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TCTAP C-108 . Presentation

Presenter

Sunip Banerjee

Authors

Sunip Banerjee1

Affiliation

SG Cardiac Care, India1,
View Study Report
TCTAP C-108
STRUCTURAL HEART DISEASE - Others (Structural Heart Disease)

Multiple Intervention as a Sequle of Infarct

Sunip Banerjee1

SG Cardiac Care, India1,

Clinical Information

Patient initials or Identifier Number

G Pan

Relevant Clinical History and Physical Exam

Patient (54 yrs/Female) had a MI and presented with postMI angina on 27.07.2015
•CAG revealed MVD and patient went through CABG on 03.08.2015
•Patient readmitted with newly developed chest discomfort on 03.02.2016
•CAG revealed LIMA-> LAD occluded. Asub-mitral aneurysm was noted.
•PTCA was done and  LAD was stented on 05.02.2016.
•Patient still had persistent symptom (with preserved EF) in spite of maximum medical management.
•Cardiac MRI was advised on 28.11.2019.



Relevant Test Results Prior to Catheterization

MRI on 05/12/2019:    Indication: Inferior Wall Aneurysm.    Finding: LVEF-56%, No LVOT obstruction. No LVH. An aneurysm of size 3.2 x 2.5 x 2.4 cm with neck size is seen arising from basal & mid inferior wall. The RV is Normal with preserved systolic function.Normal atrial diameter. No LV thrombus.Lungs and mediastinum are within normal limits.
MRI 01.wmv
MRI 02.wmv
MRI 03.wmv

Relevant Catheterization Findings

CAG revealed:Patent stent in LAD and patent SVG graft in PDA.
Catheterization (1).mp4
Catheterization (2).mp4
Catheterization (3).mp4

Interventional Management

Procedural Step

Produre name: LV aneurysm closure performed under GAClinical presentation: Recent acute coronary syndromeAccess: Right femoral artery- arteriotomyHeparin: 5000 IUCatheter: 5F JR.3.0Wire: 0.035" Teremu wire, 0.035" Exchange length Amplatzer wireDevice: 26 mm. Cere ASD Occluder.Delivery system: 12F Steer Ease Introducer.Haemodynamic Data: SPO2- 100%, Hb-11.1Procedure: Arteriotomy of right common femoral artery done and steer Ease Introducer was taken up to Ascending aorta. 5F JR-3.0 diagnostic catheter was taken to cross the aortic valve and engage the LV aneurysm. Then Amplatzer wire was placed into LV aneurysm. The 12F Steer Ease Introducer was taken over the Amplatzer wire and 5F JR 26 mm Cere ASD Occluder device was deployed and released after confirming its position by TEE. Post procedure LV angiogram showed occluder device was correctly position and no residual leak/aneurysm expansion was seen.Arteriotomy closed and patient was extubated on table.
Device closure (1).mp4
Device closure (2).mp4
Device closure (3).mp4

Case Summary

Conclusion:There is significant discrepancy in sizes via various imaging modalities, which makes sizing challenging.Tiding over this problem by oversizing may not be feasible as the disc on ventricular side may impinge on mitral leaflets/ subvalvular apparatus.Sizing also involves assessment of depth of aneurysm.Mostly ASD closure devices are appropriate choices. 

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TCTAP 2021 Virtual Apr 12, 2021
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