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. 2017 Aug;8(4):154-160.
doi: 10.14740/cr568w. Epub 2017 Aug 23.

Safety and Feasibility of Transcatheter Interruption of Ruptured Sinus of Valsalva Aneurysm Using the Cocoon Duct Occluder: Immediate Results and Mid-Term Follow-Up

Santosh Kumar Sinha  1 , Narendra Nath Khanna  2 , Mahmadula Razi  1 , Vinay Krishna  1 , Mukesh Jitendra Jha  1 , Vikas Mishra  1 , Puneet Aggarwal  1 , Amit Goel  1 , Karandeep Singh  1 , Ramesh Thakur  1 , Lawrence Rajan  3 , Chandra Mohan Varma  1
Affiliations

Safety and Feasibility of Transcatheter Interruption of Ruptured Sinus of Valsalva Aneurysm Using the Cocoon Duct Occluder: Immediate Results and Mid-Term Follow-Up

Santosh Kumar Sinha et al. Cardiol Res. 2017 Aug.

Abstract

Background: Limited data are available regarding safety and feasibility of transcatheter interruption of ruptured sinus of Valsalva aneurysm (RSOVA) using the Cocoon duct occluder (CDO) with immediate and mid-term follow-up result.

Methods: Transcatheter closure (TCC) was successfully done among eight patients, whereas five cases, not amenable to TCC, were referred for surgical correction among 13 consecutive patients of RSOVA at LPS Institute of Cardiology, Kanpur between January 2010 and March 2015.

Results: Their mean age was 26.1 ± 6.9 years. Sites of rupture were from right coronary sinus (RCS) to right atrium (RA) in one (12.5%), right ventricle in one (12.5%), and non-coronary sinus to RA in six patients (75%). The defects (9 - 17 mm) were closed by CDO (12/10 - 20/18 mm) with 100% procedural success. During follow-up (9 - 26 months), there was no residual shunt, progression of AR, infective endocarditis or device embolization.

Conclusion: TCC of RSOVA appears to be a safe and feasible alternative to surgical therapy, with high technical success and excellent mid-term follow-up.

Keywords: Amplatzer duct occluder; Cardiac device; Cocoon duct occluder; Endocarditis; Sinus of Valsalva aneurysm; Transcatheter closure.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
TTE view showing SOVA arising from right coronary cusp into right ventricle (a, b); non-coronary cusp rupturing into right atrium on TEE view (c, d).
Figure 2
Figure 2
Antero-posterior view showing SOVA from NCC rupturing into RA (a). Right anterior oblique view showing SOVA from RCC rupturing into RV (b).
Figure 3
Figure 3
Fluoroscopic view showing wire being snared from right atrium (a), right ventricular outflow tract (b), arterio-venous loop (c), and delivery sheath seen into ascending aorta (d).
Figure 4
Figure 4
Aortic root angiogram showing right coronary artery arising above the defect (1); CDO attached to cable with aortic end in right coronary cusp (2).
Figure 5
Figure 5
Periprocedural TEE to see degree of aortic leak (a); para-device leak (b); peri devise leak (c); and final position post deployment (d).
Figure 6
Figure 6
CDO attached to cable with aortic end in right coronary cusp (a); aortic root angiogram to confirm any residual leak (b); final position of deployed device (c); and CDO attached to cable positioned across the RSOVA from right coronary cusp opening into right ventricle (d).
Figure 7
Figure 7
Cocoon duct occluder (a) and retention diameter at aortic and pulmonary end (b).
See this image and copyright information in PMC

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