Clinical outcomes and complications following percutaneous closure of patent foramen ovale

Introduction: patent foramen ovale (PFO) has been associated with systemic embolic events, and evidence in favor of its closure is increasing. Our objective is to describe the main clinical outcomes and complications of percutaneous closure of patent foramen ovale. Materials and methods: patients who underwent percutaneous PFO closure from January 1, 2016, through September 1, 2021, were recorded retrospectively. Immediate outcomes (<72 hours), and early and late-onset clinical outcomes were evaluated. In-hospital and follow-up mortality were evaluated through medical chart reviews or telephone calls. Results: forty patients who underwent percutaneous PFO closure were included. There was a mean follow up of 2.3 years, the mean age was 43 ± 13.6 years, 7% were over 60 years old, 72.5% were women, 25% were hypertensive, 20% had diabetes, and 10% had a history of migraines. The mean RoPE score was 6, and 50% had a score greater than 7. Out of all the cases, three (7.5%) had serious adverse events and four had immediate complications. During follow-up, 2.5% had early-onset events consisting of atrial fibrillation and 2.5% had late-onset events due to CVA recurrence. There were no deaths from neurological causes and we reported a 100% survival. Discussion: From our experience, we highlight a low percentage of serious adverse events, and a low number of immediate, early and late-onset events, with a 100% survival, showing excellent results for percutaneous PFO closure. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2585).

Efficacy of echocardiography-guided alone versus fluoroscopy-guided percutaneous closure of atrial septal defect: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective     To systematically evaluate the safety and efficacy of percutaneous closure of atrial septal defect (ASD) guided by echocardiography alone versus fluoroscopy. Methods     The databases of PubMed, The Cochrane Library, EMbase, VIP, Wanfang Data and CNKI from January 2000 to October 2021 were searched by computer for relevant research literature. Two reviewers independently screened the literature, extracted the data and evaluated the quality according to the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 software. Results     A total of 19 cohort studies and 1 randomized controlled study were collected, including 2 825 patients. The Newcastle-Ottawa Scale score for cohort studies was≥7 points. Meta-analysis showed that there was no statistical difference in the operative success rate (RR=1.01, 95%CI 1.00 to 1.02, P=0.17), incidence of occluder displacement/shedding (RR=0.77, 95%CI 0.26 to 2.27, P=0.63), incidence of arrhythmia (RR=0.50, 95%CI 0.21 to 1.14, P=0.10), incidence of pericardial effusion (RR=0.98, 95%CI 0.32 to 2.98, P=0.97), operative time (MD=–0.23, 95%CI –7.56 to 7.10, P=0.95) or cost (SMD=–0.39, 95%CI –1.09 to 0.30, P=0.27) between the two groups. The echocardiography group reduced the incidence of total postoperative complications (RR=0.42, 95%CI 0.30 to 0.60, P<0.001) and residual shunt (RR=0.70, 95%CI 0.50 to 0.98, P=0.04), and shortened length of hospital stay (MD=–0.43, 95%CI –0.77 to 0.09, P=0.01). Conclusion     Compared with traditional fluoroscopy-guided percutaneous closure of ASD, echocardiography guidance alone is equivalent in terms of operative success rate, major postoperative complications, operative time and total cost, but it reduces the incidence of total postoperative complications and residual shunt, and has a shorter length of hospital stay.

Clinical analysis of congenital coronary artery fistula in 71 children / 中华实用儿科临床杂志

Objective:To explore the clinical characteristics, therapeutic efficacy and prognosis of congenital coronary artery fistula (CAF) in children.Methods:Clinical data of 71 pediatric patients diagnosed with congenital CAF at Department of Cardiology and Department of Cardiac Surgery, Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine from January 2013 to June 2019 were retrospectively analyzed.The median age was 2.2 years (0.1-14.0 years), and the median body weight was 18.3 kg (3.2-55.8 kg), including 37 males (52.1%) and 34 females (47.9%). They were divided into the transcatheter closure group (30 cases) and surgical repair group (41 cases). The therapeutic effect and follow-up data of the 2 groups were compared by the Fisher′ s exact test. Results:Among the 71 congenital CAF children, 70 had heart murmurs, 2 had chest tightness after activity, and 5 were prone to recurrent respiratory tract infection.Transcatheter closure and surgical repair were successfully performed in 22/30 (73.3%) and 41/41 (100.0%) cases with a statistically significant difference ( P=0.001). However, in the surgical repair group, 1 (2.4%) case died after operation and 2(4.9%) needed further transcatheter closure due to large residual shunt during the follow-up period.At the last follow-up, there were 2 cases with minimal or small residual shunt in both groups ( P=0.567). There were 2/71(2.8%) cases suffering from postoperative thrombosis. Conclusions:Cardiac murmur is the main sign of congenital CAF in children, and some of them may have frequent respiratory tract infection due to increased lung blood caused by a large amount of shunt.A few children have chest tightness and chest pain due to myocardial ischemia caused by coronary steal.Both percutaneous closure and surgical repair are safe and effective with few complications.

