Successful Transcatheter PDA Device Closure in an Adult with Retrograde Wiring and Antegrade Snaring Approach

Patent ductus arteriosus accounts for 5 – 10% of all congenital heart disease in children. Currently, transcatheter closure is standard of care. Device closure in PDA is usually done by an antegrade technique where PDA is crossed from the PA side. In some patients, this universal procedure may not be successful due to anatomical differences. In such patients, the retrograde technique with retrograde wiring and antegrade snaring approach followed by PDA device closure may be used successfully to close PDA. We report such a case of difficult PDA device closure where the antegrade technique was not successful and PDA device closure was completed by retrograde approach.

Percutaneous Balloon Mitral Valvotomy and Percutaneous Coronary Intervention of Left Anterior Descending Artery in Combined Procedure

In countries like India rheumatic heart disease (RHD) is still a common problem, and with improvements in diagnosis and treatment, the lifespan of these patients is increased. With increase in the lifespan, these patients may develop coronary artery disease (CAD) and present as acute coronary syndrome (ACS). In some cases especially RHD with severe mitral stenosis (MS), thrombus that develop in left atrium may embolize in one of the coronary arteries, leading to acute coronary syndrome. We report a case of 51 year old female who was a known case of rheumatic heart disease and now presented with acute coronary syndrome. Patient was hemodynamically unstable and underwent percutaneous balloon mitral valvotomy (PBMV) and percutaneous coronary intervention (PCI) simultaneously. We here discuss the possible complications that need to be addressed in such scenario and how can we approach such cases. This is first of such intervention at our institute and also there are very few such records available online. Patient tolerated the procedure well with significant clinical improvement.