A NOVEL APPROACH FOR AN EXCEPTIONAL CONDITION
“PUMPLESS” KEYHOLE ASD HYBRID DEVICE CLOSURE IN A PREGNANT LADY
(First of its kind in India)

Unusual circumstances call for innovative ideas and more so, when it comes to save lives. This is such a case where the doctors at Global Health City, Chennai were confronted with a rare medical condition that tested their ultimate expertise and gave them an unspeakable pleasure of achievement.
31 yrs old Intisar Kareem Naser from Iraq had an episode of minor Cardiac stroke along with seizures and transient weakness of the left hand. The diagnosis revealed that she was having a 25 mm Atrial Septal Defect (ASD) with transient Ischemic attack and Paradoxical embolism. She was advised to undergo the ASD closure procedure in Iraq. But, the challenging part was that she was into her third month of pregnancy and the operation could prove fatal for the unborn baby.
In an emotional despair Ms. Intisar & her husband Mr. Akran approached Global Heal City, where their case was reviewed by Dr. Nandkishore Kapadia (Senior Consultant & Cardiac Surgeon) and Dr. R. Ravikumar (Senior Consultant & Interventional Cardiologist). There was a brainstorming on the treatment approach with a sole objective to save both the lives i.e. the mother and the child. The traditional Open Heart surgery on Cardiopulmonary Pump was ruled out because of high risk of blood loss, which might lead to abortion. Closure of ASD in Catheterization laboratory was also considered to be risky; since, it could bring about radiation induced anomalies in the unborn child.
After much deliberation, the experts decided upon a unique approach; Hybrid Device Closure of the ASD through a small (2 inch) incision in the right chest (4th ICS) and deployment of a 28 mm ASD Device, which is a Double disc mesh made of NITINOL.
The patient was put under anaesthesia and a 4 cm incision was made in the left chest for passing the device. First, the ASD device was loaded into a 14F sheath and the sheath was used to move the device across the ASD through a Small Pin sized incision made in the Right Atrium. The device was opened on both sides of the septum and released under Echo Guidance. Bleeding was controlled using a Purse string suture. The passage of the Sheath and Device was monitored using a NOVEL ECHO probe attached to patient’s chest during operation.
The operation lasted for 45 minutes. After deployment of the device, anaesthesia was reversed and the patient was extubated in the Operation Theatre itself. The child was safe. There was no need for blood transfusion during the whole operation and also, because of the cosmetic incision, the visibility of the scar was also minimized.
Ms. Naser was under observation in the ICU for a day and then she was shifted to the ward. The recovery from such a major operation was very fast and she was on her feet the third day.