Historia natural del cierre percutáneo de foramen oval permeable / Natural history of patent foramen ovales closure

INTRODUCCIÓN: El cierre percutáneo del foramen oval permeable (FOP) se ha posicionado como el tratamiento de elección para la prevención secundaria de pacientes con infartos encefálicos (IE) criptogénicos asociados a FOP. OBJETIVO: Revisar los cierres de FOP realizados en nuestra institución, evaluando las características clínicas y del procedimiento, los resultados a mediano plazo luego del procedimiento y la tendencia en el número de intervenciones durante el período estudiado. MÉTODOS: Se incluyeron 101 pacientes consecutivos en que se realizó cierre de FOP, con una mediana de seguimiento de 4,6 años. Se analizaron las características basales de los pacientes, la indicación del cierre de FOP, el éxito del procedimiento y la presencia de shunt residual en ecocardiografía al año. Se realizó una encuesta telefónica estructurada a todos los pacientes, en la cual se preguntó por nuevo IE o crisis isquémica transitoria (CIT), otros eventos cardiovasculares y la presencia de sangrados. El seguimiento fue completado en el 95%. Se calculó el puntaje RoPE ("Risk of Paradoxical Embolism") el cual provee una estimación de la posibilidad de que ese IE se haya debido al FOP y del riesgo de repetir un nuevo IE en caso de no cerrar el FOP para cada paciente. RESULTADOS: La edad promedio fue de 49,1±13,7 años, con 53% mujeres. Sólo en 3 pacientes se diagnosticó una trombofilia. En 96 pacientes la indicación fue para prevención de embolía paradojal e IE (74% IE, 17% CIT y 4% embolía periférica), mientras que en 5% por síndrome de ortodeoxia/platipnea. El cierre de FOP fue exitoso en todos los pacientes. Shunt residual en ecocardiograma al año se observó en 5% - ninguno de estos pacientes presentó un nuevo evento encefálico durante el seguimiento. Se registraron 2 nuevos IE (4 IE por 1000 pacientes/año) y 1 nueva CIT (2 CIT por 1000 pacientes/año) en el seguimiento, con un promedio de presentación de 3,6 años post procedimiento. Esta tasa de eventos fue significativamente menor a lo predicho por el puntaje RoPE en nuestra cohorte. Se observó un marcado aumento en el número de procedimientos desde el año 2017 en adelante. CONCLUSIONES: En nuestra cohorte, el cierre de FOP fue un procedimiento exitoso y seguro. Se asoció a una baja tasa de nuevos eventos cerebrales, marcadamente menor a lo estimado por el puntaje de riesgo actualmente disponible (RoPE).

INTRODUCTION: The percutaneous closure of a patent foramen ovale (PFO) has been established as the preferred treatment for those with an ischemic stroke (IS) and associated PFO. AIMS: To review the PFO closure experience at our institution, characterizing the patients and procedures, mid-term results and the trend in the number of interventions during the study period. METHODS: One hundred and one consecutive patients undergoing PFO closure were included, with a median follow-up of 4.6 years. Baseline demographics, PFO closure indications, procedural success rates and residual shunt at 1-year were recorded. A telephonic survey was performed to complete follow-up, asking for new IS or transient ischemic attacks (TIA), other cardiovascular events and bleeding. Follow-up was completed by 95%. The RoPE score was calculated for each patient, providing an estimate of the chance a given IS being due to a PFO and the risk of a new event when the defect is not closed. RESULTS: Mean age was 49.1±13.7 years and 53% were females. Whereas the indication for PFO closure was paradoxical embolism in 96 patients (74% IS, 17% TIA and 4% peripheral embolism), in 5 it was for platypnea-orthodeoxia syndrome. All patients had a successful PFO closure procedure. Residual shunt at 1 year was found in 5% - yet, none of these patients experienced a new stroke during the study period. During follow-up there were 2 new IS (4 IS per 1,000 patients/year) and 1 new TIA (2 TIA per 1,000 patients/year), with a mean incidence time of 3.6 years after the procedure. This rate of new events was significantly lower than the one predicted by the RoPE score. From 2017 onwards, there was a marked increase in the number of procedures performed at our institution. CONCLUSION: In this cohort, PFO closure was a successful and safe procedure. It was associated to a low rate of new cerebral events during mid-term follow-up, markedly lower than the RoPE predicted rate.

Cierre de ruptura del seno de Valsalva no coronariano con dispositivo de Amplatzer asociado a implante de válvula aórtica transcateterismo / Amplatzer device closure of a ruptured sinus of Valsalva aneurysm associated with a transcatheter aortic valve implant

Resumen Objetivo: Reportar un caso de implante de cierre de ruptura del seno de Valsalva e implante de válvula aórtica transcateterismo. Material y métodos: Paciente femenina de 82 años, con diagnóstico de estenosis valvular aórtica severa asociada con ruptura del seno de Valsalva no coronariano a la aurícula derecha e hipertensión arterial pulmonar severa, en quien, por sus comorbilidades, se decidió efectuar cierre percutáneo de la ruptura del seno de Valsalva con dispositivo de Amplatzer y posterior implante de válvula aórtica por cateterismo. Resultados: Se realiza procedimiento percutáneo de implante del dispositivo de cierre Amplatzer VSD Occluder de 8 mm sellando la ruptura del seno de Valsalva no coronariano. En segundo tiempo se realiza procedimiento de Implante de válvula aórtica transcateterismo vía femoral derecha. Se corrobora su adecuada implantación mediante angiografía y ecocardiograma transesofágico. Se considera exitoso el procedimiento ya que se implantaron ambos dispositivos en forma rápida, adecuada y sin complicaciones. Conclusiones: Se reporta un caso de cierre de ruptura de seno coronario con dispositivo Amplatzer e implante de prótesis aórtica transcateterismo.

Abstract Objective: To report the case of an implant for the closure of a Valsalva sinus rupture and implantation of a transcatheter aortic valve. Material and methods: An 82 year-old female patient, with a diagnosis of severe aortic valve stenosis associated with a non-coronary rupture of the sinus of Valsalva, at the right atrium, as well as severe pulmonary arterial hypertension. Due to her comorbidities, it was decided to perform a percutaneous closure of the sinus of Valsalva rupture with an Amplatzer device, and a subsequent aortic valve implantation by catheterisation. Results: A percutaneous procedure was performed by implanting an 8 mmAmplatzer VSD Occluder device, sealing the non-coronary rupture of the sinus of Valsalva. In a second time, an aortic valve was implanted using transcatheterisation via the right femoral artery. It was checked that it was appropriately implanted using angiography and a transoesophageal echocardiogram. The procedure was considered successful, since both devices could be implanted rapidly, adequately, and with no complications. Conclusions: The case is reported of the closure of the sinus of Valsalva rupture with an Amplatzer device and the transcatheterisation implantation of an aortic valve.

