PFM Medical Nit-Occlud Le VSD Mode D'emploi page 14

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Fig. 14: Final coil configuration
Once the coil has acquired its optimum form, follow the subsequent steps as described for membranous VSDs (❼).
Technical Complications and Their Prevention
The technical complications described below may be prevented by observing the following rules:
• A lways use Touhy-Borst Y-connectors to prevent undesirable component movement.
• A ll components should be repeatedly flushed with a heparinised physiological saline solution to prevent them from
becoming stuck. This applies particularly during protracted interventions.
• Maintaining the straightest possible alignment of components during the procedure will reduce frictional resistance
to a minimum.
Failure of the Coil Release Manoeuvre
The following are possible reasons for failure of the coil release manoeuvre:
• T he coil may jam in the implantation catheter in the case of a lengthy implantation procedure and if there has been
insufficient flushing with heparinised saline solution.
• T he coil has not been pushed far enough out of the implantation catheter. The connection point between the coil and
delivery system may still be in the implantation catheter.
The distal section of the delivery system should be pushed out of the implantation catheter immediately prior to detach-
ment. If the coil is "jammed", however, the entire product should be removed and replaced. Flush the catheter of the
replacement coil continuously to minimise friction or obstructions in the system due to blood clotting.
Coil Causing an Embolism
Coils may cause an embolism in the following situations:
• Coil too small for the defect size. This causes the coil to migrate, and then create an embolism.
• Coil is released in error before it has reached its final position.
• Coil is pulled against excessive resistance, and comes away from the delivery system.
If an embolism is created, attempt an intervention to remove the coil via the vascular system. Possible methods for snar-
ing and retrieving a coil include the use of loops, snares or baskets. If this is not possible, an emergency operation must
be carried out.
Protrusion/Obstruction
Windings protruding into the left-ventricular outflow tract or into the tricuspid valve may lead to blood flow disturbance
or valve insufficiency. Because of the shape memory properties of the material, the coil tends to revert to its original
configuration whenever possible, retracting its windings and/or pressing them against the septum.
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Fig. 15: Coil release
GA053/Rev02_2019-04-18