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Vinothkumar SP, Mandava SS, Mallick A, Singhal M, Rohit MK. A large type I right pulmonary artery to left atrium fistula: underwent successful percutaneous device closure with duct occluder-a rare case report. Egypt Heart J 2024; 76:24. [PMID: 38381361 PMCID: PMC10881914 DOI: 10.1186/s43044-024-00438-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/13/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Pulmonary artery to left atrium fistula is an unusual structural cause of silent cyanosis. Only less than 100 cases have been reported so far. A high index of clinical suspicion and proper evaluation with bubble contrast echocardiography and cardiac computed tomography (CT) will help to detect this treatable anomaly. The advent of safer percutaneous closure methods has replaced the need for more invasive surgical closure. CASE PRESENTATION We report an adolescent boy, who presented with long-standing cyanosis and progressive dyspnea with normal clinical cardiovascular examination. On evaluation, echocardiography and bubble contrast study revealed a large right pulmonary artery (RPA) to left atrium (LA) fistula. Cardiac CT confirmed the same with normal pulmonary venous drainage s/o a large 20 mm Type I RPA LA Fistula. He underwent successful percutaneous closure of the fistula tract with a 22 × 24 mm Cera™ duct occluder via transseptal approach uneventfully. CONCLUSION Our case enlightens the methodological approach to diagnosing this rare anomaly as well as the feasibility of percutaneous intervention in such cases as it is one of the largest fistula tracts closed percutaneously to date.
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Affiliation(s)
- S P Vinothkumar
- Department of Cardiology, Level-3, Faculty Offices, Advanced Cardiac Centre, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Satya Sahitya Mandava
- Department of Cardiology, Level-3, Faculty Offices, Advanced Cardiac Centre, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Abhishek Mallick
- Department of Cardiology, Level-3, Faculty Offices, Advanced Cardiac Centre, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Manoj Kumar Rohit
- Department of Cardiology, Level-3, Faculty Offices, Advanced Cardiac Centre, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
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Haddad RN, Saliba Z. Word of caution: silent late device embolisation after perimembranous ventricular septal defect closure in a 6-Kg infant. Cardiol Young 2024; 34:455-458. [PMID: 38167420 DOI: 10.1017/s104795112300433x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
We report on a 6-month-old infant (6 Kg/ 64 cm) with perimembranous ventricular septal defect (absent sub-aortic rim, 10 mm left ventricular entry, and 4 and 6 mm right ventricular exists) and successful retrograde closure using an 8x6 mm KONAR-MF™ VSD occluder (Lifetech, China). Immediate and 48 hours post-procedure ultrasounds showed an accurately positioned device and two jets of mild-to-moderate residual shunts. At the 2-week follow-up, the device did not change position and the shunt was stable and intra-prosthetic. The scheduled 3-month follow-up was skipped for familial reasons. The patient came back without alarming symptoms for the regular 6-month follow-up, and the device was found embolised to the left pulmonary artery. The device was retrieved surgically, and the defect was patch-closed with excellent outcomes. There was a pseudoaneurysm involving the tricuspid valve chordae and the device was endothelialized partially on one edge suggesting that embolization occurred somewhere between 3 months and 6 months post-operative. Defects with compromised anatomies should be closed surgically to avoid suboptimal results, especially in small infants.
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Affiliation(s)
- Raymond N Haddad
- Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker-Enfants malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Zakhia Saliba
- Department of Pediatric Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
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Skibsted CV, Korsholm K, Pedersen L, Bonnesen K, Nielsen-Kudsk JE, Schmidt M. Long-term risk of atrial fibrillation or flutter after transcatheter patent foramen ovale closure: a nationwide Danish study. Eur Heart J 2023; 44:3469-3477. [PMID: 37279491 DOI: 10.1093/eurheartj/ehad305] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023] Open
Abstract
AIMS Transcatheter closure of patent foramen ovale (PFO) is the recommended stroke prevention treatment in patients ≤60 years with cryptogenic ischemic stroke and PFO. Atrial fibrillation or flutter (AF) is a known potential procedure-related complication, but long-term risk of developing AF remains unknown. This paper studied the long-term risk of developing AF following PFO closure. METHODS AND RESULTS A Danish nationwide cohort study was conducted. During 2008-2020, this study identified a PFO closure cohort, a PFO diagnosis cohort without PFO closure, and a general population comparison cohort matched 10:1 to the PFO closure cohort on age and sex. The outcome was first-time AF diagnosis. Risk of AF and multivariable-adjusted hazard ratio (HR) of the association between PFO closure or PFO diagnosis and AF were calculated. A total of 817 patients with PFO closure, 1224 with PFO diagnosis, and 8170 matched individuals were identified. The 5 year risk of AF was 7.8% [95% confidence interval (CI): 5.5-10] in the PFO closure cohort, 3.1% (95% CI: 2.0-4.2) in the PFO diagnosis cohort, and 1.2% (95% CI: 0.8-1.6) in the matched cohort. The HR of AF comparing PFO closure with PFO diagnosis was 2.3 (95% CI: 1.3-4.0) within the first 3 months and 0.7 (95% CI: 0.3-1.7) thereafter. The HR of AF comparing PFO closure with the matched cohort was 51 (95% CI: 21-125) within the first 3 months and 2.5 (95% CI: 1.2-5.0) thereafter. CONCLUSION Patent foramen ovale closure was not associated with any substantial increased long-term risk of developing AF beyond the well-known procedure-related short-term risk.
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Affiliation(s)
- Christian Valdemar Skibsted
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus University Hospital A1001, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Kasper Korsholm
- Department of Clinical Medicine, Aarhus University, Aarhus University Hospital A1001, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus University Hospital A1001, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus University Hospital A1001, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jens Erik Nielsen-Kudsk
- Department of Clinical Medicine, Aarhus University, Aarhus University Hospital A1001, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus University Hospital A1001, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Abstract
PURPOSE OF REVIEW The goal of this paper is to review currently available devices for closure of atrial septal defects (ASDs) and ventricular septal defects (VSDs). RECENT FINDINGS Favorable results from the ASSURED trial resulted in FDA approval for the most recently developed device for transcatheter ASD closure in the United States. Further studies are required to assist in the development or approval of safe devices for transcatheter perimembranous VSD closure in pediatric patients. Device closure is the less invasive and preferred management option for many ASDs, with multiple studies demonstrating lower complication rates, shorter hospital stays, and lower mortality than surgical repair. Complex ASDs that make device closure more difficult include large defects, rim deficiencies, fenestrated defects, multiple defects, and the presence of pulmonary arterial hypertension. Device closure has also become an accepted alternative to surgery for some types of ventricular septal defects VSDs, though challenges and limitations remain. Future innovations including novel devices and techniques are needed to further expand on the types of defects that can be safely closed via transcatheter approach.
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Affiliation(s)
- Kathleen P Wood
- Division of Pediatric Cardiology, Duke University, Durham, USA
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Lozier JS, Sati M, Cheifetz IM, Bocks ML. Update on percutaneous and perventricular device closure of congenital ventricular septal defect. Expert Rev Cardiovasc Ther 2023; 21:337-345. [PMID: 37096558 DOI: 10.1080/14779072.2023.2206566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Ventricular septal defect is the most common congenital heart defect. Surgical repair has been standard therapy for symptomatic ventricular septal defects since the 1950's. Catheter-based device closure of ventricular septal defects emerged in the 1980's and has become a safe and effective alternative in select patients. AREAS COVERED This review focuses on patient selection and procedural techniques for device closure of ventricular septal defects, including percutaneous and hybrid perventricular approaches. The available devices used for these procedures, and outcomes of their use, are reviewed. EXPERT OPINION Percutaneous and perventricular device closure of ventricular septal defects is safe and effective in select patients. However, the majority of ventricular septal defects requiring closure continue to be managed with conventional surgery. Further development and investigation of transcatheter and hybrid surgical approaches for closing ventricular septal defects is required.
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Affiliation(s)
- John S Lozier
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Maram Sati
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ira M Cheifetz
- Divisions of Pediatric Cardiac Critical Care and Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Martin L Bocks
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
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Gupta U, Karimi M. Utility of Three-Dimensional and Four-Dimensional Transesophageal Echocardiography in Decision-Making in a Patient with Iatrogenic Left Ventricle-to-Right Atrium Shunt (Gerbode Defect). CASE (Phila) 2023; 7:138-141. [PMID: 37123629 PMCID: PMC10147519 DOI: 10.1016/j.case.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Two-dimensional echocardiography is the workhorse of cardiovascular imaging. Three-dimensional echocardiography can improve diagnostic capability. In structural and congenital heart disease, 3D echo can be extremely useful. Three-dimensional echo should be used more often in cardiac interventional procedures.
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Affiliation(s)
- Umang Gupta
- Correspondence: Umang Gupta, MD, MBA, University of Iowa, 200 Hawkins Drive, BT 1010, Iowa City, IA 52242.
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Song S, Shao Z, Liang W, Dong H, Li B, Zhao L, Li M, Fan T. Peratrial device closure of perimembranous ventricular septal defects via a small right subaxillary incision: Midterm results in patients <12 months of age. Int J Cardiol 2023; 372:50-54. [PMID: 36460210 DOI: 10.1016/j.ijcard.2022.11.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Both percutaneous and perventricular device closures of perimembranous ventricular septal defects (Pm-VSDs) are alternatives to surgical procedures,but they all present certain drawbacks. OBJECTIVE To report our clinical experiences and midterm follow-up results of minimally invasive peratrial device closure of Pm-VSDs under the guidance of transesophageal echocardiography(TEE) in patients <12 months of age. METHODS Between January 2015 and December 2020,268 patients <12 months of age with Pm-VSDs underwent peratrial device closure in our institute. The procedure was performed under TEE guidance via a small right subaxillary incision. The delivery pathways is established by manipulating the hollow probe, and then the device is installed. RESULTS A total of 263 cases (98.1%) underwent successful closure, whereas five cases failed and were converted to cardiopulmonary bypass operation via the original incision during the procedure. The mean age was 9.5 ± 2.0 months and the mean body weight was 8.8 ± 1.4 kg. The mean diameter of the VSD was 4.4 ± 0.5 mm. One patient (0.4%) underwent a second thoracotomy for postoperative intercostal hemorrhage on the second day after surgery. The mean diameter of the occluder size was 5.5 ± 0.6 mm. During the follow-up (4.3 ± 1.4 y), there was no mortality, no new aortic valve regurgitation and atrioventricular block. CONCLUSION Peratrial device closure of Pm-VSDs via the right subaxillary route under TEE guidance is safe and effective at midterm follow-up, confirming this is an valuable alternative method for patients <12 months of age.
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Affiliation(s)
- Shubo Song
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Zehua Shao
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Weijie Liang
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Haoju Dong
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Bin Li
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Liyun Zhao
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Menghao Li
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Taibing Fan
- Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China.