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.

Seguridad y eficacia a corto plazo del cierre de orejuela izquierda con dispositivo WATCHMAN ® en fibrilación auricular no valvular en pacientes con alto riesgo de sangrado / Short-term safety and efficacy of left atrial appendage closure using WATCHMAN ® device for non-valvular atrial fibrillation in patients with a high risk of bleeding

Resumen Objetivo: Evaluar la seguridad y eficacia del cierre percutáneo de la orejuela izquierda en pacientes con fibrilación auricular no valvular con alto riesgo de sangrado o con contraindicación para anticoagulación oral. Métodos: Estudio prospectivo no aleatorizado en una cohorte de pacientes con fibrilación auricular con contraindicación o dificultades con anticoagulación oral y puntaje de CHA2DS2-VASc ≥ 2 y de HASBLED ≥ 2, elegibles para doble antiagregación con aspirina y clopidogrel. Resultados: Se incluyeron 53 pacientes, con edad promedio de 72,24 ± 9,22 años, de los cuales 54,72% eran hombres; 20,75% tenían fibrilación auricular paroxística, 15,1% persistente y 64,15% permanente. Además, 18,9% tenían insuficiencia cardíaca, 22,64% enfermedad coronaria, 92,45% hipertensión arterial, 41,51% eran mayores de 75 años, 18,9% eran diabéticos y 37,7% tenían enfermedad cerebrovascular previa. El promedio del puntaje de CHADS2 y CHA2DS2-VASc fue de 2,73 ± 1,34 y 4,24 ± 1,54, respectivamente. El procedimiento fue exitoso en un 98% (52/53). Sólo en un caso no fue posible implantar el dispositivo por causas anatómicas. No hubo eventos adversos serios relacionados con la implantación; durante el procedimiento se registró un episodio de derrame pericárdico leve que no requirió drenaje. En los 45 días de seguimiento, 2 pacientes (3,77%) desarrollaron enfermedad cerebrovascular y se registró un deceso por causa no cardíaca (1,89%). Conclusiones: El cierre percutáneo de la orejuela izquierda con dispositivo WATCHMAN® es un procedimiento seguro y eficaz en pacientes de alto riesgo con fibrilación auricular no valvular y contraindicación o dificultades para la anticoagulación oral.

Abstract Motivation: To assess the safety and efficacy of percutaneous left atrial appendage closure in patients with non-valvular atrial fibrillation with a high risk of bleeding or a contraindication to oral anticoagulation drugs. Methods: Prospective non-randomised study of a cohort of patients with atrial fibrillation who had a contraindication to or difficulties with oral anticoagulation, CHA2DS2-VASc ≥ 2 and HASBLED ≥ 2 scores, and who were eligible for dual antiaggregation therapy with aspirin and clopidogrel. Results: 53 patients with an average age of 72.24 ± 9.22 years were included, out of whom 54.72% were men, 20.75% had paroxysmal, 15.1% persistent and 64.15% permanent atrial fibrillation, respectively. Besides, 18.9% suffered from heart failure, 22.64% from coronary disease, 92.45% from arterial hypertension, 41.51% were over 75 years old, 18.9% were diabetic and 37.7% had a history of cerebrovascular disease. Average CHADS= y CHA=DS2-VASc scores were of 2.73 ± 1.34 and 4.24 ± 1.54 respectively. Procedure was successful in 98% of the cases (52/53). It was not possible to implant the device in only one case due to anatomical reasons. There were no severe adverse events related to the insertion; during the procedure an episode of mild pericardial effusion that did not require drainage was registered. DUring the 45-day follow up period, 2 patients (3.77%) developed a cerebrovascular disease, and there was one noncardiac death (1.89%). Conclusions: The percutaneous left atrial appendage closure with device is a safe and efficient procedure in high-risk patients with non-valvular atrial fibrillation and contraindications to or difficulties for oral anticoagulation therapy.

Value of 3D-Transesophageal Echocardiography in Percutaneous Closure of the Left Atrial Appendage / 中山大学学报(医学科学版)

Objective]To evaluate the value of three-dimensional transesophageal echocardiography(3D-TEE)in the applica?tion of percutaneous left atrial appendage occlusionin patients with atrial fibrillation.[Methods]7 patients with atrial fibrillation in Da?lian area(female 4,male 3,mean age 71.5 ± 3.3 years)were enrolled in the study.The maximum and minimum diameter and the max?imum depth ofleft atrial appendage were measured by 3D-TEE,and export morphology and leaf number were viewed.WATCHMAN occlude size was selectedby 3D-TEE. The process of operation was monitored by 3D-TEE. 3D-TEE was also performed in 3 months after the transcatheter closure.[Results]7 patients were performed the transcatheter closure therapy successfully. Preoperative 3D-TEE showed left atrial appendage export:5 cases were oval,and 2 cases were nearly circular. The leaf number was 1.6 ± 0.8. The maximum diameter of the left atrial appendage export was(23.1 ± 1.7)mm,(19.2 ± 2.1)mm minimum diameter,maximum depth of(27.6 ± 3.3)mm. The maximum diameter had good correlation with the size of occluder(r=0.944,P=0.001). 3D-TEE was used for guidance in the transcatheter therapy and succeeded. There were 1 case with little shunt after the transcatheter closure. 3 months af?ter the treatment ,position and shape of the occluderswere all in good.[Conclusion]3D-TEE has the great value in the percutaneous closure of left atrial appendage.

