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Atrial fibrillation is the most common arrhythmia associated with significant mortality and morbidity secondary to thrombo-embolism. To prevent this thrombo-embolism oral anticoagulation therapy is the recommended treatment. In patients with contraindications to oral anticoagulation therapy, percutaneous left atrial appendage occlusion device is indicated. TEE is essential to guide in all the stages of LAA device deployment. Right from pre-procedure screening, to guiding during deployment, to rule out any complications and post-procedure surveillance and monitoring long term outcomes.
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Objectives: To compare the effect of 2 different occlusion devices for treating cryptogenic stroke (CS) patients combining patent foramen ovale (PFO) and large right-to-left shunt (RLS). Methods: A total of 123 CS patients combining PFO and large RLS treated in our hospital from 2013-05 to 2016-08 were enrolled. All patients received percutaneous PFO interventional closure, based on different occlusion devices, the patients were divided into 2 groups: Cardi-O-fix PFO occluder group, n=80 and Amplatzer PFO occluder group, n=43. CS diagnosis was confirmed by 3 experienced neurologists via medical imaging examination; PFO and large RLS were diagnosed by transthoracic echocardiography and right heart contrast echocardiography. The baseline features, clinical symptoms, operation and follow-up data were reviewed to observe the efficacy of 2 occlusion devices. Results: Each group had 1 patient suffered from paroxysmal atrial fibrillation after the operation; 1 patient in Cardi-O-fix PFO occluder group had inguinal hematoma. No stroke recurrence, no death during follow-up period; the residual shunt was similar between 2 groups. Conclusions: PFO occlusion was beneficial for preventing stroke recurrence in CS patients combining PFO and large RLS. The safety and efficacy were similar in Cardi-O-fix and Amplatzer PFO occlusion devices.
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Objective To compare the efficacy of ureteroscopic lithotripsy(URL)combined with occlusion device and the supine and lithotomy position mini-invasive percutaneous nephrolithotomy(mPCNL)in the treatment of upper incarcerated ureteral stones. No difference could be found in age,sex and size of stones between the two groups. Method From Jan. 2014 to Dec. 2016 in our hospital,all cases of upper incarcerated ureteral stones were diviede into two groups:52 in ureteroscopic lithotripsy combined with occlusion device group and 45 in mini-inva-sive percutaneous nephrolithotomy group. Result The hospitalization and operation time in URL group were(5.5 ± 1.4)days and(53.3 ± 12.4)mins,which were significantly shorter than that in mPCNL group with(9.1 ± 3.2)days and(78.2 ± 14.1)mins,(P 0.05),stone clearance rate(100% vs 91.8,P > 0.05)and complication rate (4.4%vs 3.9%,P>0.05). Conclusion URL combined with occlusion device can obtain satifactory results as well as the supine and lithotomy position mPCNL in the treatment of upper incarcerated ureteral stones.
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Device based closure of the left atrial appendage (LAA) has emerged as a viable approach for stroke prevention in atrial fibrillation (AF) patients with contraindications to chronic oral anticoagulation. One of the most feared complications is device related thrombus formation. We present a 66-year-old male with chronic AF who developed a life-threatening intracranial bleed on oral anti-coagulation. He subsequently underwent LAA closure using an Amplatzer muscular ventricular septal defect closure device for stroke prevention. However, he was found to have a large thrombus attached to the device a year later. We present a review of the various LAA closure devices, importance of periodic surveillance via echocardiography and management options to prevent this complication. Also, the case highlights the importance of contrast-enhance echocardiography in diagnosis of LAA closure device thrombus.
Subject(s)
Aged , Humans , Male , Atrial Appendage , Atrial Fibrillation , Diagnosis , Echocardiography , Heart Septal Defects, Ventricular , Heart , Stroke , ThrombosisABSTRACT
Objective To compare the treatment outcomes between minimally invasive perventricular device occlusion (MIPDO) and right subaxillary incision surgical repair(RSISR) on perimembranous ventricular septal defect(PmVSD) in children less than 15 kilograms.Methods From January,2010 to January,2013,a total of 530 infants(age ＜ 3 years,weigh ＜ 15 kg) with PmVSD enrolled and they were divided into two groups according to different treatment methods at random.Group 1 (265 cases) was arranged perventricular device closure with modified occluders through a lower partial median sternotomy under transesophageal echocardiography (TEE) guidance;group 2 (265 cases) was arranged surgical repair on cardiopulmonary bypass(CPB) through a right subaxillary small incision.A prospective randomized controlled study was performed between two groups on success rate,operation time,volume of blood loss and transfusion,length of intubation and ICU stay,complications,expenses and follow-up results etc.Results All patients in two groups obtained effective treatment with no death or serious life-threatening complications.Group 1:255 cases (96.23％) underwent successfully MIPDO.The remainder 10 cases (3.77％) who failed in attempt were successfully converted to conventional open heart operation by extending the original incision.Different arrhythmias arose in 30 cases(11.76％),including incomplete left bundle branch block(ILBB) in 3 cases(1.18％),complete right bundle branch block(CRBB) in 3 cases(1.18％),incomplete right bundle branch block(IRBB) in 16 cases(6.27％),Ⅰ° atrioventricular block(Ⅰ°AVB) in 8 cases(3.14％);trivial residual shunt(RS) in 18 cases(7.06％);newly arose trivial tricuspid regurgitation(TR) in 