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Luo D, Yang Z, Zhang G, Shen Q, Zhang H, Lai J, Hu H, He J, Wu S, Zhang C. Machine learning in a real-world PFO study: analysis of data from multi-centers in China. BMC Med Inform Decis Mak 2022; 22:305. [PMID: 36434650 PMCID: PMC9694545 DOI: 10.1186/s12911-022-02048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The association of patent foreman ovale (PFO) and cryptogenic stroke has been studied for years. Although device closure overall decreases the risk for recurrent stroke, treatment effects varied across different studies. In this study, we aimed to detect sub-clusters in post-closure PFO patients and identify potential predictors for adverse outcomes. METHODS We analyzed patients with embolic stroke of undetermined sources and PFO from 7 centers in China. Machine learning and Cox regression analysis were used. RESULTS Using unsupervised hierarchical clustering on principal components, two main clusters were identified and a total of 196 patients were included. The average age was 42.7 (12.37) years and 64.80% (127/196) were female. During a median follow-up of 739 days, 12 (6.9%) adverse events happened, including 6 (3.45%) recurrent stroke, 5 (2.87%) transient ischemic attack (TIA) and one death (0.6%). Compared to cluster 1 (n = 77, 39.20%), patients in cluster 2 (n = 119, 60.71%) were more likely to be male, had higher systolic and diastolic blood pressure, higher body mass index, lower high-density lipoprotein cholesterol and increased proportion of presence of atrial septal aneurysm. Using random forest survival (RFS) analysis, eight top ranking features were selected and used for prediction model construction. As a result, the RFS model outperformed the traditional Cox regression model (C-index: 0.87 vs. 0.54). CONCLUSIONS There were 2 main clusters in post-closure PFO patients. Traditional cardiovascular profiles remain top ranking predictors for future recurrence of stroke or TIA. However, whether maximizing the management of these factors would provide extra benefits warrants further investigations.
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Affiliation(s)
- Dongling Luo
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2Nd Road, Guangzhou, 510080 Guangdong China
| | - Ziyang Yang
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2Nd Road, Guangzhou, 510080 Guangdong China
| | - Gangcheng Zhang
- grid.413247.70000 0004 1808 0969Zhongnan Hospital of Wuhan University, Wuhan, China
| | | | - Hongwei Zhang
- Hubei Huiyi Cardiovascular Center, Enshi, Hubei China
| | - Junxing Lai
- Jiang Men Central Hospital, Jiangmen, Guangdong China
| | - Hui Hu
- grid.452881.20000 0004 0604 5998The First People’s Hospital of Foshan, Foshan, Guangdong China
| | - Jianxin He
- General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Shulin Wu
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2Nd Road, Guangzhou, 510080 Guangdong China
| | - Caojin Zhang
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2Nd Road, Guangzhou, 510080 Guangdong China
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Mumtaz ZA, Sagar P, Rajendran M, Sivakumar K. Transcatheter Versus Surgical Closure of Acute Ruptured Sinus of Valsalva Aneurysms with Associated Ventricular Septal Defects. Pediatr Cardiol 2022; 43:1494-501. [PMID: 35380217 DOI: 10.1007/s00246-022-02873-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
Transcatheter ruptured sinus of valsalva aneurysm (RSOVA) closure is an alternative to surgery. When a restrictive ventricular septal defect (rVSD) coexists, there are doubts about support for an occluder and persistent left ventricular (LV) dilatation. We compared the outcomes of patients from a single centre with rVSD and RSOVA after surgery or transcatheter intervention in the past 8 years in this study. Location of rVSD did not alter the approach. Compliant balloon interrogation before transcatheter closure was occasionally used to assess significance of interventricular shunt or aortic regurgitation. Procedural success and LV dimensions before and after treatment were analyzed. Seventeen patients with a mean age of 36.64 ± 12.58 years were analyzed. 12/13 catheter procedures (92%) were successful, of whom eight patients had an outlet VSD. rVSD was closed with device in one patient with perimembranous rVSD, but unaddressed in others. Four patients underwent balloon interrogation. Surgery included the single patient who failed intervention. Transcatheter group had more acute symptoms and advanced functional class than surgical group, though not significant. At a median follow-up of 4.5 (1-7.5) years, the mean LV dimensions (50.3 ± 10.1 mm and 50.1 ± 3.1 mm, p = 0.46) were not different in the transcatheter and surgical groups. Mean end-diastolic volumes (110.5 ± 42. 1 ml and 98.5 ± 37.5 ml, p = 0.91) were not significantly different either. Transcatheter RSOVA closure success was not altered by rVSD despite their location underneath the aneurysms, including outlet rVSD with defect in aortoventricular junction. Persistent LV dilatation was not observed after catheter intervention even when the VSD was not closed.
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Haddad RN, Bonnet D, Malekzadeh-Milani S. Embolization of vascular abnormalities in children with congenital heart diseases using medtronic micro vascular plugs. Heart Vessels 2022; 37:1271-1282. [PMID: 35088203 DOI: 10.1007/s00380-021-02007-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/03/2021] [Indexed: 11/04/2022]
Abstract
This study aimed at evaluating our experience with Micro Vascular Plug (MVP) for embolization of vascular abnormalities in children with congenital heart diseases (CHDs). MVP is one of the most recent additions to the armamentarium for peripheral embolization. Data on its use in congenital cardiology are scarce. Medical records of children with CHDs who had embolizations with MVPs between April 2015 and September 2020 were reviewed. Immediate and follow-up data were assessed. A total of 153 patients underwent 172 procedures during which 240 embolizations using 259 MVPs were attempted. Median age and weight were 34.9 months (IQR, 4-75 months) and 12.5 kg (IQR, 4.8-19.4 kg), respectively. Targets were abnormal systemic arteries (n = 163), patent arterial ducts (n = 26), venous (n = 45), and coronary-cameral fistulas (n = 6). Median vessel diameter was 3.3 mm (IQR, 2.5-4 mm). Veins were larger than arteries (2.3 mm > 2.1 mm, p < 0.01). MVPs were implanted in narrower diameters compared to manufacturer's recommendations. Compared to veins, solitary implanted MVPs in arteries were additionally oversized at 12.4%, 5.1%, and 7.9% for MVP-3Q, 5Q, and 7Q, respectively. Additional occlusion material (16.7%) and 2 MVPs (5.8%) were needed at the same site for complete closure. Implantation and procedure success rates were 99.2% and 96.7%, respectively. Five complications were treated percutaneously (n = 4) and surgically (n = 1). Efficacy of vascular embolization using MVPs was demonstrated in the largest cohort of children with CHDs and a variety of clinical settings. Immediate and stable closure is obtained with a single device in most cases. Detailed device selection chart according to vessel type and diameter is proposed to achieve intended outcomes.
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Affiliation(s)
- Raymond N Haddad
- Service de Cardiologie Congénitale et Pédiatrique, Centre de Référence Des Malformations Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker-Enfants Malades, 149, rue de Sèvres, 75015, Paris, France.
| | - Damien Bonnet
- Service de Cardiologie Congénitale et Pédiatrique, Centre de Référence Des Malformations Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker-Enfants Malades, 149, rue de Sèvres, 75015, Paris, France.,Université de Paris, Paris, France
| | - Sophie Malekzadeh-Milani
- Service de Cardiologie Congénitale et Pédiatrique, Centre de Référence Des Malformations Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker-Enfants Malades, 149, rue de Sèvres, 75015, Paris, France
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Al-Muhaya MA, Alkodami AA, Khoshhal S, Najjar AHA, Al-Mutairi M, Abdelrehim AR. Transcatheter occlusion of the vertical vein in a partial anomalous pulmonary venous connection with dual Drainage, case series with literature review. Int J Cardiol Heart Vasc 2021; 37:100889. [PMID: 34901378 DOI: 10.1016/j.ijcha.2021.100889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/29/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022]
Abstract
Transcatheter occlusion of vertical vein in a partial anomalous pulmonary venous connection with dual drainage, case series with literature review. In our manuscript we highlight the possibility of transcatheter Amplatzer device closure of PAPVD with dual drainage is an effective, safe and reproducible approach. It offers many advantages over surgical treatment such as fast recovery, avoidance of mechanical ventilation and PCICU stay, short in-hospital stay, low cost and more patient satisfaction. In our series, it has been demonstrated that this approach showed appealing results, however larger scale studies and more follow-up periods are required to consolidate these findings.
Partial anomalous pulmonary venous return (PAPVR) is an uncommon type of congenital heart disease occurring due to abnormal drainage of one or more, but not all the pulmonary veins to the systemic veins or directly to the right atrium. The PAPVR might have single (to the systemic veins) or dual drainage (to the systemic as well as left atrium). Management depends on the shunt impact on the heart and lungs, and it is usually surgical correction. In case of PAPVR with dual drainage, there is a new trend of percutaneous occlusion of the vertical vein with dual drainage anatomy, so that the blood is obliged to flow to the left atrium as in normal hearts. The scope of this manuscript is to highlight the availability of this alternative option and to present our experience and outcome in 6 PAPVR patients with dual drainage treated using this percutaneous approach.
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Gopalakrishnan A, Krishnamoorthy KM, Sivasubramonian S, Valaparambil A. Percutaneous device closure of an aorto-right ventricular outflow tract fistula after Bentall repair. Acta Cardiol 2021; 76:1154-1155. [PMID: 33300433 DOI: 10.1080/00015385.2020.1824739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Arun Gopalakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | - Sivasankaran Sivasubramonian
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Ajitkumar Valaparambil
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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Lin L, Liu J, Guo X, Chen H, Huang Y, Zheng H, Chen W, Chen L, Chen L, Chen Z. Risk factors for atrioventricular block after occlusion for perimembranous ventricular septal defect. Heart Rhythm 2021; 19:389-396. [PMID: 34843969 DOI: 10.1016/j.hrthm.2021.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The risk factors for complete atrioventricular block (CAVB) after device closure of perimembranous ventricular septal defect (pmVSD) remain unclear. OBJECTIVE The purpose of this study was to analyze the incidence and risk factors for CAVB after device closure for pmVSD. METHODS We reviewed 1884 patients with pmVSD who had undergone successful device occlusion between June 2005 and January 2020. Permanent CAVB was defined as CAVB requiring implantation of a permanent pacemaker (PPM) or extraction of the occluder. RESULTS In total, 14 patients (0.7%) developed permanent CAVB. Of these patients, 10 (0.5%) required PPM implantation. Four permanent CAVB occurred within 7 days after the procedure (acute), 2 between 7 and 30 days (subacute), 3 between 30 days and 1 year (late), and 5 more than 1 year (very late). None of the subacute, late, and very late CAVB recovered normal conduction with medication and eventually required device removal or PPM implantation. Four patients with acute CAVB and 1 with subacute CAVB underwent device removal, and 4 (80%) recovered normal conduction. Multivariate regression revealed that the ratio of device to defect size was the only independent risk factor for permanent CAVB (odds ratio 3.027; 95% confidence interval 1.476-6.209; P = .003). CONCLUSION The incidences of permanent CAVB after occlusion for pmVSD and PPM implantation were 0.7% and 0.5%, respectively. The ratio of device to defect size was the only independent risk factor for permanent CAVB. Device removal is an effective therapeutic modality for recovering normal conduction in acute and subacute CAVB patients.