Amplatzer® Vascular Plug III, para cierre de fuga paravalvular mitral residual: imagen de ecocardiograma transesofágico tridimensional / Amplatzer® Vascular Plug III, for closing residual mitral paravalvular leak: three-dimensional transesophageal echocardiography image

La fuga paravalvular es una complicación relevante después del cambio valvular quirúrgico. Tradicionalmente la cirugía ha sido considerada el tratamiento de elección, sin embargo, conlleva una elevada morbimortalidad, así como un incremento en el riesgo de desarrollar fuga paravalvular recurrente. El tratamiento percutáneo de la fuga paravalvular se presenta como una atractiva alternativa. Dicho tratamiento ha sido posible por la capacidad actual de integrar múltiples modalidades de imagen que han ayudado a definir la anatomía del defecto y a planificar y guiar el procedimiento de cierre percutáneo, resultando en mejores desenlaces. El Amplatzer® Vascular Plug III (St. Jude Medical) es el primer dispositivo específicamente diseñado para el cierre percutáneo de la fuga paravalvular con resultados prometedores. Presentamos la imagen ecocardiográfica transesofágica tridimensional del resultado exitoso de cierre percutáneo de una fuga paravalvular mitral residual con un dispositivo Amplatzer® Vascular Plug III (St. Jude Medical), después de un procedimiento inicial de cierre percutáneo con un dispositivo Amplatzer® Duct Occluder (St. Jude Medical).

Paravalvular leak is a significant complication after surgical valve replacement. Traditionally, redo surgery has been considered the treatment of choice, but is associated with high morbidity and mortality as well as increase risk of developing new leaks. Percutaneous treatment of paravalvular leak appears as an attractive alternative. Such treatment has been made possible by the current ability to integrate multiple imaging modalities that have helped to define the anatomy of the defect and planning and guiding the percutaneous closure procedure, thus resulting in better outcomes. The Amplatzer® Vascular Plug III (St. Jude Medical) is the first device specifically designed for percutaneous closure of paravalvular leak with promising results. We present the three-dimensional transesophageal echocardiographic images of a successful outcome of percutaneous closure of a residual mitral paravalvular leak with an Amplatzer® Vascular Plug III device (St. Jude Medical), after an initial procedure of percutaneous closure with an Amplatzer® duct occluder (St. Jude Medical).

Estudio de la perfusión pulmonar posterior al cierre percutáneo del conducto arterioso permeable utilizando el dispositivo Amplatzer Duct Occluder en niños / Lung perfusion studies after percutaneous closure of patent ductus arteriosus using the Amplatzer Duct Occluder in children

Objetivo: La reducción en la perfusión pulmonar se ha descrito tras el cierre percutáneo del conducto arterioso permeable con varios dispositivos. Evaluamos la perfusión pulmonar posterior al cierre percutáneo del conducto arterioso con el dispositivo Amplatzer Duct Occluder utilizando la gammagrafía pulmonar de perfusión. Métodos: Treinta pacientes con oclusión transcatéter exitosa del conducto arterioso permeable utilizando el dispositivo Amplatzer Duct Occluder fueron incluidos en este estudio. La gammagrafía pulmonar de perfusión se realizó 6 meses después del procedimiento. Las velocidades de flujo máximo y la protrusión del dispositivo fueron analizadas por ecocardiografía Doppler. Una perfusión pulmonar izquierda < 40% se consideró anormal. Resultados: El implante del dispositivo fue exitoso en todos. La media de perfusión hacia el pulmón izquierdo fue de 44.7 ± 4.9% (37.8-61.4). Cinco pacientes (16.6%) mostraron disminución en la perfusión pulmonar izquierda. Tanto la edad y el peso bajo, así como la longitud del conducto arterioso y la relación diámetro mínimo y máximo con la longitud del conducto arterioso fueron estadísticamente significativos en los pacientes con anomalías de la perfusión pulmonar. Se observó protrusión del dispositivo en 6 pacientes con una velocidad de flujo máximo mayor en la arteria pulmonar izquierda. Conclusión: La perfusión pulmonar izquierda puede comprometerse tras el cierre percutáneo del conducto arterioso con el Amplatzer Duct Occluder. El aumento en la velocidad de flujo en el origen de la arteria pulmonar izquierda puede ser un pobre indicador de la reducción en la perfusión pulmonar y puede ocurrir en ausencia de protrusión del dispositivo.

Objective: The closure of patent ductus arteriosus with multiple devices has been associated with a reduction in lung perfusion. We evaluated the pulmonary perfusion after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder device using perfusion lung scan. Methods: Thirty patients underwent successful percutaneous patent ductus arteriosus occlusions using the Amplatzer Duct Occluder device were included in this study. Lung perfusion scans were preformed 6 months after the procedure. Peak flow velocities and protrusion of the device were analyzed by Doppler echocardiography. A left lung perfusion < 40% was considered abnormal. Results: The device implantation was successful in all patients. Average perfusion of left lung was 44.7 ± 4.9% (37.8-61.4). Five patients (16.6%) showed decreased perfusion of the left lung. Age, low weight, the length of the ductus arteriosus and the minimum and maximum diameter/length of the ductus arteriosus ratio were statistically significant in patients with abnormalities of lung perfusion. It was observed protrusion the device in 6 patients with a higher maximum flow rate in the left pulmonary artery. Conclusion: The left lung perfusion may be compromised after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder. The increased flow velocity in the origin of the left pulmonary artery can be a poor indicator of reduction in pulmonary perfusion and can occur in the absence of protrusion of the device.

