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Doost A, Chilmeran A, Gomes A, Dworakowski R, Eskandari M, MacCarthy P, Cockburn J, Byrne J, Hildick-Smith D. Single arterial access closure of post-infarction ventricular septal defect: A case series. Catheter Cardiovasc Interv 2023; 101:209-216. [PMID: 36478105 DOI: 10.1002/ccd.30510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/23/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Post-infarction ventricular septal defect (PIVSD) carries a very poor prognosis. Surgical repair offers reasonable outcomes in patients who survive the initial healing period. Percutaneous device implantation remains a potentially effective earlier alternative. METHODS AND RESULTS From March 2018 to May 2022, 11 trans-arterial PIVSD closures were attempted in 9 patients from two centers (aged 67.2 ± 11.1 years; 77.8% male). Two patients had a second procedure. Myocardial infarction was anterior in four patients (44.5%) and inferior in five cases (55.5%). Devices were successfully implanted in all patients. There were no major immediate procedural complications. Immediate shunt grade postprocedure was significant (11.1%), minimal (77.8%), or none (11.1%). Median length of stay after the procedure was 14.8 days. Five patients (55%) survived to discharge and were followed up for a median of 605 days, during which time no additional patients died. CONCLUSION Single arterial access for percutaneous closure of PIVSD is a good option for these extremely high-risk patients, in the era of effective large-bore arterial access closure. Mortality remains high, but patients who survive to discharge do well in the longer term.
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Affiliation(s)
- Ata Doost
- Department of Cardiology, King's College Hospital, London, UK
| | - Ahmed Chilmeran
- Department of Cardiology, Sussex Cardiac Centre, Brighton, UK
| | | | | | - Mehdi Eskandari
- Department of Cardiology, King's College Hospital, London, UK
| | | | - James Cockburn
- Department of Cardiology, King's College Hospital, London, UK
| | - Jonathan Byrne
- Department of Cardiology, King's College Hospital, London, UK
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Li Y, Song C, Sun K. Finite Element Analysis and Bench Testing of Ventricular Septal Defect Occluder. J Med Device 2022. [DOI: 10.1115/1.4054082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Complications after transcatheter closure of the ventricular septal defect (VSD) is significantly associated with the mechanical behaviour of the VSD occluder. This study aims to investigate the effect of structural parameters of the VSD occluder. A mechanical model of the VSD occluder was constructed by theoretical modelling. The mechanical properties of the VSD occluders with different braiding angles (30°, 45°, 60°), materials (nitinol (NiTi), polydioxanone (PDO)) and waist-heights (3 mm, 4 mm) were analysed and validated by bench tests. For the 30°NiTi, 45°NiTi, 60°NiTi and 45°PDO occluders, the bending angles at the waist under 1 mm radial shrinkage were 112°, 121°, 155° and 155°, respectively. And the maximum principal strains at the waist were 16.62%, 8.19%, 1.20%, and 0.66%, respectively. The maximum radial deformations with 0.5 rad axial bending at the waist were 1.73, 1.44, 0.41 and 1.68 mm, respectively. When the occluders were implanted into VSD with the mean thickness of 3.5 mm, high stress appeared at the margin and the contact area, and the area with the 3-mm-occluder was much larger. In conclusion, the 60°NiTi occluder showed better ability to fit the deformation of the defect than the other NiTi occluders, and the 45°PDO occluder performed better under compression conditions but poorly under bending conditions than the 45°NiTi occluder. The choice of the appropriate waist-height is beneficial to eliminate associative complication by reducing the contact stress.
