PP-151 THE SAFETY AND EFFICACY OF THE ANGIO-SEAL CLOSURE DEVICE IN DIAGNOSTIC AND INTERVENTIONAL CARDIOLOGY SETTING: PRELIMINARY RESULTS OF SINGLE-CENTER EXPERIENCE WITH 551 CLOSURES

Abstract

Methods: A 70 year old man who presented with a history of class II heart failure was found to have a left ventricular pseudoaneurysm. Cardiac magnetic resonance angiography and echocardiography showed a large pseudoaneurysm with a neck of approximately 24 mm, and a high velocity bi-directional jet between the posterolateral wall of the left ventricle (LV) and a vast sump. Hand contrast angiography together with conventional angiography confirmed a communication between the LV cavity and a large false cavity. A trans-septal catheterization was deemed suitable as the delivery catheter length would preclude a femoral arterial approach. Results: A 24 mm Amplatzer sizing balloon was advanced into the pseudoaneurysm cavity which sized the orifice at 22 mm. A 10 French Amplatzer sheath was passed through the defect and a 26 mm Amplatzer septal occluder was deployed across the defect (1F). We noticed a collapse in the center of the discus deployed on the ventricular site suggesting that the design of the device may not be strong enough to withstand the pressure difference. Upon release of the delivery system, the device was dislocated. We attempted to retrieve the device with a snare catheter but we were unsuccessful. Afterwards the patient was given to surgery for device removal, and pseudoaneurysm resection. Unfortunately he died during early post-operative period. Conclusions: The novel and important aspects of our intervention is that a femoral vein approach with trans-septal puncture is safe and effective for percutaneous closure of a left ventricular pseudoaneurysm. We recommend a gentile Minnesota maneuver to be employed just to make sure releasing the delivery system is safe. A different Amplatzer device with a more robust design on one discus, which would be deployed on the ventricular site could be more appropriate for closure of a larger left ventricular pseudoaneurysm.