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Affiliation(s)
- Li Lin
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Jianwen Liu
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Xiufen Guo
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Hang Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Yu Huang
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Huiying Zheng
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Wanhua Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Lianglong Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Liangwan Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China
| | - Zhaoyang Chen
- Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China.
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Chen TY, Ju YT, Wei YJ, Hsieh ML, Wu JM, Wang JN. Clinical Experience of Transcatheter Closure for Ventricular Septal Defects in Children Weighing under 15 kg. Acta Cardiol Sin 2021; 37:618-624. [PMID: 34812235 PMCID: PMC8593479 DOI: 10.6515/acs.202111_37(6).20210726a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Failure to thrive and poor weight gain are the main problems associated with ventricular septal defects complicated by heart failure in pediatric patients. Recent advances in transcatheter closure have enabled safe and effective interventions in these patients. OBJECTIVES The purpose of this study was to describe our experience with transcatheter closure of ventricular septal defects in young children with low weight. METHODS Pediatric patients weighing < 15 kg who underwent transcatheter closure of ventricular septal defects between January 2018 and December 2019 at our hospital were retrospectively enrolled. RESULTS Twelve patients were enrolled: one with a muscular defect, two with outlet defects, and nine with perimembranous defects. Their median age was 24 (7-60) months, and their median weight before the procedure was 11.8 kg (4.7-14.9 kg; mean Z-score: -1.3). The median precordial echocardiographic defect diameter was 5.6 (2.0-9.3) mm. Successful transcatheter closure was achieved in 11 cases. The mean weight at 1-month follow-up after defect closure was 13.5 kg (6.2-19.8 kg; mean Z-score: -0.2). The mean length of hospitalization was 2.7 days. CONCLUSIONS This study highlights the potential safety and therapeutic efficacy of transcatheter ventricular septal defect closure in infants with low weight. Considerable weight gain and heart failure symptom attenuation at 1 month after transcatheter closure were observed.
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Affiliation(s)
- Tsung-Yen Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- Department of Pediatrics, E-Da Hospital and School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ying-Tzu Ju
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Yu-Jen Wei
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Min-Ling Hsieh
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Jing-Ming Wu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Jieh-Neng Wang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
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15
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Sharma AK, Agarwal A, Sinha SK, Razi MM, Pandey U, Shukla P, Thakur R, Verma CM, Bansal RK, Krishna V. An echocardiographic evaluation to determine the immediate and short-term changes in biventricular systolic and diastolic functions after PDA device closure-an observational analytical prospective study (echo- PDA study). Indian Heart J 2021; 73:617-621. [PMID: 34627579 PMCID: PMC8551535 DOI: 10.1016/j.ihj.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 06/03/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives –This prospective study with a sizable cohort was undertaken to assess changes in left and right ventricle systolic and diastolic functions after percutaneous patent ductus arteriosus device closure with appropriate follow up evaluation. Methods – It is an observational analytical prospective study. Ninety-eight patients were recruited out of which sixty-eight patients underwent percutaneous PDA device closure and were taken for final analysis. The primary objective was to study the left and right ventricular systolic and diastolic functions pre- and post-procedure at 48 h with follow up analysis at six months. Results – The mean age of the patients was 7.88 ± 5.05 years with the female to male ratio was 3.85:1. Thirty-three (48.52%) of the patients had immediate post PDA device closure LV systolic dysfunction. It was more common in those having pre-procedure mean low LVEF and those having a significant reduction in mitral A velocity. It became normal at six months follow up. The study reported immediate decrease in mea/n LVEF from 63.55 ± 8.11% to 48.19 ± 7.9%. The changes in LVEDD, LVEF, LVFS and LVEDV were statistically significant (p < 0.0001). In diastolic functions, there were significant reductions in peak early and late diastolic velocities. There was no statistically significant difference in right chamber functional assessment. Conclusion Asymptomatic LV systolic and diastolic dysfunction in immediate post PDA closure period is a common complication and reported in around 48.5% cases. It was more common in those having pre-procedure mean low LVEF and those having a significant reduction in mitral A velocity.
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Affiliation(s)
- Awadhesh Kumar Sharma
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India.
| | - Abhishek Agarwal
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - M M Razi
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Praveen Shukla
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - C M Verma
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - R K Bansal
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Vinay Krishna
- Department of Cardiothoracic Surgury, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
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16
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Brida M, Chessa M, Celermajer D, Li W, Geva T, Khairy P, Griselli M, Baumgartner H, Gatzoulis MA. Atrial septal defect in adulthood: a new paradigm for congenital heart disease. Eur Heart J 2021; 43:2660-2671. [PMID: 34535989 DOI: 10.1093/eurheartj/ehab646] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/09/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Atrial septal defects (ASDs) represent the most common congenital heart defect diagnosed in adulthood. Although considered a simple defect, challenges in optimal diagnostic and treatment options still exist due to great heterogeneity in terms of anatomy and time-related complications primarily arrhythmias, thromboembolism, right heart failure and, in a subset of patients, pulmonary arterial hypertension (PAH). Atrial septal defects call for tertiary expertise where all options may be considered, namely catheter vs. surgical closure, consideration of pre-closure ablation for patients with atrial tachycardia and suitability for closure or/and targeted therapy for patients with PAH. This review serves to update the clinician on the latest evidence, the nuances of optimal diagnostics, treatment options, and long-term follow-up care for patients with an ASD.
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Affiliation(s)
- Margarita Brida
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK.,Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre Zagreb, Kispaticeva ul. 12, Zagreb 10000, Croatia.,Department of Medical Rehabilitation, Medical Faculty, University of Rijeka, Ul. Braće Branchetta 20/1, Rijeka 51000, Croatia
| | - Massimo Chessa
- ACHD Unit - Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, Piazza Edmondo Malan, 2, Milan 20097, Italy.,UniSR - Vita Salute San Raffaele University, Via Olgettina, 58, Milan 20132, Italy
| | - David Celermajer
- Heart Research Institute, University of Sydney, Camperdown, NSW 2050, Australia
| | - Wei Li
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.,Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
| | - Paul Khairy
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Massimo Griselli
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Helmut Baumgartner
- Department of Cardiology III: Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster 48149, Germany
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
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17
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Hu M, Fang Z, Bo Z, Wei X. A novel pathway: chest wall percutaneous closure for an aortic pseudoaneurysm. Eur J Cardiothorac Surg 2020; 58:1306-1308. [PMID: 32830225 DOI: 10.1093/ejcts/ezaa253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/24/2020] [Accepted: 06/04/2020] [Indexed: 11/12/2022] Open
Abstract
Ascending aortic pseudoaneurysm is difficult to treat with traditional surgical techniques. We report a case involving a 32-year-old man with ascending aortic pseudoaneurysm who underwent a series of prior operations, including the Bentall procedure with total aortic arch replacement for type A aortic dissection and postoperative sternal resection for chronic osteomyelitis of the sternum. He was successfully treated with percutaneous device closure of the pseudoaneurysm with an atrial septal defect occluder. This case illustrates successful closure of ascending aortic pseudoaneurysm via a chest wall percutaneous approach.
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Affiliation(s)
- Min Hu
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zemin Fang
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhixiang Bo
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Wei
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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18
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Wunderlich NC, Lorch GC, Honold J, Franke J, Küx H. Why Follow-up Examinations After Left Atrial Appendage Closure Are Important: Detection of Complications During Follow-up and How to Deal with Them. Curr Cardiol Rep 2020; 22:113. [PMID: 32770393 DOI: 10.1007/s11886-020-01357-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Device-related thrombus (DRT) formation and incomplete left atrial appendage closure (LAAC) are the two major complications that can occur after LAAC and can potentially limit the success of such a procedure. This review discusses the incidence, clinical and/or prognostic significance, detection methods, treatment options, and potential strategies to prevent these complications. RECENT FINDINGS It has recently been proven that the presence of a DRT represents an independent predictor for ischemic stroke after LAAC. Continued need for anticoagulation due to incomplete LAAC is clinically relevant to the patient. The appearances of a DRT or an incompletely closed LAA after a LAAC procedure are not rare complications. Due to the clinical and/or prognostic significance of these complications, it is important to detect them in a timely manner during follow-up by using the appropriate diagnostic imaging techniques. Since a DRT is associated with an increased risk of stroke, the therapy should be aggressive. In the case of incomplete LAA closure, an additional closure device may be used to complete occlusion and avoid lifelong anticoagulation therapy.
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Affiliation(s)
- Nina C Wunderlich
- Cardiovascular Center Darmstadt, Dieburgerstrasse 31c, 64287, Darmstadt, Germany.
| | - Gabriele C Lorch
- Cardiovascular Center Darmstadt, Dieburgerstrasse 31c, 64287, Darmstadt, Germany
| | - Jörg Honold
- Cardiovascular Center Darmstadt, Dieburgerstrasse 31c, 64287, Darmstadt, Germany
- Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt, Germany
| | - Jennifer Franke
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Harald Küx
- Cardiovascular Center Darmstadt, Dieburgerstrasse 31c, 64287, Darmstadt, Germany
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19
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Singhi AK, Roy RR, De A, Bari EA, Kumar RK. Percutaneous closure of large pulmonary artery to left atrial fistula. J Cardiol Cases 2020; 22:166-169. [PMID: 33014197 DOI: 10.1016/j.jccase.2020.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/21/2020] [Accepted: 05/26/2020] [Indexed: 01/10/2023] Open
Abstract
Pulmonary artery to the left atrial fistula is a rare anomaly. Two young males presented with effort intolerance and cyanosis and had large pulmonary artery to left atrial fistula from right and left pulmonary artery, respectively. The right-sided fistula was closed with a large duct occluder device in transseptal approach whereas the left-sided fistula was closed with a large muscular ventricular septal device. Complete occlusion and symptomatic relief was achieved in both cases. In the follow up the patients were doing well.