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Affiliation(s)
- Yiming Li
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China; Department of Property Management, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China, 200092
| | - Chengli Song
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China, 200092
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Hildick-Smith D, Briceno N, Alsanjari O, Clesham GJ, Keeble T, Hill A, Gomes A, Cockburn J. Amplatzer Post-Infarction Ventricular Septal Defect Closure via Retrograde Transarterial Access: Easier and Better. STRUCTURAL HEART 2021. [DOI: 10.1080/24748706.2021.1894371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Azadgoli B, Munabi NCO, Fahradyan A, Auslander A, McCullough M, Aflatooni N, Davidson Ward SL, Kumar SR, Sanchez-Lara PA, Swanson J, Magee WP. Congenital Heart Disease in Patients With Cleft Lip/Palate and Its Impact on Cleft Management. Cleft Palate Craniofac J 2020; 57:957-966. [DOI: 10.1177/1055665620924915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate characteristics of congenital heart disease (CHD) in patients with cleft lip and/or palate (CL/P) and assess potential associations with cleft outcomes. Design: Retrospective review of all patients with CL/P who underwent primary cleft treatment from 2009 to 2015. Setting: Children’s Hospital Los Angeles, a tertiary hospital. Patients: Exclusion criteria included microform cleft lip diagnosis, international patients, and patients presenting for secondary repair or revision after primary repair at another institution. Main Outcomes Measured: Patient demographics, prenatal and birth characteristics, CL/P characteristics, syndromic status, postoperative complications, and other outcomes were analyzed relative to CHD diagnoses and management. Patients with CL/P with (+CHD) were compared to those without (−CHD) CHD using χ2 tests and analysis of variance. Results: Among 575 patients with CL/P, 83 (14.4%) had CHD. Congenital heart disease rates were significantly higher in patients with cleft palate (CP) compared to other cleft types (χ2, P = .009). Eighty-one (97.6%) out of 83 +CHD patients were diagnosed prior to initial CL/P surgical assessment. Twenty-three (27.7%) +CHD patients required surgical repair of 10 cardiac anomalies prior to cleft care. Congenital heart disease was associated with delayed CP repair and increased rates of fistula in isolated patients with CP. Conclusions: Congenital heart disease is known to be more prevalent in patients with CL/P. These data suggest the condition is particularly increased in patients with CP. Severe forms of CHD are diagnosed and treated prior to cleft care however postoperative fistula may be more common in patients with CHD. Therefore, careful attention is required for patient optimization and palatal flap dissection in patients with coexisting CHD and CL/P.
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Affiliation(s)
- Beina Azadgoli
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Naikhoba C. O. Munabi
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Artur Fahradyan
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, CA, USA
| | - Allyn Auslander
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, CA, USA
| | - Meghan McCullough
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | | | | | - S. Ram Kumar
- Heart Institute, Children’s Hospital Los Angeles, CA, USA
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | | | - Jordan Swanson
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, CA, USA
- Division of Research and Outcomes, Operation Smile International, Virginia Beach, VA, USA
| | - William P. Magee
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, CA, USA
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Bertrand PB, Grieten L, Smeets CJP, Verbrugge FH, Mullens W, Vrolix M, Rivero-Ayerza M, Verhaert D, Vandervoort PM. The figure-of-eight artifact in the echocardiographic assessment of percutaneous disc occluders: impact of imaging depth and device type. Echocardiography 2014; 32:557-64. [PMID: 25048733 DOI: 10.1111/echo.12685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Echocardiography is increasingly important in the guidance and follow-up of percutaneous transcatheter device closures. It was recently shown that the Amplatzer left atrial appendage occluder frequently presents as a figure-of-eight artifact due to interaction of device mesh and ultrasound waves. It remains unknown whether this can be translated to other types of disc occluders. Furthermore, the morphology of this figure-of-eight artifact appears to be different in the transesophageal and transthoracic image of the same device. The aim of this study was to evaluate the echocardiographic appearance of different types of disc occluders, and to clarify differences in morphology of the figure-of-eight artifact. METHODS A mathematical model of an epitrochoid curve was used for numerical simulation of disc occluder appearance at various imaging depths. In addition, an in vitro setup was used for echocardiographic analysis of different types of disc occluders at adjustable imaging depth and position. RESULTS Mathematically, decreasing the imaging depth resulted in a more asymmetric figure-of-eight, i.e. with small upper part and wide lower part. In vitro results were in close agreement with the mathematical results. In addition, in vitro a figure-of-eight artifact was obtained in all different types of disc occluder devices. CONCLUSIONS Different types of percutaneous disc occluders all present as a figure-of-eight artifact on echocardiography when imaged from a coronal imaging position. The morphology of the artifact depends on the imaging depth, with a more asymmetric figure-of-eight morphology at smaller probe-to-device distance. This clarifies the differences observed between transesophageal and transthoracic imaging.
