Innovative Stent-Graft Closure of Complex Sinus Venosus Atrial Septal Defect: A Non-Surgical Approach
Introduction
Atrial Septal Defect (ASD) is a congenital condition characterized by an opening in the septum between the heart’s two upper chambers (atria). This defect can lead to abnormal blood flow between the chambers, potentially causing complications such as heart enlargement, arrhythmias, and pulmonary hypertension over time. While ASDs can be closed through catheter-based devices or surgery, certain cases present unique challenges due to the location of the defect. In such complex scenarios, tailored approaches are crucial to ensure safe and effective closure, emphasizing the importance of advanced cardiac care and multidisciplinary expertise.
Case Presentation
A 48-year-old female presented with progressive breathing difficulty. Initial evaluations at another hospital revealed a large ASD located in a way that presented a high risk of blood flow obstruction if closed using conventional devices. Generally surgery is recommended for holes at such locations, however the patient was strongly inclined to avoid it. At Yashoda Hospitals, our Cardiology and Cardiac Surgery teams reviewed her case and explored a device-based closure strategy, implementing an innovative, non-surgical approach using stent graft to close the defect without surgery.
Diagnostic Assessment
Pre-procedure a detailed transesophageal echo and a cardiac CT scan was performed to confirm the ASD’s size, location, and proximity to the right upper pulmonary vein. Detailed imaging helped identify a safe path for the stent graft while minimizing the risk of venous obstruction. An interdisciplinary discussion followed with the involvement of interventional cardiologists, cardiac surgeons, anesthesiologists, and radiologists to finalize a treatment plan.
Treatment Approach
After comprehensive planning and obtaining the patient’s consent, the team proceeded with a non-surgical approach to close the ASD. The procedure, led by Dr. Bharat Vijay Purohit, Senior Consultant Interventional Cardiologist and Director of the Cath Lab, involved the use of a 25x50mm stent graft to seal the ASD while ensuring unimpeded pulmonary venous drainage. The procedure steps included:
- Balloon occlusion test to check the closure of the stent graft and the unimpeded pulmonary venous flow.
- Positioning the 25x50mm stent graft with precision to close the ASD and avoid obstructing the pulmonary vein.
- Placing the device under imaging guidance to achieve exact placement and optimal stability.
- A collaborative team, including cardiology, anesthesiology, and critical care experts, monitored the process to ensure rapid intervention for any potential complications.
Outcome
The procedure was successfully completed, with the ASD closed using the stent graft, and no pulmonary vein obstruction was observed. The patient showed improved oxygen saturation and cardiac function and experienced no postoperative complications. She was closely monitored in the ICU and later discharged in stable condition, with instructions for follow-up care.
Discussion
The unique ASD location in this patient necessitated an innovative approach to avoid surgical correction due to the risk of pulmonary vein obstruction. Although non-surgical, the use of a 25x50mm stent graft was challenging due to the defect’s complexity. This case highlights the value of multidisciplinary teamwork, advanced imaging, and custom-tailored care planning in managing intricate cardiac cases.
Conclusion
This case underscores the importance of advanced facilities, expertise, and a coordinated team effort in treating complex ASDs with minimally invasive solutions. The approach at Yashoda Hospitals provided a solution that aligned with the patient’s preferences, ensuring both safety and effective cardiac function. The successful outcome demonstrates the role of innovative, personalized treatment in modern cardiology.
About Author –
Dr. Bharat Vijay Purohit, Senior Consultant Interventional Cardiologist and Director of the Cath Lab at Yashoda Hospitals, Hitec City
MD, DM, FSCAI (USA)
