Simplified percutaneous closure of patent foramen ovale and atrial septal defect with use of plain fluoroscopy: Single operator experience in 110 consecutive patients

Objective Percutaneous closure of patent foramen ovale (PFO) and atrial septal defect (ASD) is routinely performed under general anesthesia or deep sedation and use of transesophageal (TEE) or intracardiac echocardiography, incurring longer duration and higher cost. We have used a simplified, economical, fluoroscopy-only guided approach with local anesthesia, and herein report our data. Methods The study includes 112 procedures in 110 patients with PFO (n = 75) or ASD (n = 35), with use of an Amplatzer occluder, heparin and prophylactic antibiotics. Balloon sizing guided ASD-device selection. All patients received aspirin and clopidogrel for 6 months, when they all underwent TEE. Results All PFOs but one (98.7%) and all (100%) ASDs were successfully closed with only one complication (local pseudoaneurysm). At the 6-month TEE, there was no residual shunt in PFO patients, but 2 ASD patients had residual shunts. During long-term (4.3-year) follow-up, no stroke recurrence in PFO patients, and no other problems were encountered. Among 54 patients suffering from migraine, symptom relief or resolution was reported by 45 (83.3%) patients. Conclusion Percutaneous placement of an Amplatzer occluder was safe and effective with use of local anesthesia and fluoroscopy alone. There were no recurrent strokes over >4 years. Migraine relief was reported by >80% of patients.

Cierre percutáneo primario del defecto del tabique interventricular postinfarto con el dispositivo de Amplatzer: resultados inmediatos y seguimiento a largo plazo / Primary percutaneous closure of postinfarction septal defect with Amplatzer device: immediate results and long-term follow-up

Introducción: La reparación quirúrgica inmediata de una comunicación interventricular que complica el infarto agudo del miocardio (CIV post-IAM) se asocia con la alta mortalidad. El cierre con dispositivo percutáneo parece ser seguro y efectivo en pacientes con CIV post-IAM; reportamos los resultados inmediatos y a largo plazo en la utilización del dispositivo Amplatzer en el cierre primario de una CIV post-IAM. Material y métodos: De junio del 2006 a enero del 2014, 17 pacientes portadores de una CIV post-IAM se sometieron a un cierre percutáneo con Amplatzer a una edad promedio de 66.8 ± 5.5, 82.4% en shock cardiogénico (ShC), el 35.3% recibieron tratamiento trombolítico (TT) en ventana, el tiempo promedio del diagnóstico de CIV al cierre percutáneo (IP) fue de 8.7 ± 5.8 días. Resultados: Con un seguimiento actual de 13.25 ± 12.6 meses, el éxito del procedimiento fue del 100%, el shunt (QP:QS) se redujo de 2.9 ± 0.95 a 1.5 ± 0.40 L/min p = 0.0001, 12 pacientes (70.6%) se sometieron a una Angioplastía Coronaria Transluminal Percutánea (ACTP) del vaso culpable posterior al cierre de la CIV. La mortalidad a 30 días fue de 52.9%, siendo más alta en el paciente con ShC versus no-ShC 64.3 versus 0% p = 0.043 OR 2.8 (IC 95% 1.38-5.6). Conclusión: El cierre primario de CIV post-IAM es una técnica muy promisoria que puede ser realizada con una alta tasa de éxito y mínimas complicaciones y puede ser tomado como una alternativa a la cirugía. Sin embargo, a pesar de ser una técnica menos invasiva, la mortalidad permanece alta y muy evidente en el paciente en ShC.

Introduction: The immediate surgical repair of a ventricular septal defect complicating acute myocardial infarction (VSD post-AMI) is associated with high mortality. The percutaneous closure device is safe and effective in patients with post-infarction VSD; we report the immediate and long term results in the use of the Amplatzer device in the primary closure of post infarction VSD. Material and methods: From June 2006 to January 2014, 17 patients carriers of post-infarction VSD underwent percutaneous Amplatzer closure with a mean age 66.8 ± 5.5, 82.4% in cardiogenic shock (CS), 35.3% were thrombolyzed (TT) in window, the average time to percutaneous closure of VSD 8.7 ± 5.8 days. Results: With a current monitoring of 13.25 ± 12.6 months procedural success were in 100% shunt (QP:QS) was reduced from 2.9 to 1.5 ± 0.40 ± 0.95 L/min p = 0.0001, 12 patients (70.6%) undergoing PTCA the culprit vessel post-closure of the VSD. Global mortality at 30 days was 52.9%, being higher in patients with CS versus 64.3 versus 0% no-CS p = 0.043 OR 2.8 (CI 95% 1.38-5.6). Conclusion: The primary closure of postinfarction VSD is a very promising technique that can be performed with a high success rate and minimal complications and may be taken as an alternative to surgery. However despite being a less invasive technique remains high mortality very evident in patients in CS.