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Affiliation(s)
- Anil Kumar Singhi
- Department of Pediatric Cardiology, Medica Super Specialty Hospital, Kolkata, India
| | - Rana Rathod Roy
- Department of Cardiology, Medica Super Specialty Hospital, Kolkata, India
| | - Arnab De
- Department of Cardiology, Medica Super Specialty Hospital, Kolkata, India
| | - Ezaj Ahmad Bari
- Department of Radiodiagnosis, Medica Super Specialty Hospital, Kolkata, India
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences Kochi, Kerala, India
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20
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Kanabar K, Bootla D, Kaur N, Pruthvi CR, Krishnappa D, Santosh K, Guleria V, Rohit MK. Outcomes of transcatheter closure of patent ductus arteriosus with the off-label use of large occluders (≥16 mm). Indian Heart J 2020; 72:107-112. [PMID: 32534682 PMCID: PMC7296248 DOI: 10.1016/j.ihj.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/23/2019] [Accepted: 03/28/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Transcatheter closure is the first-choice strategy for the management of appropriate patients with patent ductus arteriosus (PDA). The management of large PDAs is challenging due to the limited available sizes of approved devices and the inherent risks of surgical ligation, especially in adults with calcified PDAs. This study aimed to assess the outcomes of the off-label use of large occluders at a tertiary center. METHODS This retrospective review included patients who underwent transcatheter PDA closure with large occluders (≥16 mm) over 16 years. The baseline patient data, procedural details, angiograms, and immediate outcomes were recorded and patients were followed up at 3, 6, 12 months after the intervention and annually thereafter. RESULTS Of the 685 patients who underwent transcatheter PDA closure, 36 patients (mean age 16.6 ± 12.5 years) needed occluders ≥ 16 mm in size. Cocoon duct occluder, Cera duct occluder, Amplatzer atrial septal occluder (ASO), and Cera muscular ventricular septal defect occluders were used for PDA closure. There was no device embolization, one patient in whom ASO was used had residual shunt with intravascular hemolysis requiring surgery, and one patient had mild left pulmonary artery narrowing after the intervention, which was managed conservatively. No patient had residual shunt and one patient had persistent pulmonary hypertension at an intermediate duration of follow-up. CONCLUSION Transcatheter PDA closure with the use of large devices, which are available in Asia and Europe, is an effective and safe method, especially in adolescents and adults. However, a close follow-up of these patients is mandatory.
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Affiliation(s)
- Kewal Kanabar
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Dinakar Bootla
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Navjyot Kaur
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - C R Pruthvi
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Darshan Krishnappa
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Krishna Santosh
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vivek Guleria
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Manoj Kumar Rohit
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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21
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Mylonas KS, Ziogas IA, Evangeliou A, Hemmati P, Schizas D, Sfyridis PG, Economopoulos KP, Bakoyiannis C, Kapelouzou A, Tzifa A, Avgerinos DV. Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A Systematic Review and Meta-analysis. Pediatr Cardiol 2020; 41:853-861. [PMID: 32162027 DOI: 10.1007/s00246-020-02341-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
Device closure is the first-line treatment for most atrial septal defects (ASDs). Minimally invasive cardiac surgery (MICS) has been found safe and effective for ASD closure with comparable mortality/morbidity and superior cosmetic results compared to conventional median sternotomy. Our goal was to compare percutaneous versus MICS of ASDs. A systematic review was performed using PubMed and the Cochrane Library (end-of-search date on May 22, 2019). Meta-analyses were conducted using fixed and random effects models. In the present systematic review, we analyzed six studies including 1577 patients with ASDs who underwent either MICS (n = 642) or device closure (n = 935). Treatment efficacy was significantly higher in the MICS (99.8%; 95% CI 98.9-99.9) compared to the device closure group (97.3%; 95% CI 95.6-98.2), (OR 0.1; 95% CI 0.02-0.6). Surgical patients experienced significantly more complications (16.2%; 95% CI 13.0-19.9) compared to those that were treated with a percutaneous approach (7.1%; 95% CI 5.0-9.8), (OR 2.0; 95% CI 1.2-3.2). Surgery was associated with significantly longer length of hospital stay (5.6 ± 1.7 days) compared to device closure (1.3 ± 1.4 days), (OR 4.8; 95% CI 1.1-20.5). Residual shunts were more common with the transcatheter (3.9%; 95% CI 2.7-5.5) compared to the surgical approach (0.95%; 95% CI 0.3-2.4), (OR 0.1; 95% CI 0.06-0.5). There was no difference between the two techniques in terms of major bleeding, hematoma formation, transfusion requirements, cardiac tamponade, new-onset atrial fibrillation, permanent pacemaker placement, and reoperation rates. MICS for ASD is a safe procedure and compares favorably to transcatheter closure. Despite longer hospitalization requirements, the MICS approach is feasible irrespective of ASD anatomy and may lead to a more effective and durable repair.
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Affiliation(s)
- Konstantinos S Mylonas
- Department of Pediatric Cardiac Surgery, Mitera Children's Hospital, HYGEIA Group, Athens, Greece. .,First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, 11527, Athens, Greece.
| | - Ioannis A Ziogas
- Department of Surgery, Vanderbilt Medical Center, Nashville, TN, USA.,Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | | | - Pouya Hemmati
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dimitrios Schizas
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Panagiotis G Sfyridis
- Department of Pediatric Cardiac Surgery, Mitera Children's Hospital, HYGEIA Group, Athens, Greece
| | - Konstantinos P Economopoulos
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christos Bakoyiannis
- Division of Vascular Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alkistis Kapelouzou
- Clinical, Experimental Surgery & Translational Research, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | - Aphrodite Tzifa
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Mitera Children's Hospital, HYGEIA Group, Athens, Greece
| | - Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York City, NY, USA
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22
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Ye Z, Li Z, Yi H, Zhu Y, Sun Y, Li P, Ma N. Percutaneous device closure of pediatirc patent ductus arteriosus through femoral artery guidance by transthoracic echocardiography without radiation and contrast agents. J Cardiothorac Surg 2020; 15:107. [PMID: 32448306 PMCID: PMC7245820 DOI: 10.1186/s13019-020-01119-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/27/2020] [Indexed: 11/20/2022] Open
Abstract
Background For many years, percutaneous interventional occlusion of congenital patent ductus arteriosus (PDA) has been completed using radiation and contrast agents. In this study, transthoracic echocardiography without radiation and contrast agents was used to complete percutaneous occlusion of pediatric PDA. Methods Thirty-two children (8 males and 24 females) with normal heart function and no other intracardiac deformities were diagnosed with PDA (20 funnel type; 12 tube type), One patient had peripheral facial paralysis, 1 patient had epilepsy, and 1 case had multiple cervical deformities. All procedures were performed in the surgical operating room (without Digital Subtraction Angiography (DSA) equipment) under basic anesthesia through the femoral artery pathway. The procedures were guided by transthoracic echocardiography (TTE) by establishing an orbit with a catheter through the femoral artery to thepatent ductus arteriosus,pulmonary artery and right ventricle. A suitable ventricular septal defect occluder was placed using the femoral artery approach,and the treatment effect was evaluated by echocardiography after occlusion. The Outpatient follow-up was performed at 1, 3 months after the operation. Results All cases had successful closure of PDA, which took only 35.6 ± 6.4 min. The diameter of the device was 4.8 ± 2.3 mm, and the heart murmur disappeared. There was no shunt between the left pulmonary artery and the descending aortic artery, and the length of hospitalization was 3.4 ± 0.5 days. No other incisions were needed in 32 cases. No occluder was removed, and no residual shunt was found after operation; moreover, no ICU stay was needed, and the mean hospital stay was 3.4 ± 0.5 days. No residual shunt was found at the 1-, 3-month follow-up visit. Conclusions PDA closure guided by transthoracic echocardiography via femoral artery puncture is a minimally invasive procedure that avoids injuries due to radiation and contrast agents. This method has wider application prospects in pediatrics.
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Affiliation(s)
- Zankai Ye
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Zhiqiang Li
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Hanlu Yi
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yaobin Zhu
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yan Sun
- Department of Echocardiography, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Pei Li
- Department of Echocardiography, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Ning Ma
- Department of Echocardiography, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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Jain SM, Pradhan PM, Sen S, Dalvi BV. Transcatheter closure of elongated and pulmonary hypertensive patent arterial duct in infants using Amplatzer vascular plug II. Cardiol Young 2020; 30:243-8. [PMID: 31996273 DOI: 10.1017/S1047951120000104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the feasibility, efficacy, and safety of Amplatzer vascular plug II in large and elongated ducts in infants. INTRODUCTION Patent arterial duct device closure is technically challenging in infants with large and elongated ducts because Amplatzer duct occluder and Amplatzer duct occluder II have high chances of causing aortic coarctation and left pulmonary artery stenosis, respectively. The Amplatzer vascular plug II being soft with no retention discs on either sides helps in mitigating these problems. METHOD This is a prospective, observational study involving infants with clinical, echocardiographic and angiographic evidence of large left to right shunt. All the children underwent duct closure using Amplatzer vascular plug II. RESULTS Eighteen infants qualified for the study. Mean age and weight were 8.63 ± 3.84 months and 6.3 ± 1.7 kg, respectively. The angiographic mean duct diameter at the pulmonary artery end was 4.66 ± 0.92 mm, and the mean duct length was 9.4 ± 2.48 mm. The size of Amplatzer vascular plug II used varied from 6 mm to 10 mm. Technical success was achieved in 16/18 cases. One patient had device embolisation, and in the other, the device was found to be unstable. The ratio of Amplatzer vascular plug II size to the duct diameter was 1.65 ± 0.27, while the ratio of ductal length to device length was 1.48 ± 0.46 in those with successful outcome. CONCLUSIONS Amplatzer vascular plug II is a safe and effective option in appropriately selected infants with elongated ducts. Diameter and length of Amplatzer vascular plug II vis-a-vis those of the ductus are important determinants of the successful outcome.
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Shah JH, Bhalodiya DK, Rawal AP, Nikam TS. Long-Term Results of Transcatheter Closure of Large Patent Ductus Arteriosus with Severe Pulmonary Arterial Hypertension in Pediatric Patients. Int J Appl Basic Med Res 2020; 10:3-7. [PMID: 32002377 PMCID: PMC6967341 DOI: 10.4103/ijabmr.ijabmr_192_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/02/2019] [Accepted: 12/04/2019] [Indexed: 12/02/2022] Open
Abstract
Aims: Patent ductus arteriosus (PDA) is one of the most commonly seen congenital heart diseases prevalent today. The aim of this study is to evaluate the safety and efficacy of transcatheter closure of hypertensive ductus at long-term follow-up. Materials and Methods: Transcatheter closure was attempted in 52 patients with hypertensive ductus arteriosus. A lateral or right anterior oblique view aortogram was done to locate and delineate PDA. All the patients underwent clinical examination, electrocardiography, chest X-rays, and echocardiography before discharge and at 1, 6, and 12 months after the procedure and yearly thereafter. Results: The mean age of patients at procedure was 7.98 ± 4.79 (11 months–17 years), and the mean weight was 17.72 ± 10.81 (4–47) kg. Transcatheter closure of hypertensive ductus was successful in 50 (96.15%) patients. The mean preprocedural pulmonary artery pressure was 81.38 ± 17.31 (range: 55–113) mmHg which decreased to 29.65±8.63 (19-38) mmHg at follow up. The most commonly used device was Amplatzer duct occluder in 63% of the patients followed by Amplatzer muscular ventricular septal defect occluder in 37% of the patients. There were two procedural failures, namely aortic obstruction and left pulmonary artery stenosis, which were managed uneventfully. There were no procedural deaths or device embolization. At median follow-up of 86 months, all the patients are well with no complications. Conclusion: The long-term results suggested that transcatheter closure of PDA with severe pulmonary hypertension in pediatric patients is safe and effective with minimal complications.
