Dr. Amir Solhpour, interventional cardiologist and Director of the Structural Heart Program at Adventist Health Glendale discusses the successful closure of a highly complex 34 mm atrial septal defect (ASD) in a middle-aged female patient. Dr. Solhpour outlines the anatomical challenges of the case, his stepwise problem-solving approach, and the advanced techniques used to achieve a successful outcome for a patient referred following two failed closure attempts at other institutions.
This case underscores Adventist Health Glendale’s capacity to manage complex structural heart interventions.
I'm Doctor Amir Solur, um, interventional cardiologist and director of uh structural heart program at Adventist Health Glendale, and I'm here since 2018. When I finished my training in Houston, I was, uh, working there for two years, uh, as a faculty and then moved to, uh, Los Angeles in Glendale in 2018. And, and since then I have the privilege of working here with uh other colleagues in Adventist Health Glendale. So we have more than 120 hospitals in Greater Los Angeles County. It's good to say that in terms of the number of the, let's say for instance micro clip that we do, we are number 4 in Southern California, not just in. Basically Los Angeles and we also do a a very high number of the transcortic valve replacement and watchman procedures and patients who are at high risk, there are a lot of features that when we do these procedures, we do the CT scan. And based on the anatomy and the distances of the coronary artery to the valve, some of them become very complex and risky procedures, so you should be well trained to be able to have a strategy how you are going to handle that without having that risk. And if a complication happens. In the procedures, what is your approach and what is your plan A, Plan B, Plan C? There was a case that there was a young, relatively young lady housekeeper I remember that had a very big hole between the two upper chambers of the heart. Usually when you have a smaller hole, it's very routine that we go through the groin and put a patch and Close that hole, but that was at least 34 mm 3.4, 3.5 centimeter hole, and because of the anatomy, it was very challenging to close that and uh this patient was in two hospitals before in the Los Angeles area and um she went underwent the procedures but it was failed so they were not able to close it successfully. So she came to my office and she was very symptomatic, having shown up with the exertion. And dilated the right side of the chamber of the heart, which both of these are indication to proceed with the closure and so um I reviewed the echocardiogram and then I talked to the patient. Of course there is always a chance of failure, but to me it was very. doable and it was very reasonable to proceed and give it a try and when we did it successfully, we were able to close the hole with a patch and then we used the largest patch available in the market to be able to close that hole. And she was discharged the following day, came to the office, was very happy and already saw her a few weeks ago, and she's doing very well. There are a lot of procedures that I like to do and I was trained for, but if I want to pick up one or two, I would say mitral clip is one of the. Top procedures that I'm interested in and the reason for that is that you need to have a very good understanding of the three dimension of the heart. So the 3D dimension also physics and at the same time the hemodynamics of the patient, and the beauty of that is that these patients are mostly elderly. They can be in mid 80s or even 90s, and they are not. A good candidate for open heart surgery, but they can undergo the surgery and they stay in the hospital just one night and they get discharged the following day and the recovery is very fast and always tell the patients, so when we do the procedures on Thursday, 99% of the people get discharged by Friday noon and if you have a party or you need to go to a restaurant, you can go on Saturday or Sunday, so you don't need to change your schedule.