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Affiliation(s)
- Philippe B Bertrand
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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Wahl A, Jüni P, Mono ML, Kalesan B, Praz F, Geister L, Räber L, Nedeltchev K, Mattle HP, Windecker S, Meier B. Long-term propensity score-matched comparison of percutaneous closure of patent foramen ovale with medical treatment after paradoxical embolism. Circulation 2012; 125:803-12. [PMID: 22238228 DOI: 10.1161/circulationaha.111.030494] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with ischemic stroke or transient ischemic attack presumably related to patent foramen ovale (PFO) are at risk for recurrent cerebrovascular events. Differences in long-term clinical outcome were investigated among patients with percutaneous PFO closure and those who received medical treatment. METHODS AND RESULTS Between 1994 and 2000, 308 consecutive patients with cerebrovascular events presumably related to PFO underwent either percutaneous PFO closure (150 patients) or medical treatment (158 patients). Patients were followed up prospectively for up to 15 years. Seven patients were lost during follow-up. The primary outcome was a composite of stroke, transient ischemic attack, or peripheral embolism. We analyzed 103 propensity score-matched pairs of patients who underwent percutaneous PFO closure or medical treatment. At a median follow-up of 9 years, the primary composite outcome occurred in 11 patients slated to PFO closure (11%) and 22 patients slated to medical treatment (21%; hazard ratio=0.43; 95% confidence interval=0.20-0.94; P=0.033). The treatment effect was driven by a decrease in the risk of transient ischemic attack of 5% versus 14%, respectively (hazard ratio=0.31; 95% confidence interval=0.10-0.94; P=0.039). The risk of all-cause (6% in both groups) and cardiovascular (3% in both groups) mortality appeared to be identical. CONCLUSION In this long-term observational, propensity score-matched study, percutaneous PFO closure was more effective than medical treatment for the secondary prevention of recurrent cerebrovascular events among patients with PFO-related transient ischemic attack or stroke.
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Affiliation(s)
- Andreas Wahl
- Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
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Wu W, Yip J, Tang YD, Khoo V, Kong JF, Duong-Hong D, Boey F, Venkatraman SS. A Novel Biodegradable Septal Defect Occluder the “Chinese Lantern” Design, Proof of Concept. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011. [DOI: 10.1177/155698451100600403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wei Wu
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - James Yip
- Cardiac Department, National University Hospital, Singapore, Singapore
| | - Yong-Dan Tang
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Vincent Khoo
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Jen Fong Kong
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Duc Duong-Hong
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Freddy Boey
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Subbu S. Venkatraman
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
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A Novel Biodegradable Septal Defect Occluder the “Chinese Lantern” Design, Proof of Concept. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011; 6:221-30. [DOI: 10.1097/imi.0b013e31822a2c42] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective Atrial septal defect (ASD) is a general term used to describe an opening in the atrial septum that divides the two atria; unless the hole is occluded, it can give rise to serious complications. Given the need for percutaneous deployment for ASD or patent foramen ovale (PFO) occluders, all currently available devices are made of metals (specifically nitinol) and synthetic fabric. However, their permanent presence in the human body is not desirable due to the risks of long-term allergy, toxicity, and complications such as thrombus formation, device arm fracture, and nickel allergy. Once the hole is covered by a newly regenerated tissue, the device is no longer needed; thus it is ideal if the device is fully absorbed by the body when healing is completed. Methods The “Chinese Lantern” device is made of fully biodegradable polymers featured with a unique pull-fold mechanism. The device was inserted across the ASD/PFO model created on Yorkshire swines through a short sheath by hybrid open surgery. X-ray imaging, echocardiography, and postmortem histopathology were obtained during the 1-month follow-up study period. Results X-ray imaging showed that the devices were in satisfactory position and stable. Echocardiography showed that there is no shunting from the right atrium to the left atrium, indicating excellent sealing. The in vitro degradation study and postmortem explantation study confirmed that the devices have good integrity during the 1-month trial. Furthermore, the devices appeared to be completely endothelialized after 1 month. Conclusions This work proves the feasibility of interventional closure of ASD or PFO with an innovative biodegradable device, which we call the “Chinese Lantern” for its symbolic design.