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Affiliation(s)
- Jayal Hasmukhbhai Shah
- Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Ahmedabad, Gujarat, India
| | - Dharmin Khimjibhai Bhalodiya
- Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Ahmedabad, Gujarat, India
| | - Abhishek Pravinchandra Rawal
- Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Ahmedabad, Gujarat, India
| | - Tushar Sudhakarrao Nikam
- Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Ahmedabad, Gujarat, India
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25
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Roushdy A, El Sayegh A, Ali YA, Attia H, El Fiky A, El Sayed M. A novel three-dimensional echocardiographic method for device size selection in patients undergoing ASD trans-catheter closure. Egypt Heart J 2019; 72:1. [PMID: 31893314 PMCID: PMC6938529 DOI: 10.1186/s43044-019-0038-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Proper device size selection is a crucial step for successful ASD device closure. The current gold standard for device size selection is balloon sizing. Balloon sizing can be tedious, time consuming and increase fluoroscopy and procedure times as well as risk of complications. We aimed to establish a simple and accurate method for device size selection using three-dimensional echocardiographic interrogation of the ASD.This is a prospective observational study conducted over a period of 12 months. All patients underwent 2D TTE, three-dimensional echocardiographic assessment of the IAS and transesophageal echocardiogram. Comparison between echocardiographic variables was done using independent sample t test. Linear correlation was established between three dimensional echocardiographic variables and respective variables of device size and 2D TTE and TEE measurements. Results The study included 50 patients who underwent successful ASD device closure with properly sized device. There was no significant difference between 3D ASD maximum diameter and all diameters measured by TTE and TEE. There was a strong positive correlation between device size used for closure and both 3D measured ASD area (r = 0.907, P<0.0001) and 3D measured ASD circumference (r = 0.917, P<0.0001). Two regression equations were generated to determine proper device size where Device size = 10.8 + [3.95 x 3D ASD area] and Device size = [3.85 x 3D ASD circumference] -1.02 Conclusion Three-dimensional echocardiogram can provide a simple and accurate method for device size selection in patients undergoing ASD device closure using either 3D derived ASD area or ASD circumference
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Affiliation(s)
- Alaa Roushdy
- Cardiology Department, Congenital and structural heart diseases unit, Ain Shams University hospitals, Cairo, Egypt
| | - Aya El Sayegh
- Cardiology Department, Congenital and structural heart diseases unit, Ain Shams University hospitals, Cairo, Egypt
| | - Yasmin Abdelrazek Ali
- Cardiology Department, Congenital and structural heart diseases unit, Ain Shams University hospitals, Cairo, Egypt.
| | - Hebattalla Attia
- Cardiology Department, Congenital and structural heart diseases unit, Ain Shams University hospitals, Cairo, Egypt
| | - Azza El Fiky
- Cardiology Department, Congenital and structural heart diseases unit, Ain Shams University hospitals, Cairo, Egypt
| | - Maiy El Sayed
- Cardiology Department, Congenital and structural heart diseases unit, Ain Shams University hospitals, Cairo, Egypt
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26
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Garg A, Thawabi M, Rout A, Sossou C, Cohen M, Kostis JB. Recurrent Stroke Reduction with Patent Foramen Ovale Closure versus Medical Therapy Based on Patent Foramen Ovale Characteristics: A Meta-Analysis of Randomized Controlled Trials. Cardiology 2019; 144:40-49. [PMID: 31574522 DOI: 10.1159/000500501] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/19/2019] [Indexed: 11/19/2022]
Abstract
Efficacy of patent foramen ovale (PFO) closure in patients with cryptogenic stroke remains a matter of debate. We performed a comprehensive meta-analysis of available randomized controlled trials (RCTs) to evaluate the efficacy and safety of PFO closure versus medical therapy (MT) based on PFO characteristics. Random-effects meta-analysis was conducted to estimate risk ratio (RR) with 95% confidence intervals (CI) for the primary end points of stroke. After systematic search, six RCTs (3,747 patients) with 1,889 patients randomized to PFO closure and 1,858 patients randomized to the MT group were included in the meta-analysis. Overall, PFO closure was associated with a significant reduction in recurrent stroke compared to MT [RR 0.41; 95% CI 0.20-0.83]. While there were no differences in mortality or major bleeding between the two groups, risk of newly diagnosed atrial fibrillation was higher in the PFO closure group compared to MT [RR 5.29; 95% CI 2.32-12.06]. Further, risk reduction in stroke with PFO closure was significant in patients with high-risk PFO characteristics [RR 0.37; 95% CI 0.16-0.87] but not in low-risk patients [RR 0.73; 95% CI 0.29-1.84]. In conclusion, among patients with cryptogenic stroke, PFO closure is associated with a significantly reduced risk of recurrent stroke compared to MT. Additionally, the benefit of PFO closure might be dependent on certain PFO characteristics.
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Affiliation(s)
- Aakash Garg
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA, .,Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA,
| | - Mohammed Thawabi
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Amit Rout
- Department of Medicine, Sinai Hospital, Baltimore, Maryland, USA
| | - Chris Sossou
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Marc Cohen
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Vitarelli A. Patent Foramen Ovale: Pivotal Role of Transesophageal Echocardiography in the Indications for Closure, Assessment of Varying Anatomies and Post-procedure Follow-up. Ultrasound Med Biol 2019; 45:1882-1895. [PMID: 31104864 DOI: 10.1016/j.ultrasmedbio.2019.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/09/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
Patent foramen ovale (PFO) is present in 15%-30% of the general population and has been associated with various pathologic states, including cryptogenic stroke, platypnea-orthodeoxia syndrome, decompression sickness and migraine with auras. Transesophageal echocardiography (TEE) has a major role in the diagnostic evaluation of PFO, as well as in the post-procedural assessment after transcatheter closure. The goals of this article were to synthesize the echocardiographic transesophageal techniques required for accurate PFO diagnosis and careful anatomic assessment of its anatomic variants, to focus TEE indications for device closure as complementary to clinical indications and to assess the role of TEE in the post-procedure follow-up.
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28
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Farhaj Z, Hongxin L, Wenbin G, Zhang WL, Liang F, Zhang HZ, Yuan GD, Zou CW. Device closure of diverse layout of multi-hole secundum atrial septal defect: different techniques and long-term follow-up. J Cardiothorac Surg 2019; 14:130. [PMID: 31272459 PMCID: PMC6610982 DOI: 10.1186/s13019-019-0952-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background There are no unanimous reports on different layouts and classifications of multi-hole secundum atrial septal defects (MHASD) and subsequent standardized occlusion techniques. The MHASD can be isolated or cribriform with variable inter-defects distance. In this retrospective study, experience-based classification and two approaches-based occlusion results are presented. Methods We retrospectively collected and analyzed data of 150 MHASD patients from 1320 patients who underwent atrial septal defect occlusion in our institute. The MHASD patients were categorized into 4 types; type A, B, C and D and occluded under exclusive transesophageal echocardiographic guidance. According to different types, 122 patients were occluded using peratrial approach and 28 patients via percutaneous approach. In type A, single device implantation is performed to occlude the large hole and squeeze the small one. For type B single or double-device deployment was performed depending on an inter-defects distance. In type C and D, a patent foramen-ovale (PF) device was selectively positioned to the central defect to occlude the central defect and cover the peripheral ones. In peratrial approach, 8 patients underwent inter-defects septal puncture technique to achieve single-device occlusion. The intracardiac manipulation time, procedural time, double device deployment, redeployment rate, residual shunt, and proportions were analyzed between (and within peratrial technique) two techniques. Results Successful occlusion was achieved in all 150 patients. Single device occlusion was applied in 78/84 type A and 22/37 type B patients (p < 0.05). Double device occlusion was more applicable to type B than A patients (p < 0.01). Sixteen of 21 type C and all type D patients used PF device for a satisfactory occlusion. Redeployment of the device occurred frequently in type B patients than A (p < 0.01). The intracardiac manipulation time and procedural time were shorter in type A than B (p < 0.05). The intracardiac manipulation time was also shortened in type A peratrial than type A percutaneous group (p < 0.05). Complete occlusion rate for all patients at discharge was 70% and rose to 82% at 1 year follow up. Conclusions The diverse layouts and classification of MHASDs can help to choose different techniques and proper devices of different kinds to achieve better occlusion results.
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Affiliation(s)
- Zeeshan Farhaj
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China
| | - Li Hongxin
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China.
| | - Guo Wenbin
- Ultrasound Department, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China
| | - Wen-Long Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China
| | - Fei Liang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China
| | - Hai-Zhou Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China
| | - Gui-Dao Yuan
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China
| | - Cheng-Wei Zou
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China
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Ananthakrishna Pillai A, Sinouvassalou S, Jagadessan KS, Munuswamy H. Spectrum of morphological abnormalities and treatment outcomes in ostium secundum type of atrial septal defects: Single center experience in >500 cases. J Saudi Heart Assoc 2019; 31:12-23. [PMID: 30364462 PMCID: PMC6197373 DOI: 10.1016/j.jsha.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/26/2018] [Accepted: 09/23/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Transcatheter closure (TCC) has emerged as the first line treatment option for secundum type of atrial septal defects (ASD). Outcomes of TCC depend upon proper delineation of defect anatomy by transesophageal echocardiography (TEE). Stability and proper placement of the device mandates adequate rims and proper alignment to the septum. Failed or unfavorable morphology for TCC requires referral for surgical repair. METHODS We prospectively analyzed the ASD patients who were referred for treatment. The morphological features of the defect were evaluated and the outcomes of TCC studied. Patients who undergo TCC and surgical repair were followed for immediate and long-term outcome comparison. RESULTS Of the 512 patients who underwent treatment, TCC was attempted in 430/512 (83.2%) patients. It was successful in 393/430 (91.3%) patients. The remaining 119 patients underwent surgical patch closure. Twenty patients had failure of device alignment and device embolization occurred in 17 patients. Very large defect size ≥35 mm, absent or deficient posterior rim, absent/deficient inferior naval rim showed high chances for failure and formed major reasons for surgical referral. The surgical group had higher success (100%) across all anatomic variables. However, they had longer intensive care unit (ICU) and hospital stay (p < 0.001). CONCLUSION TCC offered a success rate of 91% in complex defects after TEE selection. Very large size and deficient inferior, posterior rims predicted failure of TCC. Surgery offered 100% success and it involved a longer hospital and ICU stay. The long-term clinical results were identical with both treatment modalities.