29 cases(11.37％).Group 2:All the patients(100％) underwent successful surgical repair through right subaxillary incision.Different arrhythmias occurred in 116 cases (43.77％),including transient complete atrioventricular block(CAVB) and ILBB in 2 cases respective(0.75％),junctional ectopic tachycardia(JET) in 1 cases(0.38％),CRBB in 61 cases(23.02％),IRBB in 52 cases(19.62％);trivial RS in 16 cases (6.04％);newly arose trivial TR in 11 cases(4.15％);heart dysfunction in 17 patients(6.42％).All patients were followed up for more than 12 months,and there were no newly happened or aggravated valve regurgitation or late onset CAVB in two groups.The final treatment effects are similar in both groups.But group 1 was significantly superior to group 2 in the aspects of operation time,volume of blood loss and consumption,length of intubation and ICU stay,hospitalizations and costs(all P ＜ 0.05).The incidence of TR is higher in group 1 (P ＜ 0.05),and that of right bundle branch block was higher in group 2 (P ＜ 0.05).The incision is longer in group 2,but in a less exposed location.CPB is not needed in group 1,but anticoagulant drug is required for 3-6 months.Conclusion Both RSISR and MIPDO are effective treatment methods of PmVSD.Though having some limitations,MIPDO which characterized by simple procedure,minimal invasion,quick recovery,saving of medical resources could not only minimize the surgical trauma to patients,but also ensure the safety of operation to the maximum extent.However,the patient selection is vital.For selected patients,especially those of moderate PmVSDs with obvious clinical symptoms but no cardiac valve regurgitation,it is an ideal approach.
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PURPOSE: Atrial fibrillation (AF) is one of the major risk factors for ischemic stroke, and 90% of thromboembolisms in these patients arise from the left atrial appendage (LAA). Recently, it has been documented that an LAA occlusion device (OD) is not inferior to warfarin therapy, and that it reduces mortality and risk of stroke in patients with AF. MATERIALS AND METHODS: We implanted LAA-ODs in 5 Korean patients (all male, 59.8+/-7.3 years old) with long-standing persistent AF or permanent AF via a percutaneous trans-septal approach. RESULTS: 1) The major reasons for LAA-OD implantation were high risk of recurrent stroke (80%), labile international neutralizing ratio with hemorrhage (60%), and 3/5 (60%) patients had a past history of failed cardioversion for rhythm control. 2) The mean LA size was 51.3+/-5.0 mm and LAA size was 25.1x30.1 mm. We implanted the LAA-OD (28.8+/-3.4 mm device) successfully in all 5 patients with no complications. 3) After eight weeks of anticoagulation, all patients switched from warfarin to anti-platelet agent after confirmation of successful LAA occlusion by trans-esophageal echocardiography. CONCLUSION: We report on our early experience with LAA-OD deployment in patients with 1) persistent or permanent AF who cannot tolerate anticoagulation despite significant risk of ischemic stroke, or 2) recurrent stroke in patients who are unable to maintain sinus rhythm.
Subject(s)
Aged , Humans , Male , Middle Aged , Anticoagulants , Atrial Appendage/physiopathology , Atrial Fibrillation/epidemiology , Risk Factors , Septal Occluder Device , Stroke/epidemiology , Treatment Outcome , WarfarinABSTRACT
Objective To evaluate the efficiency,safety and complication of transcatheter closure of large atrial septal defect (ASD) with Amplatzer occlusion device under the guidance of transthoracic echocardiography (TTE) Methods The study group consisted of 12 males and 9 females, age ranged from 17-45 years old, underwent transcatheter closure of ASD with Amplatzer occlusion device The diameter of ASD (balloon stretched diameter) was 30-36mm The Amplatzer occluder size was chosen to be 2-4 mm more than the balloon stretched diameter of ASD All cases were guided by TTE Results All cases were successfully treated under the guidance of TTE, the procedure successful rate was 100% No severe complication was observed except 1 patient with frequent atrial premature beats after procedure and disappeared 1 months later by drug Conclusion Transcatheter closure of ASD can be performed safty and effectively with Amplatzer occlusion device under the guidance of transthoracic echocardiography But it is necessary to perform TEE to examine the peri structure of ASD before procedure
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Objective To evaluate transthoracic echocardiographic guidance for closure of atrial septal defects with Amplatzer occlusion device in the adults Methods Thirty patients with atrial septal defects were occluded by use of Amplatzer septal occluder The mean age was (32 3?14 7) years (ranging from 13-65 years) Transthoracic echocardiography was undertaken for guidance for closure before and in the procedure of intervention Transthoracic echocardiography was done immediately, one month and three month respectively after intervention to evaluate the treatment efficiency Results Twenty four patients were treated successfully directly by guidance of transthoracic echocardiography during the period of closure, the total effectiveness was 80%. Five patients needed to have transesophageal echocardiography before closure to select indication and another one patient was treated successfully by adding transesophageal echocardiography for guidance in the procedure There was no significant complication that occurred during the procedures, and there was no emergency surgical case Trivial to small residual shunts were found in 2 cases (6 7%) immediately after the procedure No residual shunts were found in the one month follow up, and all patients had no displacement and recanalization in the one month follow up Conclusion Transthoracic echocardiography can guide most of atrial septal defect patients for closure of atrial septal defects with the Amplatzer occlusion device