Immediate, short and intermediate results of transcatheter closure of secondum-type atrial septal defect using Amplatzer septal occluder devices.

OBJECTIVES: To study the immediate, short, and intermediate results of transcatheter closure of secondum-type atrial septal defect using Amplatzer septal occluder devices (TCAA) in terms of clinical symptoms and residual lesions and shunts determined by transthoracic two-dimensional (TTE) and three-dimensional echocardiography (TDE). MATERIAL AND METHOD: Thirty-six patients, who underwent successful TCAA at the Chest Disease Institute between August 2002 and August 2007 and were followed up clinically, by TTE and TDE at day 1-3, 4-6 months, and 1-year post TCAA, were analyzed. RESULTS: TCAA was performed in 75 patients during the study period. Of these, 36 patients were completely followed-up. There were 92% female with a mean age of 40 +/- 16 yrs (range 19 to 65) and the mean of maximal size of ASD secondum determined by TTE, transesophageal echocardiography (TTE) and balloon sizing or balloon stretched diameter (BSD)was 18.9 +/- 4.7 mm (range 10-30), 22.6 +/- 5.3 mm (rang 10-32), and 24.3 +/- 5.3 mm (range 12-34) respectively. The size of ASOD was 26.4 +/- 4.9 mm (range 12-34). Fluoroscopic time was 16.4 +/- 7.1 min (range 6.7-35.6). The success rate of TCAA was 84%. No major complications and deaths were found. All of those with successful TCAA apparently improved their functional class. All of them showed complete ASD closure and yet 12 (31%) had Qp/Qs > or = 1.5 at year one. CONCLUSION: TCAA is safe and effective and had resulted in clinical improvement, complete closure of secondum ASD, and good immediate, short, and intermediate outcomes with fewer complications.

Experience of percutaneous mechanical mitral commissurotomy using metallic commissurotome in patients with mitral stenosis at chest disease institute.

BACKGROUND: Percutaneous metallic mitral commissurotomy (PMMC) has been accepted as an alternative to the traditional balloon technique. The advantage of the metallic commissurotome is that it is designed for several reuse and resterization and it is an interesting tool as seen by the authors. OBJECTIVE: To evaluate the efficacy and safety of PMMC among a wide range of patients with severe mitral stenosis. MATERIAL AND METHOD: Between July 2000 and August 2003, patients with severe mitral stenosis who underwent PMMC were enrolled Interatrial septum was punctured under transesophageal echocardiography guidance in all cases. Demographic data and baseline characteristics were collected Mitral valve area (MVA) was evaluated by echocardiography and hemodynamic parameters pre and post PMMC were compared RESULTS: PMMC was performed in 304 patients with a broad range of severe mitral stenosis. Mean age was 38.7 +/- 10. 9 years and 79% was female. Most were in functional class 11 (94%) and 43 patients (14%) had prior commissurotomy. Atrial fibrillation was found in 41%. Twenty-six patients were crossed over to the Inoue balloon technique. The rate of success was 81% in all patients (246/304) and 89% in patients when PMMC was actually done (246/278). The MVA increased from 84 +/- 22 to 170 +/- 36 mm2 (p < 0.0001). Transvalvular gradient decreased from 17 +/- 6 to 7 +/- 4 mmHg (p < 0.0001) and mean left atrial pressure from 26 +/- 7 to 15 +/- 6 mmHg (p < 0.0001). Separation of both commissures was found in 25% and 61% had symptom relief by a reduction in functional class at least one level (p < 0.0001). Complications developed in 16 patients (5.3%) including three serious events, one death caused by severe mitral regurgitation followed by emergency surgery, another survivor after surgical repair of left ventricular free wall rupture and the last one with surgical removal of the malfunctioned device stuck in the left atrium. CONCLUSION: Results of PMMC is not as encouraging as shown in previous studies. The risk of cardiac tamponade is minimized by interatrial septal puncture using transesophageal echocardiography (TEE) monitoring but this technique increased the possibility of crossover. Deterioration of the metallic commissurotome after a few procedures is demonstrated in the author's real practice.

Transjugular approach as a challenging access in PTMC: case report.

Advantage of transjugular approach in percutaneous mitral commissurotomy (PTMC) of severe mitral stenotic patients with venous drainage anomalies was obtained as the authors' first case experience. This approach should be considered whenever difficulties are encountered in the femoral approach in PTMC case before valve surgery.