Description of Event or Problem · 1
DESCRIPTION OF THE INTERVENTIONAL PROCEDURE: A TRANSCATHETER CLOSURE OF THE SECUNDUM ATRIAL SEPTAL DEFECT: THE BASELINE TRANSESOPHAGEAL ECHO DIAMETER OF 11 X 14 MM AND STRETCH DIAMETER OF 15 MM ON ECHO AND ON FLUOROSCOPY 18.4 MM WAS THERE. BASED ON THIS DIAMETER, 30 MM HELEX SEPTAL OCCLUDER WAS ELECTED TO BE PLACED. DEVICE WAS INSPECTED, FOUND TO BE IN EXCELLENT CONDITION. IT WAS PLACED UNDER WATERSEAL AND LOADED INTO THE CATHETER WITH METICULOUS DEBUBBLING ALONG THE WAY. A 6-FRENCH CATHETER WAS PLACED INTO THE LEFT UPPER PULMONARY VEIN AND AMPLATZ SUPER-STIFF WIRE WAS PLACED. AFTER PLACEMENT OF THE WIRE, THE 6-FRENCH SHEATH AND THE BERMAN WEDGE CATHETER WAS TAKEN OUT OVER THE WIRE LEAVING THE WIRE IN PLACE. THEN SMALL SIZING BALLOON WAS INTRODUCED AND STRETCH DIAMETER OF THE ASD WAS DONE WITH A STOP FLOW TECHNIQUE. THE BALLOON WAS THEN INFLATED SEVERAL TIMES INTO THE INFERIOR VENA CAVA BEFORE THAT SO AS TO DISLODGE ANY BUBBLES THAT NIGHT BE ADHERENT TO THE SURFACE OF THE BALLOON. THEN THE DEFLATED BALLOON WAS ADVANCED ACROSS THE ATRIAL SEPTUM AND GENTLY INFLATED UNTIL WE SAW LOSS OF FLOW ON COLOR DOPPLER EVALUATION. THE BALLOON WAS TAKEN OUT LEAVING THE WIRE IN PLACE. THE 12-FRENCH SHEATH WAS PLACED INTO THE GROIN OVER THE WIRE LEAVING WIRE STILL IN THE LEFT UPPER PULMONARY VEIN. THEN THE HELEX 30 MM DEVICE WAS PLACED OVER THAT WIRE WITH A RAILROAD TECHNIQUE AND THE ATRIAL SEPTAL DEFECT WAS CLOSED WITH THAT WIRE AND THE WIRE WAS REMOVED. THE LEFT ATRIAL DISK OF THE DEVICE WAS CONFIGURATED INTO THE LEFT ATRIUM. SUBSEQUENTLY, THE DISK WAS PULLED TO THE SEPTUM AND THE RIGHT ATRIAL DISK WAS CONFIGURED. IMMEDIATELY AFTER THAT DEVICE WAS LOCKED WITH A LOCKING MANEUVER, IT MAINTAINED ITS POSITION AND LOOKED STRAIGHT ON FLUORO AS WELL AS ON THE ECHOCARDIOGRAPHY. THERE WAS A SMALL RESIDUAL LEAK FROM THE SUPERIOR ASPECT OF THE DEVICE BY THE SVC BUT IT WAS VERY INSIGNIFICANT AMOUNT BY ECHOCARDIOGRAPHY. THERE WAS NO IMPEDIMENT ON MITRAL VALVE, TRICUSPID VALVE OR AORTIC ROOT. AFTER CONFIRMING THAT THE RETRIEVAL SLING WAS RETRIEVED AND THE DEVICE WAS CHECKED AGAIN TO BE IN A GOOD POSITION AND CONFIGURATION. THERE WERE NO COMPLICATIONS. ON FOLLOW UP ECHOCARDIOGRAM THE NEXT DAY IT SHOWED THAT THE HELEX DEVICE WAS PARTIALLY PROLAPSED FROM ITS SUPERIOR ASPECT. SUPERIOR LA DISK WAS PROLAPSED INTO THE RIGHT ATRIUM. THE HELIX WAS RETRIEVED AND AN AMPLATZ SEPTAL OCCLUDER PLACED WITHOUT FURTHER COMPLICATION.