Right coronary catheter (JR) or Multipurpose (MP) catheter • Floppy tip terumo wire • Exchange length Amplatz super stiff wire
- 10. Crossing through ASD by floppy wire followed by JR catheter Parking of amplatz exchange length stiff wire
- 11. Crossing the ASD by JR catheter with out wire Trying to park into pulmonary vein
- 12. Removing the JR catheter Exchange with Long sheath with dilator
- 13. Delivery system • Differs with device size and brand • It’s recommended to see product catalog MEMOPARTTM ASD OCCUDER Long (delivery) sheath Dilator Delivery cable Device loader Y-connector
- 15. Flushing the delivery system Removing the dilator and wire under water
- 16. Removing the stiff wire along with dilator The Sheath now ready to take device
- 18. Confirm the device position and adjacent structure by ECHO TTE TEE
- 20. Releasing the device Checking stability
- 21. Thank you
Editor's Notes
- Classification of rims around the ASD. A. Rim toward the coronary sinus B. Inferior-posterior rim (toward the inferior vena cava) C. Posterior rim (toward the pulmonary veins) D. Superior-posterior (toward the superior vena cava) E. Anterior-superior (toward the aorta) F. Inferior (toward the AV valves).