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Affiliation(s)
- Ajith Ananthakrishna Pillai
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaIndia
| | - Shabnasri Sinouvassalou
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaIndia
| | - Kabilan S Jagadessan
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaIndia
| | - Hemachandren Munuswamy
- Department of Cardiothoracic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaIndia
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30
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Roushdy AM, Attia H, Nossir H. Immediate and short term effects of percutaneous atrial septal defect device closure on cardiac electrical remodeling in children. Egypt Heart J 2018; 70:243-247. [PMID: 30591737 PMCID: PMC6303477 DOI: 10.1016/j.ehj.2018.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/21/2018] [Indexed: 12/03/2022] Open
Abstract
Background The beneficial effects of atrial septal defect (ASD) device closure on electrical cardiac remodeling are well established. The timing at which these effects starts to take place has yet to be determined. Objectives To determine the immediate and short term effects of ASD device closure on cardiac electric remodeling in children. Methods 30 pediatric patients were subjected to 12 lead Electrocardiogram immediately before ASD device closure, 24 h post procedure, 1 and 6 months after. The maximum and minimum P wave and QT durations in any of the 12 leads were recorded and P wave and QT dispersions were calculated and compared using paired T test. Results The immediate 24 h follow up electrocardiogram showed significant decrease in P maximum (140.2 ± 6 versus 130.67 ± 5.4 ms), P dispersion (49.73 ± 9.01 versus 41.43 ± 7.65 ms), PR interval (188.7 ± 6.06 ms versus 182.73 ± 5.8 ms), QRS duration (134.4 ± 4.97 ms versus 127.87 ± 4.44), QT maximum (619.07 ± 15.73 ms versus 613.43 ± 11.87), and QT dispersion (67.6 ± 5.31 versus 62.6 ± 4.68 ms) (P = 0.001). After 1 month all the parameters measured showed further significant decrease with P dispersion reaching 32.13 ± 6 (P = 0.001) and QT dispersion reaching 55.0 ± 4.76 (P = 0.001). These effects were maintained 6 months post device closure. Conclusion Percutaneous ASD device closure can reverse electrical changes in atrial and ventricular myocardium as early as the first 24 h post device closure.
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Affiliation(s)
| | - Hebatalla Attia
- Cardiology Department, Ain Shams University Hospital, Cairo, Egypt
| | - Heba Nossir
- Cardiology Department, Ain Shams University Hospital, Cairo, Egypt
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31
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Ghosh S, Sridhar A, Solomon N, Sivaprakasham M. Transcatheter closure of ventricular septal defect in aortic valve prolapse and aortic regurgitation. Indian Heart J 2017; 70:528-532. [PMID: 30170648 PMCID: PMC6117845 DOI: 10.1016/j.ihj.2017.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 11/08/2017] [Accepted: 11/26/2017] [Indexed: 11/24/2022] Open
Abstract
Objective To report intermediate follow-up result of transcatheter closure of ventricular septal defect (VSD) in presence of aortic valve prolapse (AVP) with or without aortic regurgitation (AR). Method This is a retrospective review of 19 patients with VSD with AVP with AR who underwent transcatheter closure in between September 2011–July 2014. Mean age was 8 years (1–16 years, standard deviation [SD] 4.08 years) and mean weight was 26.03 kg (9–81.5 kg, SD 16.57 kg). Among them 2 had subarterial VSD, 6 had subaortic VSD and 11 had perimembranous VSD. All of them had mild AVP and 13 of them had AR (trivial or mild). Median VSD size was 4.3 mm (4–6 mm). Transcatheter closure was done either by retrograde technique using the Amplatzer Duct Occluder-II in 17 patients or antegrade technique using the Duct Occluder-I in 2 cases. Mean follow-up period was 18 months (12–36 months). Result Immediate major complications were encountered in 2 (10.5%) cases. Significant aggravation of device related AR was seen in one case & device embolised to right pulmonary artery in another case and both of them were managed surgically. During follow up, 1 child had significant additional VSD requiring device closure. One child developed moderate AR, requiring surgery. None of the other had shown any increase in severity of AR. Conclusion Device closure of VSD in presence of mild AVP and mild AR appears to be safe. Longer follow-up is necessary to draw final conclusion.
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Affiliation(s)
- Sanjiban Ghosh
- Department of Pediatric Cardiology, Apollo Children's Hospital, Chennai, India.
| | - Anuradha Sridhar
- Department of Pediatric Cardiology, Apollo Children's Hospital, Chennai, India
| | - Neville Solomon
- Department of Cardiothoracic Surgery, Apollo Children's Hospital, Chennai, India
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32
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Ou-Yang WB, Wang SZ, Hu SS, Zhang FW, Zhang DW, Liu Y, Meng H, Pang KJ, Meng LK, Pan XB. Perventricular device closure of perimembranous ventricular septal defect: effectiveness of symmetric and asymmetric occluders. Eur J Cardiothorac Surg 2017; 51:478-482. [PMID: 28082474 DOI: 10.1093/ejcts/ezw352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/19/2016] [Indexed: 12/17/2022] Open
Abstract
Objectives To assess safety and effectiveness of symmetric and asymmetric occluders in perventricular device closure without cardiopulmonary bypass of perimembranous ventricular septal defects (pmVSDs). Methods The present retrospective study enrolled 581 patients who underwent perventricular device closure of pmVSDs under transoesophageal echocardiography guidance from May 2011 to April 2016, and outpatient electrocardiography and transthoracic echocardiography assessments at 1, 3, 6 and 12 months, and yearly thereafter. Results The overall success rate of device implantation was 92.6% (43 surgical conversions immediately). Between patients receiving symmetric ( n = 353) and asymmetric ( n = 185) occluders, there were no significant differences in age, weight and defect diameter distributions; however, both before discharge and at mean 28.6 ± 21.2 (range, 1-60)-month follow-up, the symmetric group had lower rates of trivial residual shunt (5.7% vs 11.4%, P = 0.018; and 0.8% vs 5.9%, P = 0.001) and bundle branch block (0.8% vs 5.4%, P = 0.002; and 0.6% vs 3.8%, P = 0.009); and at follow-up, the asymmetric group had lower residual shunt (47.6% vs 85.0%, P = 0.020) and similar branch block (30.0% vs 33.3%, P = 1.000) disappearance rates. There were no severe complications, i.e. aortic regurgitation, malignant arrhythmias, haemolysis or device dislocation. Conclusions Perventricular device closure of pmVSDs appears safe and effective with symmetric and asymmetric occluders. However, the lower residual shunt disappearance and higher branch block incidence rates for asymmetric occluders would favour more proactive conversion to surgical repair immediately when residual shunt is present intraoperatively.
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Affiliation(s)
- Wen-Bin Ou-Yang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Shou-Zheng Wang
- Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Innovation Center of Major Infectious Diseases, Beijing, China
| | - Sheng-Shou Hu
- Department of Psychology, National Cheng Kung University, Tainan, Taiwan
| | - Feng-Wen Zhang
- Key Laboratory of Adaptation and Evolution of Plateau Biota, Northwest Institute of Plateau Biology, Chinese Academy of Sciences, Xining, China
| | - Da-Wei Zhang
- State Key Laboratory of ASIC and System, School of Microelectronics, Fudan University, Shanghai, China
| | - Yao Liu
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg, Netherlands
| | - Hong Meng
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Kun-Jing Pang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Liu-Kun Meng
- Gene Oasis Research and Innovation, Singapore Tianjin University, Tianjin, PR China
| | - Xiang-Bin Pan
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
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33
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Kumar V, Aggarwal N, Swamy A, Garg S. Disappearing high velocity severe tricuspid regurgitation following Ventricular septal defect device closure. Indian Heart J 2017. [PMID: 28648440 PMCID: PMC5485395 DOI: 10.1016/j.ihj.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This report describes the disappearance of severe high velocity tricuspid regurgitation following a small ventricular septal defect device closure, in an eight year old girl.
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34
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Schuiteman E, Verrill T, Mina N, Dalal B. Constrictive pericarditis-induced shunting through a PFO: Persistence despite pericardiectomy. Respir Med Case Rep 2017. [PMID: 28649486 PMCID: PMC5470528 DOI: 10.1016/j.rmcr.2017.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A patent foramen ovale (PFO) is found in around 25–30% of patients. The discovery is often made only on autopsy, as most PFOs are clinically silent and any inter-atrial blood exchange typically shunts from the left to right heart [1]. Thus, when a patient presents with hypoxic respiratory failure, concern for presence of a PFO is rarely at the top of the differential. However, in the setting of elevated right heart pressures, PFOs can become of great hemodynamic importance and can lead to deadly complications, including right to left shunting and refractory hypoxic respiratory failure. We present an unusual care of constrictive pericarditis leading to significant shunting through a PFO, and resultant hypoxic respiratory failure which only resolved with PFO closure.
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Affiliation(s)
- Emily Schuiteman
- Department of Internal Medicine, Beaumont Hospital - Royal Oak, Royal Oak, MI, 48073, USA
| | - Thomas Verrill
- Department of Cardiology, Beaumont Hospital - Royal Oak, Royal Oak, MI, 48073, USA
| | - Nader Mina
- Department of Pulmonary and Critical Care Medicine, Beaumont Hospital - Royal Oak, Royal Oak, MI, 48073, USA
| | - Bhavinkumar Dalal
- Department of Pulmonary and Critical Care Medicine, Beaumont Hospital - Royal Oak, Royal Oak, MI, 48073, USA
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Affiliation(s)
- K M Krishnamoorthy
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, 695011, India.
| | - Arun Gopalakrishnan
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, 695011, India
| | - Deepa S Kumar
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, 695011, India
| | - S S Sivasankaran
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, 695011, India
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Liang F, Hongxin L, Zhang HZ, Wenbin G, Zou CW, Farhaj Z. Perventricular double- device closure of wide-spaced multi-hole perimembranous ventricular septal defect. J Cardiothorac Surg 2017; 12:24. [PMID: 28412961 PMCID: PMC5392910 DOI: 10.1186/s13019-017-0585-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/21/2017] [Indexed: 11/15/2022] Open
Abstract
Background Device closure of a wide-spaced multi-hole PmVSD is difficult to succeed in percutaneous approach. This study is to evaluate the feasibility, safety and efficacy of perventricular device closure of wide-spaced multi-hole PmVSD using a double-device implanting technique. Methods Sixteen patients with wide-spaced multi-hole PmVSD underwent perventricular closure with two devices through an inferior median sternotomy approach under transesophageal echocardiographic guidance. The largest hole and its adjacent small holes were occluded with an optimal-sized device. The far-away residual hole was occluded with the other device using a probe-assisted delivery system. All patients were followed up for a period of 1 to 4 years to determine the residual shunt, atrioventricular block and the adjacent valvular function. Results The number of the holes of the PmVSD was 2 to 4. The maximum distance between the holes was 5.0 to 10.0 mm (median, 6.4 mm). The diameter of the largest hole was 2.5 to 7.0 mm (median, 3.6 mm). The success rate of double-device closure was 100%. Immediate residual shunts were found in 6 patients (38%), and incomplete right bundle branch block at discharge occurred in 3 cases (19%). Both complications decreased to 6% at 1-year follow-up. Neither of them had a severe device-related complication. Conclusions Perventricular closure of a wide-spaced multi-hole PmVSD using a double-device implanting technique is feasible, safe, and efficacious. In multi-hole PmVSDs with the distance between the holes of more than 5 mm, double-device implantation may achieve a complete occlusion.
