Page 32 - Journal of Structural Heart Disease Volume 5, Issue 2

45 Case Report
Figure 3. Transesophageal echocardiogram of Cardioform Deployment via right internal jugular vein (Panel A). Transesophageal echocardiogram of full Cardioform Deployment (Panel B).
output by Fick of 6.87 L/min and a left atrial pressure of 8mmHg.
An IMA catheter was advanced over a J-wire into the right atrium and the J-wire was then exchanged to an angle glidewire (Terumo®, Somerset, NJ). Un- der fluoroscopic and TEE guidance, the PFO was crossed with some difficulty using the glidewire into the left pulmonary vein. The IMA catheter was then exchanged to a 4Fr glide catheter (Terumo®) across the PFO tunnel into the pulmonary vein. The glide- wire was then exchanged to a 300 cm 0.014 mailman guide wire (Boston Scientific, Marlborough, MA) and using the manipulation of the glide catheter, the wire was directed into the LV for better support and favor- able angulation. The mailman wire was exchanged to Extrastiff 260 cm 0.038 Amplatzer wire (Cook Medical, Bloomington, IN). The glide catheter was removed carefully under fluoroscopic guidance. The Cardio- form occluder was chosen because it is felt to have less risk of erosion and less rigidity to accommodate the anatomy as well as the delivery of the occluder. Due to the angulation, it was decided to use the 9Fr
AGA Amplatzer Occluder deliver system (St. Jude Medical-St. Paul, MN) with modification to accommo- date the Cardioform optimum delivery. The 30 mm Cardioform (WL. Gore Medical) was prepped in the usual manner and after carefully removing it from the delivery system; it was carefully advanced over into the LV via customized Amplatzer delivery system. Un- der fluoroscopic and TEE guidance, the cardioform was advanced and deployed across the PFO with ex- cellent results (Figure 3a and Figure 3b). TEE showed successful closure of the PFO without shunt by color doppler (Figure 4). The cardioform was released and locking mechanism was confirmed (Figure 5). Sever- al bubble saline injections were completed without signs of a residual shunt.
Three days later, she successfully underwent a mini- mal approach trans-femoral transcatheter aortic valve replacement (TF-TAVR) using a 23mm Sapien S3 valve (Edwards LifeScience) that was followed by her radical nephrectomy 5 days later with excellent result. During the 3 months follow up, she continues to do well.
Al Danaf J. et al.
PFO Closure for Primary Prevention