Page 37 - Journal of Structural Heart Disease Volume 2, Issue 1

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Slide # 61:
Air embolism:
– Evident by ST segment changes (left frame).
– Usually transient (right frame)
– Can be avoided by consciously avoiding inject- ing air through peripheral lines and checking for adequate back ow of blood from catheters and sheaths placed in the left atrium/pulmonary vein.
Slide # 65:
Device embolization:
– Rare complication (0.55%) [24]
– Usually occurs in those with large ASD and de- cient rims. Can embolize to either side of the
Original Research Report atrial septum (left frame: ASO embolized to the
right ventricle; Video 46)
– Majority do not cause acute hemodynamic
collapse
– Most can be snared and retrieved percutane- ously (right frame: ASO being retrieved from the descending thoracic aorta; Video 47); principles of percutaneous device retrieval have been well described in the literature [25]
Slide # 68:
Use of ultrasound contrast agent during echocardiography can help diagnose cardiac ero- sion. The above video depicts absence of leak of con- trast agent into the pericardial space after appearing in all the four cardiac chambers (Video 48). Pa- tient was managed medically with close supervi- sion to observe for any evidence of hemodynamic compromise or increase in the amount of pericardi- al e usion. The e usion reduced gradually followed by complete disappearance on medical manage- ment.
Acknowledgements
The authors would like to thank Dr. Larry Latson for providing an image for this article.
Con ict of Interest
Bharat Dalvi is a consultant for St. Jude Medical.
Comment on this Article or Ask a Question
Video 48.
Absence of leak of contrast agent into the peri- cardial space after appearing in all the four cardiac chambers. View supplementary video at http://dx.doi.org/10.12945/j. jshd.2016.007.14.vid.48.
References
1. King TD, Mills NL. Non-operative closure of atrial septal defects. Surgery. 1974;75:383– 388.
2. Feltes TF, Bacha E, Beekman RH 3rd, Cheatham JP, Feinstein JA, Gomes AS, et al.Indications for cardiac catheter- ization and intervention in pediatric car- diac disease: A scienti c statement from the American Heart Association. Circula- tion. 2011;123:2607–2652. DOI: 10.1161/
CIR.0b013e31821b1f10
3. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, et al. ACC/ AHA 2008 guidelines for the management of adults with congenital heart disease. J Am Coll Cardiol. 2008;52:e143–263. DOI: 10.1016/j.jacc.2008.10.001 and 10.1016/j. jacc.2008.10.002
4. Webb G, Gatzoulis MA. Atrial septal de- fects in the adults: Recent progress and
overview. Circulation. 2006;114:1645– 1653. DOI: 10.1161/CIRCULATIONA- HA.105.592055
5. Jung JW. Echocardiographic evaluation of atrial septal defect device closure. J Cardio- vasc Ultrasound. 2007;15:1–7.
6. Vaidyanathan B, Simpson JM, Kumar RK. Transesophageal echocardiography for de- vice closure of atrial septal defects: Case se- lection, planning, and procedural guidance.
Jain, S. et al.
Catheter closure of atrial septal defect