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Affiliation(s)
- Fei Liang
- Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, 250021, China
| | - Li Hongxin
- Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, 250021, China.
| | - Hai-Zhou Zhang
- Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, 250021, China
| | - Guo Wenbin
- Ultrasound Department, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Cheng-Wei Zou
- Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, 250021, China
| | - Zeeshan Farhaj
- Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, 250021, China
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El-Sisi A, Sobhy R, Jaccoub V, Hamza H. Perimembranous Ventricular Septal Defect Device Closure: Choosing Between Amplatzer Duct Occluder I and II. Pediatr Cardiol 2017; 38:596-602. [PMID: 28251252 DOI: 10.1007/s00246-016-1553-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
Transcatheter closure of perimembranous ventricular septal defects (pmVSDs) is a well-established procedure. Recently, Amplatzer duct occluders (ADO) I and II have been reported to close large series of pmVSDs successfully (off-label use). ADOs are economical compared with the standard Amplatzer VSD occluders, a major consideration in developing countries with low-budget programs. We report closure of symptomatic, hemodynamically significant pmVSDs using the ADOI and ADOII devices. Although there are no set criteria for choosing between ADOI and ADOII, the former's price tag includes snare and long sheath. Thus, we aim to predetermine device usage based on transthoracic echocardiography (TTE) findings. Between March 2013 and November 2014, 30 patients had transcatheter closure of pmVSDs using the ADO devices. The median age was 4 years (range 1.1-13 years) and median weight was 15 kg (range 6.5-85 kg). ADOII could not be used in VSDs larger than 6 mm and/or with a large aneurysm. The median VSD size as assessed by echocardiography was 5.5 mm while the mean was 5.5 mm (range 3-12 mm); while by angiography it was 5 mm & the mean was 4.75 mm (range 3-9 mm). The median fluoroscopy time (FT) was 8 min (range 5-38 min). We inserted ADOI in 13 patients and ADOII in 17 patients (no significant difference between median age and weight in each group). VSD size was significantly larger and FT was longer in ADOI patients; the device type matched what was decided from TTE data in 84% of cases. Follow-up ranged from 2 to 24 months (median 12 months). The mean LVEDD z-score of the patients was 1.1 before VSD closure, while it was 0.63, 0.35, and 0.23 at the 1-, 3 months, and last follow-up, respectively. Complete closure rates immediately, at 24 h, and at last follow-up were 87, 90, and 94% respectively. No patient developed heart block or any other complication. ADOI and ADOII are equally safe and effective in pmVSD closure. ADOII use, although cheaper than ADOI, is limited to smaller VSDs. The choice between ADOI and ADOII can be decided by TTE prior to procedure which is convenient in low economic programs.
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Kuwelker SM, Shetty DP, Dalvi B. Surgical repair of tricuspid valve leaflet tear following percutaneous closure of perimembranous ventricular septal defect using Amplatzer duct occluder I: Report of two cases. Ann Pediatr Cardiol 2017; 10:61-64. [PMID: 28163430 PMCID: PMC5241847 DOI: 10.4103/0974-2069.197052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Tricuspid valve (TV) injury following transcatheter closure of perimembranous ventricular septal defect (PMVSD) with Amplatzer ductal occluder I (ADO I), requiring surgical repair, is rare. We report two cases of TV tear involving the anterior and septal leaflets following PMVSD closure using ADO I. In both the patients, the subvalvular apparatus remained unaffected. The patients presented with severe tricuspid regurgitation (TR) 6 weeks and 3 months following the device closure. They underwent surgical repair with patch augmentation of the TV leaflets. Postoperatively, both are asymptomatic with a mild residual TR.
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Affiliation(s)
| | | | - Bharat Dalvi
- Glenmark Cardiac Centre, Mumbai, Maharashtra, India
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39
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Deshpande S, Godbole RC, Godbole YR. Percutaneous closure of aortic pseudoaneurysm in a young female with atrial septal occluder. J Cardiol Cases 2017; 15:39-42. [PMID: 30546692 PMCID: PMC6283732 DOI: 10.1016/j.jccase.2016.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/01/2016] [Accepted: 10/06/2016] [Indexed: 11/21/2022] Open
Abstract
This case report represents a novel technique for the treatment of a pseudoaneurysm of the aorta. Pseudoaneurysm of the aorta has been reported in patients post heart surgery. This case report is about a patient who had a pseudoaneurysm most probably following tuberculosis. Traditionally, the treatment of choice is surgical correction; however, in the current era, there are case reports describing the use of either stent grafts or Amplatzer occluders for occlusion of the pseudoaneurysm in high-risk surgical cases. We performed successful closure of the aortic pseudoaneurysm using atrial septal occluder. .
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Affiliation(s)
- Shantanu Deshpande
- Padmashree Dr D Y Patil Medical College, Nerul, Navi Mumbai, Maharashtra, India
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40
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Abstract
Whereas the left atrial appendage plays a rather minor role under physiological circumstances, it gains an importance in patients with atrial fibrillation. Compelling evidence has revealed that the left atrial appendage is implicated as the source of thrombus in the vast majority of strokes in atrial fibrillation. Oral anticoagulation remains the standard of care for stroke prevention in atrial fibrillation; nevertheless, this treatment has several limitations and is often contraindicated, particularly in the elderly population in whom the risk of stroke is high. Therefore, occluding the left atrial appendage is a logical approach to prevent thrombus formation and subsequent cardioembolic events in these patients. We present a review of clinical outcomes of patients with atrial fibrillation undergoing left atrial appendage closure and the challenges faced in this field.
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41
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Dalvi B, Sheth K, Jain S, Pinto R. Transcatheter closure of large atrial septal defects using 40 mm amplatzer septal occluder: Single group experience with short and intermediate term follow-up. Catheter Cardiovasc Interv 2016; 89:1035-1043. [PMID: 27862916 DOI: 10.1002/ccd.26858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/10/2016] [Accepted: 10/12/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess feasibility, safety, and efficacy of the use of 40 mm Amplatzer septal occluder (ASO 40) for the closure of large atrial septal defects (ASD). BACKGROUND There is very little data available on closure of large ASDs with ASO 40. MATERIALS AND METHODS Case records of patients who underwent ASD closure with ASO 40 between 2002 and 2014 were retrospectively analyzed. All patients had clinical, transthoracic, and transesophageal echocardiographic (TEE) evaluation prior to device closure. Postclosure follow-up was done at 6 weeks, 6 months, and annually thereafter. RESULTS 87 patients underwent ASD closure using ASO 40 during the study period. Mean age and weight of the group was 32.4 ± 11.6 years and 59.5 ± 11.3 kg respectively. Mean ASD diameter on TEE was 32 ± 2.8 mm. The balloon stretched diameter (N = 40) was 37.8 ± 1.3 mm. The balloon assisted technique was used in 80/87 patients for device deployment. The procedure was successful in 84/87 patients. Follow-up was available in 77 patients over a period of 44 ± 15.7 months. 3/77 patients had a small residual shunt. The severity of tricuspid regurgitation decreased in 40/77 patients. The pulmonary artery systolic pressure decreased from 49.7 ± 9.2 to 41.2 ± 6.2 mm Hg (N = 61; P < 0.05). The right ventricular diameter decreased from 35.1 ± 2.8 to 26.1 ± 3 mm (N = 77; P < 0.05). CONCLUSION ASO 40 can be used safely and effectively with promising short and intermediate term results.© 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Bharat Dalvi
- Glenmark Cardiac Centre, 101/102 Swami Krupa Coop Hsg Scty, D. L. Vaidya Road, Dadar (W), Mumbai, 400 028, India
| | - Kshitij Sheth
- Department of Cardiology, Fortis Hospital, Mumbai, India
| | - Shreepal Jain
- Department of Cardiology, Sir HN Reliance Foundation Hospital, Mumbai, India
| | - Robin Pinto
- Glenmark Cardiac Centre, 101/102 Swami Krupa Coop Hsg Scty, D. L. Vaidya Road, Dadar (W), Mumbai, 400 028, India
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42
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Nassif M, Heuschen CBBC, Lu H, Bouma BJ, van Steenwijk RP, Sterk PJ, Mulder BJM, de Winter RJ. Relationship between atrial septal defects and asthma-like dyspnoea: the impact of transcatheter closure. Neth Heart J 2016; 24:640-646. [PMID: 27561281 PMCID: PMC5065534 DOI: 10.1007/s12471-016-0879-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients with atrial septal defects (ASD) are often misdiagnosed as asthma patients and accordingly receive erroneous bronchodilator treatment. In order to characterise their symptoms of dyspnoea to explain this clinical observation, we investigated the prevalence of asthma-like symptoms in patients with secundum ASD who then underwent successful percutaneous closure. METHODS A total of 80 ASD patients (74 % female, mean age 46.7 ± 16.8 years, median follow-up 3.0 [2.0-5.0] years) retrospectively completed dyspnoea questionnaires determining the presence and extent of cough, wheezing, chest tightness, effort dyspnoea and bronchodilator use on a 7-point scale (0 = none, 6 = maximum) before and after ASD closure. The Mini Asthma Quality of Life (Mini-AQLQ) and Asthma Control Questionnaire with bronchodilator use (ACQ6) were administered. RESULTS A total of 48 (60 %) patients reported cough, 27 (34 %) wheezing, 26 (33 %) chest tightness and 62 (78 %) effort dyspnoea. Symptom resolution or reduction was found in 64 (80 %) patients after ASD closure. Asthma symptom scores decreased significantly on the Mini-AQLQ and ACQ6 (both p < 0.001). The number of patients using bronchodilators decreased from 16 (20 %) to 8 (10 %) patients after ASD closure (p = 0.039) with less frequent use of bronchodilators (p = 0.015). CONCLUSIONS A high prevalence of asthma-like symptoms and bronchodilator use is present in ASD patients, which exceeds the low prevalence of bronchial asthma in this study population. Future prospective research is required to confirm this phenomenon. The presence of an ASD should be considered in the differential diagnosis of patients with asthma-like symptoms, after which significant symptom relief can be achieved by ASD closure.
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Affiliation(s)
- M Nassif
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - C B B C Heuschen
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - H Lu
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - B J Bouma
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - R P van Steenwijk
- Department of Pulmonary Medicine, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - P J Sterk
- Department of Pulmonary Medicine, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - B J M Mulder
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - R J de Winter
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
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Krishnamoorthy KM, Bijulal S, Gopalakrishnan A. Severe aortic regurgitation during percutaneous closure of ventricular septal defect. Int J Cardiol 2016; 215:435. [PMID: 27131265 DOI: 10.1016/j.ijcard.2016.04.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/10/2016] [Indexed: 11/16/2022]
Affiliation(s)
- K M Krishnamoorthy
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India.
| | - S Bijulal
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
| | - Arun Gopalakrishnan
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
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Kumar V, Banerjee A, Aggarwal N, Garg S, Swamy A. Atrial and ventricular septal defects device closure in a child in one session. Indian Heart J 2016; 68:370-2. [PMID: 27316495 PMCID: PMC4912531 DOI: 10.1016/j.ihj.2016.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 03/14/2016] [Indexed: 11/11/2022] Open
Abstract
We describe a rare interventional procedure in which an 8-year-old girl underwent a successful device closure of both atrial septal and ventricular septal defects in one session.