Cierre percutáneo de la comunicación interauricular con el dispositivo Amplatzer®: 15 años de experiencia / Percutaneous closure of atrial septal defects with the Amplatzer® device: 15 years of experience

Introducción: El cierre percutáneo de la comunicación interauricular es una alternativa al tratamiento quirúrgico. Objetivos: Comunicar los resultados del cierre percutáneo de la comunicación interauricular con el dispositivo Amplatzer®. Método: Se incluyeron los pacientes sometidos a hemodinamia de septiembre de 1997 a diciembre de 2011. Resultados: Se procedió al cierre del defecto en 721 pacientes y en 85 no se cerró por considerarse no apto anatómicamente. El diámetro expandido del defecto fue de 23 ± 6.7 mm (límites, 5-42). Todos los dispositivos se colocaron con éxito. En 15 casos (2.1%) se cambió el dispositivo por considerarse inestable y en 6 (0.8%) se presentó embolización en las primeras 24 h, 4 fueron rescatados y recolocados (éxito final con intención de tratamiento 719/806-89.2%). El control inmediato mostró oclusión completa en 247 pacientes (34.3%), fuga intradispositivo en 395 (54.9%), ligera en 75 (10.4%) y moderada en 2 (0.3%). Se hace seguimiento en 626 pacientes (87.1%) durante 33 ± 27.5 meses, presentándose cefalea en 54 (8.6%), arritmias supraventriculares nuevas en 10 (1.6%), complicaciones en el sitio de punción en 4 (0.6%) y accidente vascular cerebral en uno (0.1%). Conclusión: El diseño del dispositivo Amplatzer® permite el cierre de la comunicación interauricular con una técnica sencilla y con seguridad para el paciente.

Introduction: Percutaneous closure of atrial septal defects is an alternative to surgical treatment. Objectives: We report the results of percutaneous closure of atrial septal defects with the Amplatzer® device. Method: We include patients taken to the catheterization laboratory from September 1997 to December 2011. Results: We proceeded with defect closure in 721 patients and in 85 the defect was considered not suitable for closure. The stretched diameter of the defect was 23 ± 6.7 mm (limits, 5-42). All devices were positioned successfully. In 15 cases (2.1%) the device was changed due to instability and in 6 (0.8%) the device embolized within the first 24 h, 4 were retrieved and repositioned (final success with intention to treat 719/806-89.2%). Immediate control showed complete closure in 247 patients (34.3%), leak through the device in 395 (54.9%), mild residual leak in 75 (10.4%) and moderate in 2 (0.3%). We have follow-up in 626 patients (87.1%) for 33 ± 27.5 months, with headache in 54 (8.6%), new supraventricular arrhythmia in 10 (1.6%), puncture site complications in 4 (0.6%), and stroke in one (0.1%). Conclusion: The design of the Amplatzer® device allows effective closure of atrial septal defects with a simple technique and patient safety.

Cierre percutáneo de fístula arteriovenosa pulmonar en una adolescente: Reporte de un caso / Transcatheter closure of pulmonary arteriovenous fistula in adolescent: Case report

Las fístulas arteriovenosas, también llamadas malformaciones arteriovenosas pulmonares (MAVP), corresponden a un reducido grupo de patologías vasculares que en un 85% se originan de la comunicación de una arteria aferente con una vena eferente. Las congénitas son las menos frecuentes. Se presenta el caso de una adolescente de 13 años, asintomática, con soplo continuo y saturación periférica de 88%. Mediante estudios de imagen se corrobora la presencia de una fistula arteriovenosa a nivel pulmonar, que es cerrada por intervencionismo con dispositivo oclusor. Una vez tratado el defecto, la evolución de la paciente es satisfactoria. Conclusiones: Mediante el caso se abordan las herramientas clínicas y diagnósticas de las MAVP, así como las indicaciones de los modos terapéuticos.

Arteriovenous fistulas also called pulmonary arteriovenous malformations (PAVM) are a small group of vascular pathologies in 85% originate from the communication afferent efferent artery to a vein. Congenital are less frequent. The case of a 13-year-old asymptomatic continuous murmur and peripheral saturation of 88% is presented. By imaging the presence of an arteriovenous fistula in the lung, which is closed by intervention with occluder device is corroborated. Once treated the defect, the evolution of the patient is satisfactory. Conclusions: Using the case of clinical and diagnostic tools MAVP addresses, and the particulars of the therapeutic modes.

Cierre percutáneo del conducto arterioso permeable en niños con el Amplatzer Duct Occluder II / Percutaneous closure of the patent ductus arteriosus in children with the Amplatzer Duct Occluder II

Introducción: En las últimas décadas, varios dispositivos se han utilizado para el cierre percutáneo del conducto arterioso permeable con sus propias limitaciones y riesgos. El Amplatzer Duct Occluder II ha sido diseñado para mejorar dichas limitaciones y reducir complicaciones. Objetivo: Presentar una serie inicial de pacientes llevados a cierre percutáneo del conducto arterioso con el Amplatzer Duct Occluder II, enfatizando en los aspectos técnicos del procedimiento. Métodos: Analizamos los registros clínicos de 9 pacientes con conducto arterioso permeable, llevados a cierre percutáneo con el Amplatzer Duct Occluder II. La mediana de edad fue de 24 meses (8-51 meses) y del peso de 10.7 kg (6-16.3 kg). El diámetro mínimo del conducto arterioso permeable fue de 2.7 mm (1-5 mm). Resultados: El implante fue exitoso en todos los casos. Los dispositivos más utilizados (33.3%) fueron los de dimensiones 4-4 mm (3 pacientes), en 2 pacientes se utilizó de 3-4 mm y en el resto de los pacientes se emplearon oclusores de otros tamaños. Cuatro casos mostraron flujo residual leve inmediatamente después del cierre. El cierre total a las 24 h se logró en 8 de 9 niños (89%). No hubo embolización del dispositivo o mortalidad con el procedimiento y solo observamos una complicación menor. Conclusión: El Amplatzer Duct Occluder II en esta serie de casos fue efectivo en el 89% de los pacientes a las 24 h y en el 100% al seguimiento. Su implante fue seguro debido a que no hubo complicaciones mayores. La tasa de oclusión es comparable a la informada para el Amplatzer Duct Occluder I.

