PROCEDURE FOR VSD

DEVICE CLOSURE
DISCRIPTION

 A ventricular septal defect (VSD) is a hole or a defect in the septum that

divides the 2 lower chambers of the heart, resulting in communication
between the ventricular cavities.
 A VSD may occur as a primary anomaly, with or without additional major
associated cardiac defects, It may also occur as a single component of a wide
variety of intracardiac anomalies, including tetralogy of Fallot (TÖF),
complete atrioventricular (AV) canal defects, transposition of great arteries,
and corrected transpositions.
ARTICLES NEEDED

 - PUNCTURE NEEDLE-(18 G OR 20 G) SHEATH INTRODUCER 11CM-2( 5F OR 6F)

 -FOR ARTERY AND VEIN CATHETER JR 3.5 (5F OR 6F)
 - CATHETR PIGTAIL GUIDEWIRE TERUMO 035*150 J TIP GUIDEWIRE TERUMO 035*260 J
TIP GUIDEWIRE
 TEFLON 035 15O J TIP SNARE CATHETER
 STIFF TEFLON WIRE 035 260 J TIP
 LONG SHEATH WITH DILATOR
 DEVICE DELIVERY CABLE
 CATHLAB KIT WITH KIDNEY TRAY SET 3 WAY WITH PRESSURE LINE
 Y CONNECTOR WITH EXTENSION
 - PRESSURE INJECTOR AND SYRINGE
PREPARATION OF STERILE TROLLY

 Sterile Scrubbing, Gowning and Gloving Preparation of sterile trolley

Antimicrobial painting( From umbilicus to middle of thigh) Draping the patient
in such a way that inguinal fold lies diagonal to the hole Load 10 ml of
xylocaine in BD syringe Load Heparin 5000iu According to patient's weight) in
2ml syringe Flush the puncture needle sheath, dilator catheters and guide
wire.
Procedure:

 . Puncture the femoral artery and vein with puncture needle (18 GX 7CM)
Introducing 0.035"Teflon introducer wire Removing puncture needle Making a
small incision with scalpel blade no 11 > Introducing sheath with dilator.
 Remove the dilator with wire & flush the sheath with heparinised saline
Administer 5000 iu according to the weight of the patient) heparin /A through
the sheath.
 Insert the JR catheter through the femoral vein sheath and cross the
ventricular septal device with the help of terumo wire.
 - Pass a different JR catheter through the femoral artery sheath to the Left
ventricle and snaring the wire by using a special catheter known as snare to
make it a arterial venous loop.
 - Exchange the wire with a Long sheath which is compactable with the Device
 > Preload the Device in a sheath by using the delivery cable. Push the device
through the long sheath and position the device in the defect.
 - Deploy the device with the guidance of echocardiogram and adequate
fluoroscopy.
 . - Remove the sheath and compress the site till bleeding stops. - Pressure
dressing to be applied to avoid bleeding complications.
COMPLICATIONS:

 Infection,
 postoperative bleeding requiring exploration,
 - valve injury (tricuspid, pulmonary, or aortic),
 - Pulmonary hypertension with poor cardiac output,
 - AV heart block,
 - Residual VSD with continued left-to-right shunting,
 > Death