Preparing The Patient - PFM Medical Nit-Occlud Le VSD Mode D'emploi

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P D
Fig. 01: D = distal, P = proximal
Determination of Coil Size
The distal diameter (D - left ventricular side) (Fig. 01) of the coil should be selected as at least twice the minimal diameter
of the VSD (Fig. 02) (a) (on the right-ventricular side), and equal to or 1–2 mm greater than the diameter of the VSD at the
left-ventricular opening (b). Assessment of the size of the VSD becomes more difficult where a septal aneurysm is also
involved, particularly in the case of a complex VSD with more than one opening on the right side. In this situation, coil
selection has to be carried out solely on the basis of the left-ventricular diameter (b) of the aneurysm. The closure of a
perimembranous VSD with a pronounced aneurysm does not require the observation of any specific distance from the
aortic valve. The coil selected should fill the aneurysm without projecting into the left-ventricular outflow tract.
Ref. No:
Diameter distal (D)
Diameter Proximal (P)
Recommended long sheath
Tab.: Selection of the Nit-Occlud® Lê VSD
Auxiliary Imaging Procedures
Closure of the VSD should be carried out in the cardiac catheterisation laboratory with radiology and echocardiography
support. Correct implantation of a Nit-Occlud® Lê VSD coil requires transoesophageal echocardiography (TOE), transtho-
racic echocardiography (TTE) or a similar imaging procedure. If a TOE is used, it is important to ensure that the patient's
oesophageal anatomy allows the placement and manipulation of the ultrasonic probe.
Closure of a Perimembranous or High Muscular VSD
❶

Preparing the Patient

• T he intervention is normally performed under general anaesthetic. Strong sedation and local anaesthetic may be suf-
ficient in some cases, following careful verification.
• Heparinise the patient to achieve an activated clotting time (ACT) on coil implantation of 200–250 sec.
• Administer prophylactic antibiotics.
❷
Preparing Vessel Access
• T he standard procedure is access with a 4 F or 5 F sheath via the left femoral artery, and with a 6 or 7 F sheath via the
right femoral vein. Haemodynamic parameters should be determined with a normal right and left cardiac catheterisa-
tion examination. Take a left-ventricular angiogram with lateral beam projection and/or left anterior oblique (LAO).
Measure the VSD over its maximum extent in the optimum profile.
8
149086V1 149106V1
8 mm 10 mm
6 mm 6 mm
6 F 6 F
a
Fig. 02: a = right ventricular opening,
b = left ventricular opening
149126V1 149128V1
12 mm 12 mm
6 mm 8 mm
6 F 7 F
b
149148V1 149168V1
14 mm 16 mm
8 mm 8 mm
7 F 7 F
GA053/Rev02_2019-04-18