Introduction: In the last decades, several devices have been used for the percutaneous closure of patent ductus arteriosus, with its own limitations and risks. The Amplatzer Duct Occluder II has been designed to overcome those limitations and reduce risks. Objective: We described our initial series of patients who underwent percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder II, emphasis on the technical aspects of the procedure. Methods: We reviewed the clinical records of 9 patients with patent ductus arteriosus who underwent percutaneous closure with the Amplatzer Duct Occluder II. Median age was 24 months (range 8-51 months) and the median weight was 10.7 kg (range 6-16.3 kg). The minimal ductus arteriosus diameter was 2.7 mm (1-5 mm). Results: Implantation was successful in all cases. The devices most commonly used (33.3%) were the dimensions 4-4 mm (3 patients), in 2 patients were used 3-4 mm and in the rest of the patients were employed occluder other sizes. Four cases showed slight residual flow immediately after implantation. Total closure was achieved in 24 h in 8 of 9 patients (89%). There was no embolization of the occluder or deaths during the procedure and we only observed one minor complication. Conclusions: The Amplatzer Duct Occluder II in this series was effective in 89% of the patients at 24 hs after the procedure and 100% follow-up. The implantation was safe and no major complications were observed. The occlusion rate is comparable to those reported for the Amplatzer Duct Occluder I.

Seis años de experiencia en el cierre percutáneo de defectos del tabique interauricular / Six years of experience in percutaneous closure of interatrial septal defects

Marco de referencia: los defectos del tabique interauricular son anormalidades congénitas del tabique interauricular que comprenden la comunicación interauricular y el foramen oval permeable. Objetivo: analizar y evaluar los resultados del cierre percutáneo con dispositivo percutáneo de pacientes con defectos del tabique interauricular en el Hospital Universitario Santa Fe de Bogotá desde la introducción de esta técnica en 2005 hasta 2011. Materiales y métodos: se realizó un estudio descriptivo ambispectivo. La población estuvo conformada por pacientes adultos, independiente de edad y género, a quienes se les realizó cierre percutáneo de cualquier defecto del septo interauricular desde la introducción de esta técnica en enero 1º. de 2005 hasta junio de 2011 en el servicio de hemodinamia del Hospital Universitario Fundación Santa Fe de Bogotá. Resultados: durante el periodo se hicieron 53 procedimientos de corrección de defecto del tabique interauricular por vía percutánea, en los que se usó dispositivo Amplatzer en 94,3% de los casos. El 75% (27 pacientes) se trataron de manera ambulatoria, dándose de alta luego de cuatro horas de efectuado el procedimiento. El 29,8% fueron hombres y 70,2% mujeres, con edad promedio de 52,2 ± 15,1 años. 57,8% de los pacientes tuvo foramen oval permeable y de éstos 54,5% tenía aneurisma asociado; el porcentaje restante, 42%, fue intervenido por comunicación interauricular. Conclusiones: la experiencia en la Fundación Santa Fe de Bogotá muestra un excelente resultado con muy baja tasa de complicaciones, mejorías clínicas en el seguimiento a largo plazo y gran seguridad, factores que permiten que este procedimiento se lleve a cabo de manera ambulatoria.

Context: atrial septal defects are congenital atrial septal abnormalities that comprise the interatrial communication (IAC) and the patent foramen ovale (PFO). Objective: to analyze and evaluate the results of percutaneous closure with device in patients with interatrial septal defects in the University Hospital Santa Fe de Bogotá since the introduction of this technique in 2005 to 2011. Materials and Methods: descriptive ambispective study. The population consisted of adult patients, regardless of age and gender, who underwent percutaneous closure of any atrial septal defect since the introduction of this technique in January 1st. 2005 to June 2011 in the service of hemodynamics of the University Hospital Fundación Santa Fe de Bogotá. Results: during this period, 53 procedures of percutaneous correction of the atrial septal defect were performed, using the Amplatzer device in 94.3% cases. 75% (27 patients) were treated on an outpatient basis, being discharged four hours after the performance of the procedure. 29.8% were men and 70.2% women with mean age 52.2 ± 15.1 years. 57.8% of patients had patent foramen ovale and of these, 54.5% had associated aneurysm. The remainder 42%, was operated for interatrial communication. Conclusions: the experience in the Fundación Santa Fe de Bogota shows excellent results with a very low complication rate and clinical improvements in the long-term follow-up, factors that allow that this procedure can be performed on an outpatient basis.

Percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder

OBJECTIVE: Ventricular septal defects resulting from post-traumatic cardiac injury are very rare. Percutaneous closure has emerged as a method for treating this disorder. We wish to report our experience in three patients who underwent percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder. METHODS: We treated three patients with post-traumatic ventricular septal defects caused by stab wounds with knives. After the heart wound was repaired, patient examinations revealed ventricular septal defects with pulmonary/systemic flow ratios (Qp/Qs) of over 1.7. The post-traumatic ventricular septal defects were closed percutaneously with a patent ductus arteriosus occluder (Lifetech Scientific (Shenzhen) Co., LTD, Guangdong, China) utilizing standard techniques. RESULTS: Post-operative transthoracic echocardiography revealed no residual left-to-right shunt and indicated normal ventricular function. In addition, 320-slice computerized tomography showed that the occluder was well placed and exhibited normal morphology. CONCLUSION: Our experiences indicate that closure of a post-traumatic ventricular septal defect using a patent ductus arteriosus occluder is feasible, safe, and effective.