Cardiac resynchronization therapy for heart failure induced by left bundle branch block after transcatheter closure of ventricular septal defect / 老年心脏病学杂志（英文版）

A 54-year-old female patient with congenital heart disease had a persistent complete left bundle branch block three months after closure by an Amplatzer ventricular septal defect occluder. Nine months later, the patient suffered from chest distress, palpitation, and sweating at daily activities, and her 6-min walk distance decreased significantly (155 m). Her echocardiography showed increased left ventricular end-diastolic diameter with left ventricular ejection fraction of 37%. Her symptoms reduced significantly one week after received cardiac resynchronization therapy. She had no symptoms at daily activities, and her echo showed left ventricular ejection fraction of 46%and 53%. Moreover, left ventricular end-diastolic diameter decreased 6 and 10 months after cardiac resynchronization therapy, and 6-min walk dis-tance remarkably increased. This case demonstrated that persistent complete left bundle branch block for nine months after transcatheter closure with ventricular septal defect Amplatzer occluder could lead to left ventricular enlargement and a significant decrease in left ventricular systolic function. Cardiac resynchronization therapy decreased left ventricular end-diastolic diameter and increased left ventricular ejection fraction, thereby improving the patient’s heart functions.

A Case Demonstrating a Percutaneous Closure Using the Amplatzer Duct Occluder for Paravalvular Leakage after Tricuspid Valve Replacement

There has been a dramatic increase in the number and type of procedures performed in the field of cardiac intervention in the past decade. Percutaneous intervention is becoming an increasingly recognized modality for the management of prosthetic paravalvular leakages (PVLs) in severely symptomatic non-surgical candidates. Herein, we report our experience of percutaneous closure using the Amplatzer duct occluder for a PVL in a patient who underwent tricuspid valve replacement.

Transcatheter closure of secundum atrial septal defects and fenestrated Fontan using the Amplatzer septal occluder: Initial prospective study / Cierre transcateterismo de defectos septales atriales y Fontan fenestrado mediante el dispositivo de Amplatzer: Estudio prospectivo inicial

Objective: To evaluate the safety and efficacy of transcatheter closure of secundum atrial septal defects and fenestrated Fontan with the Amplatzer septal occluder. Methods: Fifteen consecutive patients, with a significant interatrial communications, were considered for the procedure; four patients with defects that were too large or with deficient margins were excluded after initial transesophageal echocardiography. Results: Eleven procedures were performed in 11 patients (10 atrial septal defects and 1 fenestrated Fontan) aged 9 to 38 years, mean 17.7 ± 9 years; body weight 30 to 87 kg, mean 51.4 ± 16. The stretched balloon diameter of the defects ranged from 8 to 28 mm, mean 18.8 ± 6.9; the diameter of the devices ranged from 10 to 30 mm, mean 20.8 ± 6. Immediate total occlusion rate was 18.1%, rising to 63.6% after 24 hours. Total occlusion rate at one month reached 100%. Severe transient sinus bradycardia in one (9%) was the only complications. At follow-up (10 to 26 months, mean 13.2 ± 5.0) all patients remain asymptomatic with no residual shunt. Conclusions: The Amplatzer septal occluder is very efficient and offered interventional interatrial communications closure in 100% of our group of consecutive patients with excellent intermediate results.

Objetivo: Evaluar la seguridad y eficacia del cierre transcateterismo de defectos septales atriales y Fontan fenestrado mediante el dispositivo de Amplatzer. Método: Quince enfermos consecutivos con comunicaciones interauriculares significativas fueron considerados inicialmente; se excluyeron 4 de ellos por defectos demasiado grandes o con bordes deficientes después de ecocardiografía transesofágica inicial. Resultados: Se realizaron 11 procedimientos en 11 enfermos (10 con defectos septales auriculares y uno con Fontan fenestrado), el rango de edad fue de 9 a 38 años, media 17.9 ± 9 años; peso de 30 a 87 kg, media 51.4 ± 16. El diámetro de balón ajustado al defecto varió de 8 a 28 mm, media 18.8 ± 6.9; el diámetro de los dispositivos varió de 10 a 30 mm, media 20.8 ± 6. La oclusión total inmediata ocurrió en el 18.1%, subiendo a 63.6% a las 24 horas. La oclusión total en el 100% de los enfermos se obtuvo al mes de seguimiento. Complicaciones: Se produjo severa bradicardia sinusal transitoria en un enfermo (9%). El seguimiento varió de 10 a 26 meses, media 13.2 ± 5.0. Todos los enfermos se encuentran asintomáticos sin corto circuito residual. Conclusiones: El oclu-sor Amplatzer es muy eficiente y ofrece el cierre de las comunicaciones interauriculares en el 100% de nuestro grupo de enfermos consecutivos con excelentes resultados a mediano plazo. (Arch Cardiol Mex 2003; 73:185-189).

