Đóng thông liên thất loại không có gờ động mạch chủ bằng dụng cụ ADO II

Transcatheter closure of VSD deficient aortic rim using ADO II device Nguyen Van Hieu Nguyen Lan Hieu Vietnam Heart Institue Outline VSD deficient aortic rim Can VSD deficient aortic rim be closed by device ? How to use ADO II device to close VSD deficient aortic rim? Our study results VSD deficient aortic rim  What is VSD deficient aortic rim?  How about treatment ? Ventricular septal defect (VSD) VSD deficient aortic rim Perimembranous VSD without aortic rim Subarterial VSD illustration of VSD deficient aortic rim Subarterial VSD Perimembranous VSD without aortic rim Risk AR of VSD deficient aortic rim AR Natural history of subarterial VSD Study: 214 pts 73% of 139 asymptomatic pts develop AVP 80% of pts with AVP develop AR AVP and AR: – year: 8% – years: 30% – 10 years: 64% – 15 years: 83% Lun K, Li H, Leung MP et al; Am J Cardiol 2001; 87(11): 1266-1270 Which choice for treatment ? Instruments • Crossing catheter (soft tip) – JR 3.5; – IMA – Cut Pigtail • • • • Terumo exchange guide wire Snare Delivery catheter : – Fr TOE or TTE Device size selection Waist size of ADO II device ≥ B + 0.5 or mm Our study results Indications for intervention • Significant VSD: Symptomatic without irreversible pulmonary HTN – – – – – – Qp/Qs > 1.5 PA systolic pressure > 50 mmHg Increased LV and LA size Deteriorating LV function Perimembranous VSD with more than mild AR History of IE • Subarterial VSD – high incidence of aortic valve prolapse / AR Exclusion criteria • • • • • • Pts can’t adapt the criteria above Active endocarditis or evidence of bacteremia Coagulation disorders Presence of intra cardiac mass or vegetation Pregnancy, allergic Calculated pulmonary vascular resistance > Wood units Our Study • 28 pts: subarterial VSDs and 19 pm VSDs without aortic rim • Age: – 47 yrs • Weight 36,9 ± 17,9 kg • Implanted in centers (4/2015 – 6/2016) • Follow up: months – years Early results Results Pts (n = 28) % Successfully implanted Failure 27 96,42 2,58 Severe complication (ischemic stroke) Mild complication PAC Failure: Unfixation ADO II 6-6 due to underestimated the sizes of defects Ischemic stroke: Lack of heparin Follow up Before procedure (n=28) After procedure (n=27) 48,15 % months (n=24) 12 months (n=11) 12,5% 9,1% (17,86%) (14,81%) (20,83%) (18,2%) (3,7%) 0 No No No No Shunt Minor AR Moderate AR Severe arrhythmia Conclusion • It is feasible to close VSD deficient aortic rim by device • Using ADO II device has demonstrated efficacy and safe in short – term outcome • Further data are necessary to assess the long term outcomes THANKS FOR YOUR ATTENTION ! ... can close VSD deficient aortic rim by device! How to use ADO II device to close VSD deficient aortic rim? Amplatzer duct occluder (ADO) II device Theory: The pm VSD form look like type A of PDA... ! ADO II - Advantages • Softer (No polyester patch) • Designed for flexibility • Retention disc: Raise aortic valve • Small delivery system • CHB has not been reported • Ease of deployment ADO. ..Outline VSD deficient aortic rim Can VSD deficient aortic rim be closed by device ? How to use ADO II device to close VSD deficient aortic rim? Our study results VSD deficient aortic rim  What