Successful Transcutaneous Closure of Atrial Septal Defect
[ Congenital Heart Disease ] [A Nanavati Hospital ]

Dr. Bharat Dalvi, Dr. Rita Dixit

Department Of Cardiac Surgery

Mr KP is a 43 yrs old Bank manager with high blood pressure of a few yrs duration.

In Oct 03 he developed severe back pain for which he was hospitalized and given traction for suspected prolapsed disc. A few months later he started developing severe cough for which a chest X-rays was ordered. This revealed a large shadow on the left side. A CT scan revealed this to be an aneurysm (swelling) of the descending thoracic aorta. The aneurysm measured at 7.4 cms in its widest part. The scan also revealed a tear in the descending aorta which extended up to the arteries in his legs. This is classified as Debakey IIIB type of dissection. His blood pressure was controlled with medication. As his aneurysm continued to increase in size he was advised surgery or endovascular repair of the dilated segment.

The advantages and risks of both these procedure were discussed with the patient and his wife. After much discussion and thought they elected for an endovascular repair of his aneurysm.

Further investigation including a repeat CT angio and a conventional aortogram were performed. This data was sent to the stent graft manufacturer (Cook Inc), to help them design and manufacture a stent graft for this patient. It was ready in 4 weeks.

On 4/8/04 the patient was admitted for this procedure. The procedure was performed in the cardiac cath lab by Cardiologist Dr Suresh Vijan, Radiologist Dr Girish Warvedakar and Cardiac surgeon DR Pawan Kumar. The whole procedure was performed under local anaesthesia through a cut in the right femoral artery. A 24 FR stent graft (Zenith, Cook Inc) was positioned to occlude the tear in the descending aorta, after the origin of the left subclavian artery. The stent was 130 mm in length. The stent completely blocked the mouth of the dissection and excluded the dilated aneurysmal segment, allowing blood to flow into the descending aorta. Further study revealed retrograde filling of the abdominal aorta dissection though the iliac tear. This was closed with the implantation of two covered stents in the iliac arteries.

The whole procedure was completed in 3 hours, under local anaesthesia. The patient was transferred to the ICU for monitoring. He is now fully mobile and walking around in the hospital. He is expected to be discharged by 9/8/04.