Cierre de la comunicación interauricular por cateterismo intervencionista con dispositivo Amplatzer en pediatría / Atrial Septal defect closure by interventional catheterization with Amplatzer device in Pediatrics

Introducción: El cateterismo intervencionista corrige las cardiopatías complejas, donde el dispositivo Amplatzer es el más usado y está disponible en Cuba. Objetivo: Evaluar el cateterismo intervencionista con Amplatzer, en el cierre de la comunicación interauricular ostium secundum. Métodos: Estudio de evaluación, longitudinal y prospectivo en 92 pacientes. El cierre de la comunicación por cateterismo con Amplatzer, se realizó en el Cardiocentro Pediátrico William Soler (2010-2016). Se utilizaron variables demográficas, ecocardiográficas (transtorácicas y transesofágicas) antes, durante y al año del cateterismo. Se observaron las complicaciones. La evaluación clínica y ecocardiográfica se realizó al año poscateterismo. Los pacientes a quienes se les realizó el proceder en el 2016, se evaluaron a los 6 meses. Resultados: Se encontraron diferencias significativas en el sexo (p<0,05): femenino 64,1 por ciento con homogeneidad para la edad (p= 0,244): media 9,8 años ( 5 desviaciones estándar. Precateterismo: 28,3 por ciento eran desnutridos y 17,4 por ciento delgados; poscateterismo la desnutrición mejoró significativamente (p= 0,000): desnutridos 9,8 por ciento y delgados 8,7 por ciento. El diámetro medio del defecto por ecocardiografía transcateterismo fue significativo (p= 0,000). Transcateterismo: 98,9 por ciento con cierre de defecto, 16,3 por ciento con insuficiencia tricúspidea y 4,3 por ciento con insuficiencia mitral. Poscateterismo: 98,9 por ciento con Amplatzer bien colocado. Hubo complicaciones inmediatas en 8,7 por ciento (arritmias, derrame pericárdico y embolización). Al año se detectó cortocircuito residual pequeño (n= 1) e insuficiencias valvulares auriculoventriculares (n= 3). La evolución fue satisfactoria (n= 91). Conclusiones: La evolución del cierre de la comunicación interauricular ostium secundum con dispositivo Amplatzer es satisfactoria, con mejoras de la desnutrición(AU)

Introduction: The interventional catheterization corrects complex heart diseases, and the Amplatzer device is the most widely used and is available in Cuba. Objective: To assess the interventional catheterization with Amplatzer device in the ostium secundum atrial septal closure. Methods: Longitudinal and prospective evaluation study in 92 patients. The closure of the communication by Amplatzer catheterization was performed in the William Soler Pediatric Cardiocenter of (2010-2016). Demographic and echocardiographic (transthoracic and transesophageal) variables were used before, during, and at the year of the catheterization. Complications were observed. Clinical and echocardiographic assessment was made a year after catheterism. The patients who underwent the procedure in 2016 were evaluated at 6 months. Results: Significant differences were found in the sex (p< 0.05): Female 64.1 t percent with homogeneity of the age (p= 0.244): average 9.8 years ( 5 standard deviations. Pre-catheterism: 28.3 percent were malnourished and 17.4 percent thin; post-catheterism: malnutrition improved significantly (p= 0.000): 9.8 percent malnourished and 8.7 percent thin. The average diameter of the defect by transcatheter echocardiography was significant (p= 0.000). Transcatheter: 98.9 percent : with default closure, 16.3 percent with tricuspid insufficiency and 4.3 percent with mitral regurgitation. Post-catheterism: 98.9 percent with Amplatzer device correctly positioned. There were immediate complications in 8.7 percent (arrhythmia, pericardial effusion, and embolization). A year after, small residual short circuit was detected (n= 1), and atrioventricular valve regurgitation (n= 3). The evolution was satisfactory (n= 91). Conclusions: The evolution of ostium secundum atrial septal defect´s closure with Amplatzer device is satisfactory and improves malnutrition(AU)

Conscious sedation using dexmedetomidine for percutaneous transcatheter closure of atrial septal defects: A single center experience.

Objective: The aim of this study is to determine safety and feasibility of conscious sedation using dexmedetomidine for transcatheter atrial septal defect (ASD) device closure. Materials and Methods: A retrospective institutional review of transcatheter ASD device closure without endotracheal intubation over 18 months. The protocol included topical oropharyngeal anesthesia using lignocaine followed by dexmedetomidine bolus 1 μg/kg intravenously over 10 min and maintenance dose 0.2–0.7 μg/kg/h. Ramsay sedation score 2–3 was maintained. Patients were analyzed regarding demographic profile, device size, procedure time, anesthesia time, recovery time, hospital stay, and any hemodynamic or procedural complications. Results: A total of 43 patients with mean age 31.56 ± 13.74 years (range: 12–56 years) were analyzed. Mean anesthesia duration was 71.75 + 21.08 min. Mean recovery time was 7.6 ± 3.01 min. 16 females and one male patient required additional propofol with a mean dose of 30.8 ± 10.49 mg. No hemodynamic instability was noted. No patient required general anesthesia with endotracheal intubation. The procedure was successful in 93.02% of patients. Four patients developed atrial fibrillation. All patients were satisfied. Conclusion: Conscious sedation using dexmedetomidine is a safe and effective anesthetic technique for percutaneous ASD closure.