Tratamiento endovascular de una fuga paraprotésica mitral con dispositivo Amplatzer® / Percutaneous closure of a mitral paraprosthetic leak with an Amplatzer® device

El leak o fuga paraprotésica mitral se presenta entre el 5 y el 17% de los pacientes tratados con cirugía de reemplazo valvular. En general, los defectos son únicos, la mayoría se encuentran localizados en la región postero-medial del anillo valvular y solo la tercera parte produce reflujo de grado grave. El cierre percutáneo por vía endovascular es una alternativa terapéutica válida en pacientes con elevado riesgo para re-operación. La estrategia de abordaje depende de la localización, tamaño, morfología y relaciones adyacentes del o los defectos. El procedimiento debe ser realizado por profesionales con experiencia en el tratamiento de cardiopatías estructurales y en el manejo de estos dispositivos de cierre, y se considera imprescindible la utilización de un ecocardiograma transesofágico tridimensional. Se presenta el caso de un paciente con una fuga paraprotésica valvular mitral que fue cerrada con un dispositivo Amplatzer ® introducido en forma percutánea desde la vena femoral.

Mitral paraprosthetic leaks are present in 5 to 17% of patients who receive valve replacement surgery. Overall, the defects are single, most of them are located in the postero-medial region of the annulus, and only one third produce a severe reflux. Percutaneous closure by endovascular surgery is a valid therapeutic alternative in patients at high risk for re-operation. The approach depends on the location, size, morphology and relationships or neighboring defects. The procedure must be performed by professionals with experience in the treatment of structural heart disease and in the management of these closure devices. Guidance with three dimensional transesophageal echocardiography is considered essential. A case of a mitral paraprosthetic leak that was closed with an Amplatzer ® device introduced percutaneously from the femoral vein is here presented.

Cierre percutáneo de la orejuela izquierda para prevención de tromboembolia en la fibrilación auricular / Percutaneous closure of left atrial appendage to prevent thromboembolism in atrial fibrillation

El accidente vascular encefálico embólico constituye la complicación más importante de la fibrilación auricular (FA) y el tratamiento anticoagulante es de elección para su prevención. Alrededor del 20% de los pacientes con FA presentan contraindicaciones de anticoagulación (ACO). La orejuela izquierda (OI) se ha identificado como el principal sitio de formación de trombos en la FA, especialmente en pacientes sin enfermedad valvular y sin deterioro de la función ventricular. La oclusión de la OI reduce la incidencia de eventos embólicos en este tipo de pacientes. En esta presentación se describe un caso de cierre percutáneo de la OI, con empleo del dispositivo Amplatzer Cardiac Plug. El paciente tenía riesgo embólico alto y contraindicación absoluta de ACO. El procedimiento se realizó en el Laboratorio de Hemodinamia, bajo guía radioscópica y ecocardiografía transesofágica, con anestesia general; se logró la oclusión completa de la OI. No se presentaron complicaciones durante el procedimiento y luego de un seguimiento de 3 meses, la OI se encuentra totalmente excluida y no se han evidenciado eventos embólicos.

Percutaneous closure of left atrial appendage to prevent thromboembolism in atrial fibrillation Embolic stroke is a major concern in atrial fibrillation (AF), and anticoagulation is the therapy of choice to prevent it. Around 20% of patients with AF have contraindications for anticoagulation (OAC). The left atrial appendage (LAA) has been identified as the most common place of thrombosis in patients with AF, particularly in those with non-valvular AF or impaired ventricular function. LAA occlusion reduces the incidence of embolic events in these patients. This article describes a case of percutaneous closure of LAA with the Amplatzer Cardiac Plug device. The patient was at high risk of embolism and had absolute contraindication for OAC. The procedure was performed at the cardiac catheterization laboratory under fluoroscopic guidance and transesophageal echocardiography, with general anesthesia; complete closure of the LAA was achieved. During the procedure, no complications were reported. The patient remained event-free at three-month follow-up, with complete exclusion of LAA. No embolic events have been reported.

Multiplanar transesophageal echocardiography for the evaluation and percutaneous management of ostium secundum atrial septal defects in the adult / Ecocardiografía transesofágica multiplanar para la evaluación y el tratamiento percutáneo de la comunicación interauricular tipo ostium secundum en el adulto

The purpose of this paper is to review the usefulness of multiplanar transesophageal echocardiography before, during and after percutaneous transcatheter closure of secundum atrial septal defects. Transesophageal echocardiography imaging techniques, including their role in patient selection, procedural guidance and immediate assessment of technical success and complications are described and discussed in this review. Percutaneous transcatheter closure is indicated for ostium secundum atrial septal defects of less than 40 mm in maximal diameter. The defect must have a favorable anatomy, with adequate rims of at least 5 mm to anchor the prosthesis. Transesophageal echocardiography plays a critical role before the procedure in identifying potential candidates for percutaneous closure and to exclude those with unfavorable anatomy or associated lesions, which could not be addressed percutaneously. Transesophageal echocardiography is also important during the procedure to guide the deployment of the device. After device deployment, the echocardiographer must assess the device (integrity, position and stability), residual shunt, atrio-ventricular valve regurgitation, obstruction to systemic or venous return and pericardial effusion, in order to determine procedural success and diagnose immediate complications.