Echocardiographic guidance of transcatheter closure of vent ricular septal defects using the Amplatzer device / 中华超声影像学杂志

Objective To evaluate the applied values of echocadiography in closing membranous ventricular septal defects (VSD) with the Amplatzer devices. Methods The VSD were closed by transcatheter Amplatzer closure devices in nine patients. The patients′ age ranged between 15-45 years old,mean (26?10) years old. The VSD diameter was measured from 3 to 15 mm. Seven patients were guided by transthoracic echocardiography and 2 patients by transesophageal echocardiography. Results All VSD were successfully closed by the Amplatzer devices, without complications. The device size ranged from 6 to 18 mm. No residual shunt and complication were detected by the echocadiography in intraoperation and 3 or 4 days after operation. Conclusions Echocardiography plays an important role in closing VSD with Amplatzer device, not only in intraoperative guidance and monitor, but also in post-operative follow up study.

Transcatheter closure of atrial septal defect and patent ductus arteriosus with Amplatzer occluder / 第三军医大学学报

Objective To evaluate the therapeutic efficacy and safety of transcatheter closure of atrial septal defect (ASD) and patent ductus arteriosus (PDA) using Amplatzer occluder. Methods Routine cardiac catheterization and angiography were performed in 50 patients (23 male, 27 female, age ranging from 3 to 64 years old), including 19 cases of ASD and 31 cases of PDA under local or general anesthesia. After balloon sizing of the ASD, the optimal Amplazter septal occluder (ASO) was transmitted into the left atrial, and the left and right disks were released in turn. The Amplatzer occluder was completely released after transthoracic echocardiography confirmed that there was no residual shunts or new onset mitral valve regurgitation. The Amplatzer duct occluder (ADO) size was selected according to the narrowest point of PDA measured by angiography, and the occluder was released after the repeated angiography showed no residual shunts. Results ① The mean diameter of the ASD measured by balloon was 13-31 (23?6) mm and the diameter of ASO was (17-40) mm. The immediate closure rate was 100%. ② Angiography confirmed that closure of the ductus using ADO was achieved in 30 patients, and closure of the large size (12 mm) was achieved in 1 case of PDA patient using ASO (17 mm). No complications were encountered. Conclusion Transcatheter closure of ASD and PDA using Amplatzer device, with the advantages of simple operation, confirmative occlusion efficacy, minimal invasiveness, wide indications, and less complications, has a bright future of clinical application.

Catheter closure of ventricular septal defects using Amplatzer occluder / 介入放射学杂志

Objective To evaluate the clinic effectiveness and safety of transcatheter closure of ventricular septal defect using homemade Amplatzer VSD occluder. Methods From Jan 2003 to April 2005,16 patients (11 males,5 femles) with VSD underwent an attempt of catheter closure using homemade Amplatzer occluder.The mean age of patients was (13.98 ?11.05) years (ranged from 3.5 to 41 years);the mean weight of patients was (32. 1 ?17.59) kg (ranged from 12.5 to 59 kg);the mean diameter ofVSD measured by transthoracic echocardiography (TTE) was(5.34?1.75)mm(ranged from 3.7 to 9mm). All patients underwent closure under TTE or transthoracic echocardiography(TEE)guidance. Results The devices were deployed successfully in 12patients.There was complete closure in 11patients immediatelly,and residual sbunt in 1 patients.After proccdure, bundle branch block(right and left bundle) were occurred in 7patients.Hemolysis was in 1patients.There were no other servere complications.Conclusions Transcatheter closure of VSD using this new occluder is safe and effective. Early results are good.Further clinical trials are underway to assess the long-term results.

