PFM Medical Nit-Occlud Le VSD Mode D'emploi page 9

Fig. 03: Crossing the VSD
• I n some cases, a membranous VSD can be probed directly from the right ventricle, e.g. with a right-coronary Judkins®
catheter (JR). In this scenario, it is possible to advance the guide wire from the right ventricle into the ascending aorta
and position the long sheath for the implantation procedure without forming an arteriovenous loop. Often, however,
the membranous defect can be probed only from the left ventricle, making the formation of an arteriovenous loop
unavoidable.
• ( Fig. 03) Start forming the arteriovenous loop by advancing a right-coronary 4F Judkins® catheter (JR) or, if applicable,
an internal mammary catheter (IM) via the left femoral artery until it enters the left ventricle, using a soft-pointed
guide wire. Insert the excess-length guide wire (e.g. 0.035" / 260 cm) through the VSD and out into the pulmonary
artery (or the superior vena cava). The guide wire should traverse the VSD with a slightly cranial orientation, to make
it easier to advance it into the pulmonary artery. This precaution is important in order to prevent the guide wire cross-
ing under the moderator band (Trabecula septomarginalis). The use of an angled wire is therefore recommended (e.g.
Terumo® angled wire).
• ( Fig. 04) Via the femoral vein, advance a 6F or 7F end-hole balloon catheter as far as the pulmonary artery or superior
vena cava. If the interior lumen of this catheter is large enough to accommodate the pfm medical Multi-Snare® loop,
the loop may now be inserted immediately. If the interior lumen is too small for the snare loop, replace with a suitable
end-hole balloon catheter.
Fig. 05: Snaring the wire
• ( Fig. 05) Then insert the multi-snare loop via the vein, snare the guide wire placed in the pulmonary artery or vena
cava, and pull it out via the access in the right femoral vein. This creates an arteriovenous guide wire splint.
• ( Fig. 06) Remove the end-hole balloon catheter or venous catheter and advance the JR catheter on the left side, via the
guide wire, through the VSD until it enters the inferior vena cava.
GA053/Rev02_2019-04-18
Fig. 04: Advancing of end-hole balloon catheter
Fig. 06: Advancing the catheter into the inferior vena cava
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