Adjustable inspiratory occlusion valve in experimental bronchopleural fistula. A new therapeutic perspective

PURPOSE: To assess the efficacy of an adjustable inspiratory occlusion valve in experimental bronchopleural fistula during mechanical ventilation.METHODS:We studied six mechanically ventilated pigs in a surgically created, reproducible model of bronchopleural fistula managed with mechanical ventilation and water-sealed thoracic drainage. An adjustable inspiratory occlusion valve was placed between the thoracic drain and the endotracheal tube. Hemodynamic data, capnography and blood gases were recorded before and after the creation of the bronchopleural fistula as well as after every adjustment of the inspiratory occlusion valve.RESULTS:When compared with the standard water-sealed drainage treatment, the use of an adjustable inspiratory occlusion valve improved the alveolar tidal volume and reduced bronchopleural air leak (p<0.001), without hemodynamic compromise when compared with conventional water sealed drainage.CONCLUSION: The use of an adjustable inspiratory occlusion valve improved the alveolar tidal volume, reduced alveolar leak, in an experimental reproducible model of bronchopleural fistula, without causing any hemodynamic derangements when compared with conventional water sealed drainage.

Percutaneous closure of using Occlusion DeviceOstium Secundum Septal defect amplatzer occlusion device: Experience of cardiology department, Hedi Chaker Hospital, Sfax, Tunisia

To report our clinical experience with transcatheter closure of ostium secundum atrial septal defects [OS ASDs] using Amplatzer septal occluder. It's a retrospective study conducted between October 2005 and April 2010 and involving 34 patients. The procedures were conducted in the hemodynamic laboratory under general anesthesia with transthoracic [TTE] and transoesophageal echocardiographic [TEE] monitoring. Clinical and echocardiography assessments of the patients were conducted within 24 hours post procedure and several months after the procedure. From the 34 patients, 28 [82%] were females. The middle age was 27.5 years. The mean ASD diameter was 19.4 mm by TTE; 18.1 mm [12-38] by TEE, and 23.4 by angiography. The average size of the implanted devices was 23.2 mm ranging from 10 to 34 mm. The final success rate of the procedure was 90.9% [30/33]. One patient was excluded from transcatheter occlusion and three patients [8,6%] had complications including two prosthesis migrations and one large residual shunting. A total of 4 patients [11.7%] underwent surgery. No major complication [thromboembolic events, obstruction of intracardiac structures, cardiac perforation, device embolization and endocarditis] or death has occurred during follow-up and all devices were securely anchored without any persistent residual shunts. Compared to previous data of the literature, percutaneous closure of OS ASDs using Amplatzer device appears safe and effective according to our experience of the cardiology department of Hedi Chaker Hospital