Efficacy of VSD Occluder via Lower Ministernotomy:Short-term Evaluation / 中国微创外科杂志

Objective To evaluate the efficacy of ventricle septal defect(VSD) occluder through lower ministernotomy for patients with perimembranous VSD. Methods From January 2007 to August 2008,41 patients with perimembranous VSD(14 male,27 female,weighed 9.0 to 71 kg with a mean of 46.3?16.1) underwent a closure of perimembranous VSD through lower ministernotomy using Amplatzer occluder.Before the operation,all the cases had been confirmed as having a 3-to 8.5-cm perimembranous VSD by transthoracic echocardiography(TTE).Under general anaesthesia,a small incision was made at the lower sternum to expose the right ventricle,and then occluder was placed in the right ventricle.TEE,electrocardiography and chest X-ray were performed before discharge and 1 month after the operation.Results The procedure was completed successfully in all the patients with a mean operation time of(6.2?3.3) hours(ranged from 2.5 to 17 hours).The ICU stay was(15.1?4.3) in average(8-21 hours).The mean drainage volume after the surgery was(80?33) ml(35-210 ml).Follow-up was available in all the cases for(7.9?4.1) months(range,3-15 months).During the period,no A-V block,new AI,occluder displacement,embolization,tricuspid incompetence or residual occurred. Conclusions VSD occluder is feasible and safe for closure of perimembranous ventricular septal defects through lower ministernotomy.

Application of echocardiography in transcatheter closure of ventricular septal defect with Amplatzer occluder / 中华超声影像学杂志

Objective To probe the value of using echocardiography in transcatheter closure of ventricular septal defect (VSD).Methods Under transthoracic echocardiography and digital subtraction angiocardiography monitoring and guidance in the operation,the Amplatzer excentric umbrella occluder was used to occlude the perimembranous defects in 15 cases of patients.Results All of the patients were treated successfully,though mitral regurgitations or residual shunts occurred in 6 cases,and disappeared at once after the position and direction of occluder were regulated in 3 and these complications disappeared gradually one month postoperation in other 3 patients.The umbrella separated from VSD in 1 and occluded successfully when manipulated once again.Complete heart block occurred in 2 and disappeared after 3 days.The positions of umbrella were normal and stable and no other complications were discovered when these patients were followed about 10 months the longest.Conclusions Echocardiography plays an important role in transcatheter closure of VSD with the Amplatzer occluder before,during and after operation and in the period of follow up.

Value of transesophageal echocardiography in transcatheter closure of secundum atrial septal defects during port-access minimally invasive cardiac surgery / 中华超声影像学杂志

ObjectiveTo determine the role and significance of transesophageal echocardiography (TEE) in the closure of atrial septal defects (ASD) during minimally invasive cardiac surgery. MethodsSeventeen patients with secundum atrial septal defect (ASD) were examined by transthoracic echocardiography (TTE) and TEE. TTE usually allowed selection of cases likely to be suitable for closure in this fashion. TEE provided indispensable informations in the selection of eligible atrial septal defects, evaluates the exact size, location and morphology of the defect. Skin incisions were made on the right anterior chest which were 2.5 ～ 3.5 cm long. A special catheter carrying Amplatzer occluder were inserted into the left atrium via ASD. Under TEE guidance, the device was released and ASD was successfully closed. ResultsThe occluder device was successfully implanted in 15 patients. The size of ASD varied from 11 to 35 mm [mean (23?6) mm] measured by TEE, upper septal rim 4 to 17 mm[mean (10?4) mm], lower septal rim 6 to 22 mm[mean (14?6) mm]. The intracardiac procedure time ranged from 10 to 45 min[(24?13) min]. They were all discharged from the hospital 3 or 4 days after the operation. ConclusionsTEE serves as an important monitoring tool during deployment of the device. It is a necessary adjunct to minimally invasive cardiac surgery. Constant echocardiographic visualisation of the device and its position relative to the atrial septum facilitates proper placement.

Clinical application of Amplatzer occluder device to treat perimembrane ventricular septal defect: a report of 6 cases for transcatheter closure of VSD / 中国介入心脏病学杂志

Objective To evaluate the therapeutic effect of transcatheter closure of perimembrane ventricular septal defect (PMVSD) using Amplatzer eccentric perimembrane VSD occluder device Methods Six patients with a mean age of 24 2 years (ranging from 11 to 41 years), were each treated with Amplatzer occluder device through the percutaneous procedure under fluoroscopy, angiography and TTE The TTE and chest film were performed 24 hours, 1 and 3 months after the procedure to evaluate its therapeutic effect Results The success rate was 100%, and no complications occured during the procedure The mean diameter of the VSDs was 5 5 mm (ranging from 3 to 9 mm) The mean diameter of the occluder selected was 8 mm (ranging from 6 to 12 mm) No residual shunts were found in the 6 cases after the procedure 24 hour, 1 and 3 months X ray examination showed that both pulmnary vascularity and heart size were improved Conclusion Transcatheter closure of perimembrane ventricular septal defect using Amplatzer occluder device is an efficient method for patients with PMVSD The operation is simple with a high success rate of placement and a good occlusion effect