Right upper pulmonary vein technique easily deploys ASD device when the conventional technique fails repeatedly. If the second attempt to deploy the device fails, I move to right upper pulmonary vein technique. We do all ASD device with just fluoro and TTE guidance, not TEE.

In all adults we do TEE before planning device closure of ASD. Never do in small kids. Inside the cath lab, we seldom do TEE as GA is unimaginable in our set up.

Same here

Neat!

Could I aska for a technical tip ? How do you make sure that the tip of occluder is in right upper pulmonary vein, not forcing right atrial wall ?

When it goes beyond the cardiac silhouette easily while turning the shaft of the sheath clockwise and advancing it little bit, we will be in right upper pulmonary vein

But is checking this with that stiff tip safe ?

As the device itself is a soft structure, that tip won’t create issues I hope. We have been doing ASDs over these years with only fluoro and transthoracic guidance as it is very difficult to get GA here due to work overload of anaesthesia dept. Over more than 1000 ASDs in last two decades, a good number deployed by right upper pulmonary vein technique. Not even a single perforation I can recollect. maximum 8-10 device embolisations, that too just because someone tried to do cases with inadequate rims.

Thank you very much

Here, most of the ASD DC are done under TEE and GA. For large ASDs also TTE good enough?

When there is no anaesthesia for intraprocedural TEE, can’t afford ICE what to do? CVTS is also work overloaded. So we do a meticulous preprocedural TEE in echo room for all adults ASDs. That case selection is crucial. If the rims are inadequate, or any suspicion in findings they all go for surgery straight away. Survive with whatever we have is our policy.

Beatiful 👏🏻 Amplatzer ASD? And what is the size of the device?

Sir please explain the sequence of movements at delivery cable and sheath, you do after the LA disc is there in RUPV....???

Do you use ICE?

@AbdulbaqiMd Can’t afford. Used only once. Everything is free here under government scheme, so we have restriction in using costly accessories