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Affiliation(s)
- V Kumar
- Pediatric Cardiologist, Army Hospital R&R, India.
| | - A Banerjee
- Deputy Commandant and Consultant Cardiology, Army Hospital R&R, India
| | - N Aggarwal
- Consultant and HOD Cardiology, Army Hospital R&R, India
| | - S Garg
- Consultant Cardiology, Army Hospital R&R, India
| | - A Swamy
- Consultant Cardiology, Army Hospital R&R, India
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45
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Shamsuddin AM, Chen YC, Wong AR, Le TP, Anderson RH, Corno AF. Surgery for doubly committed ventricular septal defects. Interact Cardiovasc Thorac Surg 2016; 23:231-4. [PMID: 27170744 DOI: 10.1093/icvts/ivw129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/09/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Doubly committed ventricular septal defects (VSDs) account for up to almost one-third of isolated ventricular septal defects in Asian countries, compared with only 1/20th in western populations. In our surgical experience, this type of defect accounted for almost three-quarters of our practice. To date, patch closure has been considered the gold standard for surgical treatment of these lesions. Our objectives are to evaluate the indications and examine the outcomes of surgery for doubly committed VSDs. METHODS Between October 2013, when our service of paediatric cardiac surgery was opened, and December 2014, 24 patients were referred for surgical closure of VSDs. Among them, 17 patients (71%), with the median age of 6 years, ranging from 2 to 9 years, and with a median body weight of 19 kg, ranging from 11 to 56 kg, underwent surgical repair for doubly committed defects. In terms of size, the defect was considered moderate in 4 and large in 13. Aortic valvular regurgitation (AoVR) was present in 11 patients (65%) preoperatively, with associated malformations found in 14 (82%), with 5 patients (29%) having two or more associated defects. RESULTS After surgery, there was trivial residual shunting in 2 patients (12%). AoVR persisted in 6 (35%), reducing to trivial in 5 (29%) and mild in 1 (6%). Mean stays in the intensive care unit and hospital were 2.6 ± 1.2 days, ranging from 2 to 7 days, and 6.8 ± 0.8 days, ranging from 6 to 9 days, respectively. The mean follow-up was 14 ± 4 months, ranging from 6 to 20 months, with no early or late deaths and without clinical deterioration. CONCLUSIONS The incidence of doubly committed lesions is high in our experience, frequently associated with AoVR and other associated malformation. Early detection is crucial to prevent further progression of the disease. Patch closure remains the gold standard in management, not least since it allows simultaneous repair of associated intracardiac defects.
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Affiliation(s)
- Ahmad Mahir Shamsuddin
- Pediatric and Congenital Cardiac Surgery Unit, Department of Surgery, School of Medical Sciences, Health Campus, University of Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Yen Chuan Chen
- Pediatric and Congenital Cardiac Surgery Unit, Department of Surgery, School of Medical Sciences, Health Campus, University of Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Abdul Rahim Wong
- Pediatric Cardiology Unit, Department of Pediatrics, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
| | - Trong-Phi Le
- Department for Structural and Congenital Heart Disease, Heart Center Bremen, Klinikum Links der Weser, Bremen, Germany
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, International Centre for Life, Newcastle upon Tyne, UK
| | - Antonio F Corno
- Pediatric and Congenital Cardiac Surgery, East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
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Abstract
OBJECTIVE We aimed to assess the medium to long-term results of echocardiographic follow-up of perimembranous and muscular ventricular septal defect closure with various Amplatzer devices. METHODS We successfully closed ventricular septal defects percutaneously in 45/49 patients. There were 35 perimembranous and 10 muscular ventricular septal defects. The median age and weight was 8.50 years (range 2-36.70 years) and 24 kg (range 10-106 kg), respectively. The median size of the ventricular septal defect was 7 mm (range 3-14 mm) on transthoracic echocardiography, 6 mm (range 4-15 mm) on transesophageal echocardiography, and 6 mm (range 3-14 mm) on left ventricular angiography. The median pulmonary-to-systemic blood flow ratio was 1.40 (range 1.0-3.0). RESULTS In the 49 attempted cases, the procedure was successful in 45, with a success rate of 91.84%. At a mean follow-up of 54.50 months, echocardiography showed complete closure in 41 (91%) patients and 4 (9%) had a tiny (1-2 mm) residual defect. New-onset aortic regurgitation was seen in 6 (13.3%) patients at 54.50 months, but it was mild in nature. Tricuspid valve regurgitation was observed in 13 (29%) patients at 54.50 follow-up, of whom 10 (22%) had mild and 3 (7%) had moderate regurgitation. CONCLUSION Transcatheter closure of perimembranous and muscular ventricular septal defects is effective, however, these patients need to be followed up regularly to detect device-related problems, specifically, aortic and tricuspid valve regurgitation.
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Affiliation(s)
| | - Mohammed Numan
- Division of Pediatric Cardiology, University of Texas, Houston, TX, USA
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47
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Abu-Tair T, Wiethoff CM, Kehr J, Kuroczynski W, Kampmann C. Transcatheter Closure of Atrial Septal Defects using the GORE(®) Septal Occluder in Children Less Than 10 kg of Body Weight. Pediatr Cardiol 2016; 37:778-83. [PMID: 26895499 DOI: 10.1007/s00246-016-1350-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 02/04/2016] [Indexed: 11/26/2022]
Abstract
The GORE(®) Septal Occluder (GSO) is a well-evaluated device for interventional ASD closure with closure rates comparable to the Amplatzer(®) Septal Occluder (ASO), but there are no published reports of its use in small children weighing less than 10 kg. This may be due to the necessity of a large-sized introducing sheath of at least 10 Fr and therefore the assumed risk of complications in vascular access. The GSO is an alternative option for interventional ASD closure in children weighing less than 10 kg. Fourteen infants and children with a median body weight 8900 g (range 6350-9650 g) underwent successful ASD closure using the GSO. The closure was performed under fluoroscopic and transthoracic echocardiographic guidance. Postprocedure, the vessels passed by the occluder and delivery catheter were examined by duplex sonography. The median ASD diameter was 11 mm (5-17 mm), and the median GSO size was 22.5 mm (15-30 mm), whereas the median ASO left disc size that would have been recommended was 25 mm (17-31 mm). All ASDs were successfully closed. During a median follow-up of 1.57 years (range 0.5-4.2), no complications like erosion, embolization, arrhythmias, or vascular injuries occurred. Although using a 10-Fr introducer sheath, no vascular complications were detected. Our data suggest that the small usable size as well as the soft and flexible design of the device allows successful use of the GSO in young children.
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Affiliation(s)
- Tariq Abu-Tair
- Department of Pediatric Cardiology and Congenital Heart Disease, University Children's Hospital, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Christiane M Wiethoff
- Department of Pediatric Cardiology and Congenital Heart Disease, University Children's Hospital, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Jascha Kehr
- Department of Pediatric Cardiology and Congenital Heart Disease, University Children's Hospital, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Wlodzimierz Kuroczynski
- Department of Pediatric Cardiology and Congenital Heart Disease, University Children's Hospital, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Christoph Kampmann
- Department of Pediatric Cardiology and Congenital Heart Disease, University Children's Hospital, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
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48
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Abstract
Test occlusion with a balloon is done to predict operability of large hypertensive patent ductus arteriosus (PDA). If the fall in the pulmonary artery pressures is inadequate, a complete closure is not desired. To create a predictable premeasured fenestration in a nitinol occluder device used for closing hypertensive PDA. A large nitinol occluder device was punctured with an 18G needle to advance a 0.035˝ stiff guide wire through the occluder before loading it into the delivery system. The occluder with the guidewire was then deployed across the PDA. A coronary guide catheter was later threaded through the guidewire into the fabric of the device, which was still held by the delivery cable. A coronary stent was deployed across the fenestration in the occluder to keep it patent. An 8-year-old boy with Down syndrome and hypertensive PDA was hemodynamically assessed. Even though there was a fall in the pulmonary vascular resistance index and pressures on test occlusion, the pulmonary artery pressures were labile with fluctuations. A customized fenestration was made in a 16 mm muscular ventricular septal defect occluder (MVSO) with a 4.5 mm bare-metal coronary stent. The pulmonary artery pressures remained at half of the aortic pressures after the procedure. This fenestration model precisely and predictably fenestrated a large occluder device used to close a hypertensive large PDA. Long-term patency of these fenestrations has to be assessed on the follow-up, and may be improved through larger fenestrations, systemic anticoagulation and use of covered stents.
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Affiliation(s)
- Anil Kumar Singhi
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, The Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, The Madras Medical Mission, Chennai, Tamil Nadu, India
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Madan T, Juneja M, Raval A, Thakkar B. Transcatheter device closure of pseudoaneurysms of the left ventricular wall: An emerging therapeutic option. Rev Port Cardiol 2016; 35:115.e1-5. [PMID: 26852302 DOI: 10.1016/j.repc.2015.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/15/2015] [Accepted: 07/10/2015] [Indexed: 11/19/2022] Open
Abstract
Left ventricular pseudoaneurysm is a rare but serious complication of acute myocardial infarction and cardiac surgery. While surgical intervention is the conventional therapeutic option, transcatheter closure can be considered in selected patients with suitable morphology of the pseudoaneurysm. We report a case of successful transcatheter closure of a left ventricular pseudoaneurysm orifice and isolation of the sac using an Amplatzer septal occluder.
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Affiliation(s)
- Tarun Madan
- Cardiology Department, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India
| | - Manish Juneja
- Cardiology Department, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India.
| | - Abhishek Raval
- Cardiology Department, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India
| | - Bhavesh Thakkar
- Cardiology Department, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India
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Vijayalakshmi IB. Evaluation of Left to Right Shunts by the Pediatrician: How to Follow, When to Refer for Intervention? Indian J Pediatr 2015; 82:1027-32. [PMID: 26452492 DOI: 10.1007/s12098-015-1861-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/22/2015] [Indexed: 02/01/2023]
Abstract
Left to right shunts are the most common congenital heart defects which may cause increased pulmonary blood flow leading to dilatation of cardiac chambers, congestive heart failure, pulmonary artery hypertension and eventually Eisenmenger's syndrome. Many children are, however, referred late for correction making them either high risk for intervention or inoperable. The device closure of atrial septal defect, ventricular septal defect and patent ductus arteriosus can literally cure the patient for life, without a scar on the chest. Hence, it is important for every pediatrician to know how to follow and when to refer the patients with left to right shunts for either device closure or surgical intervention, so that the patient can lead a near normal life.
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Affiliation(s)
- I B Vijayalakshmi
- Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, 560 069, India.
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