Complications of transcatheter closure of atrial septal defects using the amplatzer septal occluder / 소아과

PURPOSE: Transcatheter closure of atrial septal defects (ASD) is currently established therapy as an alternative to surgery. But rarely, complications are reported in some studies. We report early and intermediate term complications associated with transcatheter closure of atrial septal defects using the Amplatzer septal occluder (ASO). METHODS: From June 2003 to May 2006, 64 patients underwent transcatheter closure of secundum ASD or patent foramen ovale using the ASO. The ratio of male to female was 1:2.4, the median age was 17 years (range: 2.6-64 years) and their median weight was 47.5 kg (range: 2.6-64 kg). RESULTS: The median diameter of ASD measured with transthoracic or transesophageal echocardiography was 15 mm (range: 6-28 mm), the median balloon stretched diameter was 18 mm (range: 6.5-34 mm), and the median size of device was 19.5 mm (range: 6-36 mm), was little difference with balloon stretched diameter. There were 10 cases of complications: arrhythmia (2), device malformation (2), aorta to right atrial fistula (1), hemolytic anemia (1), mitral valve encroachment (1), malposition (1), residual shunt (1), and inferior vena cava perforation (1). CONCLUSION: Transcatheter closure of ASD using ASO is effective and safe therapy. However, significant complications such as aorta to atrial fistula, atrial erosion, or device embolization can happen, so an appropriate selection of patient and device in relevance to size and anatomy of ASD is important for successful closure.

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery : Report of an Adult Case

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), also termed Bland-White-Garland syndrome, is a rare congenital cardiac anomaly characterized by myocardial ischemia which becomes symptomatic during early infancy leading to infarction, left heart failure or even death. More than 90% of patients can be dead within first year of life if untreated, so adult type ALCAPA without surgical correction is quitely rare. We present a case of a 20-year-old man with ALPACA syndrome whose diagnosis took several years to be made because he was mistaken to have organic mitral regurgitation.

A Pediatric Case of Autoimmune Hemolytic Anemia followed by Excessive Thrombocytosis and Leukocytosis

Autoimmune hemolytic anemia (AIHA) is characterized by the production of antibodies directed against red blood cells (RBCs). It is usually accompanied by normal white blood cell (WBC) and platelet counts. Severe leukocytosis and thrombocytosis in AIHA are rare. Here, we report a 3-year-old female child who showed AIHA by warm antibody testing with both leukocytosis and thrombocytosis. The patient was treated with oral steroids for 5 days. During treatment, the leukocytosis was noted on hospital day 3 and was up to 60.87 x 10(9)/L. In addition, the thrombocytosis persisted at up to 725 x 10(9)/L. After day 7, the WBC and platelet counts returned to the normal range. The clinical condition and vital signs improved. The patient was discharged on day 12. This case demonstrated that patients with primary AIHA, may also have leukocytosis and thrombocytosis.