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Hagler DJ, Latson LA, Goble J, Mathewson JW, Cutright W. Failure of the GORE HELEX atrial septal defect occluder to treat membranous VSDs in swine. Catheter Cardiovasc Interv 2010; 76:874-7. [PMID: 20506100 DOI: 10.1002/ccd.22601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We tested the suitability of the GORE HELEX septal occluder for closure of membranous ventricular septal defect in three Yucatan minipigs that had naturally-occurring membranous ventricular septal defects. METHODS The animals were studied in the Gore Science Center Laboratory in Flagstaff, Arizona. In all of the device implantations, seating of the right disk along the right ventricular septum was problematic with resultant entanglement of one device in the chordae tendinae during attempted removal, implantation of one device onto the tricuspid valve papillary muscle and unlocking of one device occurring after implantation. CONCLUSIONS A new occluder design appears to be needed to minimize the risk of disk entanglement with cardiac structures, particularly within the right ventricle. These studies did establish that the Yucatan mini swine are an acceptable and appropriate model for evaluating occluders intended for closure of membranous ventricular septal defects.
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Affiliation(s)
- Donald J Hagler
- Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
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Saguner AM, Wahl A, Praz F, de Marchi SF, Mattle HP, Cook S, Windecker S, Meier B. Figulla PFO occluder versus Amplatzer PFO occluder for percutaneous closure of patent foramen ovale. Catheter Cardiovasc Interv 2010; 77:709-14. [DOI: 10.1002/ccd.22737] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 07/07/2010] [Accepted: 07/07/2010] [Indexed: 11/05/2022]
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Patent foramen ovale and stroke: Should PFOs be closed in otherwise cryptogenic stroke? Curr Atheroscler Rep 2010; 12:251-8. [PMID: 20461560 DOI: 10.1007/s11883-010-0114-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Since initial reports of its association with ischemic stroke appeared in 1988, there has been continued controversy regarding the existence and strength of the association between patent foramen ovale (PFO) and ischemic stroke. Many case-control studies have reported an association between incident cryptogenic ischemic stroke and PFO, yet population-based studies have failed to confirm this association. Studies of the risk of recurrent stroke in patients with cryptogenic stroke with or without PFO have not shown an increased risk of recurrent stroke in patients with PFO. Meanwhile, use of devices to close PFOs and atrial septal defects percutaneously has increased dramatically since their introduction. Completion of the randomized clinical trials of PFO closure currently in progress is vital to determine if the benefits of PFO closure in cryptogenic stroke outweigh its risks.
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Rosenblatt M, Pasquale J, Kurer C. Atrioventricular Canal Defect, Pulmonary Artery Sling, and Aortic Arch Anomaly in a Patient With Down Syndrome. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2010. [DOI: 10.1177/8756479309351747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is a high prevalence of congenital heart disease in patients with Down syndrome. Atrioventricular (AV) canal defects, ventricular septal defects, and a patent ductus arteriosus are most commonly seen. The authors present a patient with a unique constellation of findings, including an AV canal defect, pulmonary artery sling, and an aberrant right subclavian artery diagnosed on a screening echocardiogram. Additional imaging modalities confirmed this atypical concurrence of congenital heart defects and also proved the accuracy of echocardiography in diagnosing rare combinations of congenital heart disease.
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Affiliation(s)
| | - Jennifer Pasquale
- Pediatric Cardiology Division at Saint Peter's University Hospital, New Brunswick, NJ, USA
| | - Cheryl Kurer
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Blood pressure treatment in acute ischemic stroke: a review of studies and recommendations. Curr Opin Neurol 2010; 23:46-52. [PMID: 20038827 DOI: 10.1097/wco.0b013e3283355694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Elevated blood pressure (BP) is frequent in patients with acute ischemic stroke. Pathophysiological data support its usefulness to maintain adequate perfusion of the ischemic penumba. This review article aims to summarize the available evidence from clinical studies that examined the prognostic role of BP during the acute phase of ischemic stroke and intervention studies that assessed the efficacy of active BP alteration. RECENT FINDINGS We found 34 observational studies (33,470 patients), with results being inconsistent among the studies; most studies reported a negative association between increased levels of BP and clinical outcome, whereas a few studies showed clinical improvement with higher BP levels, clinical deterioration with decreased BP, or no association at all. Similarly, the conclusions drawn by the 18 intervention studies included in this review (1637 patients) were also heterogeneous. Very recent clinical data suggest a possible beneficial effect of early treatment with some antihypertensives on late clinical outcome. SUMMARY Observational and interventional studies of management of acute poststroke hypertension yield conflicting results. We discuss different explanations that may account for this and discuss the current guidelines and pathophysiological considerations for the management of acute poststroke hypertension.
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