El propósito de esta revisión es analizar la utilidad de la ecocardiografía transesofágica multiplanar antes, durante y después del cierre percutáneo de la comunicación interauricular tipo ostium secundum. Las consideraciones técnicas de imagen durante la ecocardiografía transesofágica multiplanar, su utilidad en la evaluación de los pacientes, la guía peri-procedimiento, la evaluación del éxito técnico y las complicaciones son descritas y discutidas en esta revisión. El cierre percutáneo está indicado en la comunicación interauricular tipo ostium secundum con diámetro máximo de 40 mm. El defecto debe tener una anatomía favorable con bordes de al menos 5 mm. La ecocardiografía transesofágica multiplanar tiene un papel determinante antes del procedimiento para identificar a candidatos potenciales para el cierre percutáneo y para excluir aquéllos con anatomía no favorable o lesiones asociadas que no pueden ser manejados vía percutánea. La ecocardiografía transesofágica multiplanar es importante durante el procedimiento para guiar la liberación del dispositivo. Después de la liberación del dispositivo el ecocardiografista debe evaluar la posición y estabilidad del dispositivo, la presencia de corto-circuito residual, la regurgitación de las válvulas A-V, el retorno venoso sistémico y pulmonar, y el pericardio, a fin de determinar el éxito del procedimiento y descartar complicaciones asociadas.

Cierre percutáneo de fuga paravalvular mitral / Percutaneous Closure of Mitral Paravalvular Leak / Percutaneous Closure of Mitral Paravalvular Leak

El desarrollo de fuga paravalvular (FPV) luego del reemplazo valvular mitral es un fenómeno poco frecuente pero de gran repercusión sintomática. Debido a la elevada morbimortalidad de su abordaje quirúrgico se han intentado varias técnicas percutáneas con una tasa éxito que varía entre el 60% y el 90%. En esta presentación se describe el caso de una paciente joven, con múltiples cirugías valvulares mitrales previas, sintomática por disnea limitante y anemia hemolítica. Con el uso de imágenes ecocardiográficas tridimensionales, se realizó la oclusión de la FPV con un dispositivo Amplatzer III, diseñado específicamente para dicha indicación. Luego de un seguimiento de 3 meses, la FPV permanece totalmente excluida y la paciente se encuentra asintomática.

The development of mitral paravalvular leak (PVL) after mitral valve replacement is an uncommon complication with severe symptoms. The surgical repair of this condition has high morbidity and mortality; for this reason, several percutaneous techniques have been attempted with success rates between 60% and 90%. We describe the case of a young female patient with multiple mitral valve surgeries, who presented limiting dyspnea and hemolytic anemia. The PVL was closed using a specially designed Amplatzer III device under three-dimensional echocardiography. After 3 months of follow-up, the PVL remains completely excluded and the patient is asymptomatic.

Experiencia multicéntrica colombiana durante tres años en el cierre percutáneo de la comunicación interventricular con diferentes dispositivos oclusores: propuesta para la simplicación de la técnica en pacientes seleccionados / Colombian multicentric experience during three years for percutaneous closure of interventricular septal defect with different occluder devices: proposal for technique simplification in selected patients

Objetivos: se describe la experiencia del cierre endovascular de comunicación interventricular realizada durante tres años en diferentes centros de cardiología intervencionista, y se destaca el resultado en un grupo de pacientes seleccionados en quienes dicho procedimiento se efectuó mediante el uso de un dispositivo de última generación diseñado para el cierre de ductus arterioso. Pacientes: entre junio de 2006 hasta octubre de 2009 se sometió un total de 34 pacientes a la técnica de oclusión de comunicación interventricular por vía endovascular. La indicación del procedimiento incluyó sobrecarga de volumen, sobrecarga de presión y volumen, falla cardiaca crónica, prolapso de válvula aórtica con insuficiencia y lesión traumática. La edad promedio fue de 12,9 años y el peso fue de 36 kilos. Se evidenció un predominio del sexo masculino (53 porciento. El promedio de cálculo de flujos demostró Qp/Qs de 1,71 a 1 y el de resistencias vasculares pulmonares fue 1,18 U Wood/m2. Materiales y Métodos: el dispositivo PM VSD Occluder se implantó con la técnica clásica (62,5 porciento) mientras que el dispositivo Duct Occluder II (28,1 porciento) se utilizó con la técnica simplificada propuesta. Se usó anestesia general en 98 porciento de los casos, 60 porciento fueron guiados con fluoroscopia y ecocardiografía transesofágica y 40 porciento con transtorácica. Resultados: el tamaño del defecto varió entre 4 y 12 mm. El 91 porciento de los pacientes tenía un defecto septal aislado. La mediana del tiempo quirúrgico se cuantificó en 56 minutos, siendo mayor en el grupo en el cual se utilizó la técnica clásica (85 min) en comparación con aquel grupo en el que se empleó la técnica simplificada con un promedio de 36 minutos...

Objectives: we describe the experience of the endovascular closure of interventricular communication performed for three years in different centers of interventional cardiology and highlight its result in a group of selected patients in whom such procedure was made by the use of a last generation device designed for the closure of ductus arteriosus. Methodology: between June 2006 and October 2009, a total of 34 patients underwent endovascular occlusion for interventricular septal defect. Indication of this procedure included volume overload, pressure and volume overload, chronic congestive heart failure, aortic valve prolapse with insufficiency and traumatic injury. Mean age was 12,9 years old and mean weight was 36 kg. A prevalence in male gender (53 porciento) was evidenced. Main blood flow calculation showed Qp / Qs of 1.71 to 1 and the pulmonary vascular resistance was 1.18 U Wood/m2. Materials and methods: PM VSD occluder device was implanted with the classic technique (62,5 porciento) while the Duct Occluder II (28,1 porciento) was used with the proposed simplified technique. General anesthesia was used in 98 porciento cases; 60 porciento were guided by fluoroscopy and transesophageal echocardiography and 40 porciento with transthoracic echocardiography. Results: size of the defect varied from 4 to 12 mm. 91 porciento of patients had an isolated septal defect. Mean surgical time was 56 min, being longer in the group in which the classic technique was used (85 min) compared with the group in which the technique used was the simplified one, with a mean duration of 36 min. Mean hospital stay was estimated in 36 hours. Follow up: complete closure was documented in 100 porciento of patients at 30 days. There were three adverse events due to minor complications related to transient rhythm disturbances...