Transcatheter Closure of Ventricular Septal Rupture First in Bangladesh - A Case Report.

Ventricular septal rupture is a rare complication of acute myocardial infarction with important hemodynamic consequences. Without a rapid diagnosis and correction by surgical intervention, the short-term mortality of these patients is higher than 90%. Early diagnosis is based on clinical examination and transthoracic echocardiography. Transcatheter closure of ventricular septal rupture in selected patients may save lives. We report a patient with ventricular septal rupture in acute myocardial infarction that was closed by an Amplatzer 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.

Características clínicas, modalidades de tratamiento y mortalidad en la ruptura del septum interventricular posinfarto / Clinical characteristics and treatment of ventricular septum rupture after acute myocardial infarction

Objetivo: Conocer las características, estrategia de tratamiento y mortalidad en pacientes con infarto agudo al miocardio y ruptura del septum interventricular posinfarto. Métodos: Se incluyeron 40 pacientes atendidos en un periodo de ocho años por infarto agudo al miocardio complicado con ruptura del septum interventricular posinfarto. Se utilizó ecocardiograma para confirmar la ruptura del septum interventricular posinfarto. Se evaluaron las características clínicas, el tipo de tratamiento y la mortalidad hospitalaria. Las variables se compararon con prueba U de Mann-Withney o prueba exacta de Fisher. Resultados: Edad 64 años (56 a 73), 67% hombres, 53% diabetes, 43% hipertensión, 40% tabaquismo. Los tratamientos fueron: conservador 45%, quirúrgico 38% o dispositivo Amplatzer 17%. La mortalidad general fue de 65%, con manejo conservador 54%, con cirugía 35% y con Amplatzer 12% (p = 0.02), y estuvo asociada a menor tiempo entre infarto agudo al miocardio y ruptura del septum interventricular posinfarto (p <0.001) y menor tiempo entre ruptura del septum interventricular posinfarto y tratamiento de cierre (p <0.001). Todos los pacientes con Killip Kimbal III o IV murieron. Conclusiones: Hasta el momento no existe una estrategia de manejo en la ruptura del septum interventricular posinfarto que demuestre ventajas sobre las demás. El único marcador de buen pronóstico podría ser el mayor tiempo entre la ruptura y el tratamiento de cierre. Es probable que la indicación de manejo de las guías internacionales no aplique para todos los pacientes y estos deban estratificarse de acuerdo a su estado hemodinámico.

Objective: To identify the characteristics, management strategy and mortality of patients with acute myocardial infarction (AMI) and rupture of ventricular septum (RVS). Methods: The study included 40 patients admitted during a period of 8 years, due to AMI complicated with RVS. RVS was confirmed by echocardiogram. The clinical characteristics, type of treatment and hospital mortality were evaluated. Variables were compared by Mann-Withney U tests or Fisher exact test. Results: Patients were 64 years old (56 - 73), 67% men, 53% diabetes mellitus, 43% hypertension, 40% smokers. Treatments were medical (45%), surgical (38%) or Amplatzer (17%). Overall mortality was 65%, in conservative group was 45%, in surgery group 38%, and Amplatzer group 17% (p = 0.02), it was associated to shorter time between AMI and RVS (p <0.001) and shorter time between and treatment (p <0.001). All patients with Killipp Kimbal III or IV died. Conclusions: Currently there is no management strategy in RSV with demonstrated advantage over other strategies. The only marker with good prognosis could be a long time between rupture and treatment. It is likely that the indication of management of International guidelines does not apply to all patients and these should be stratified according to their hemodynamic status.

Device Closure of Perimembranous Ventricular Septal Defect Under Deep Sedation and Transthoracic Echo Guide: A Case Report.

T, an eight years old girl was diagnosed as a case of perimembranous Ventricular Septal Defect (VSD) since 6 months of her age. She had recurrent chest infection since early infancy. Her Echocardiography with colour Doppler showed a 4.5 mm perimembranous VSD which was 5 mm away from the aortic valve. As pulmonary artery pressure was normal, she was kept under follow up and device closure was planned. At last she was taken into the catheterization laboratory of combined military Hospital, Dhaka on 1st July 2008 and VSD was closed with an 8 mm Amplatzer perimembranous VSD device. Whole procedure was done under deep sedation with Ketamine and transthoracic echocardiography (TTE) and fluroscopy guide. It is the first ever case of VSD device closure where procedure was done under sedation and TTE guide which lead to the writing of this report.

Meta-Analysis on Controlled Trials of Transcatheter Amplatzer Device Closure and Cardiac Surgery on Patent Ductus Arteriosus / 实用儿科临床杂志

ObjectiveTo evaluate the effectiveness of transcatheter Amplatzer device closure on patent ductus arteriosus(PDA),and to give some evidences for the clinical application.MethodsAll studies in the world regard to the controlled trials(CT) about transcatheter Amplatzer device closure and cardiac surgery on PDA were searched and made synthetic evaluation by means of Meta-analysis.RevMan 4.2.2 software was used for statistical analysis.Cases relative risk(RR)and its 95% confidence interval(CI)of procedure failure,the incidence of complication and residual shunt were calculated.ResultsTotally 5 studies including 349 cases were analyzed.Operation failure of Amplatzer device occlusion was higher than cardiac surgery [5 CT,349 cases,3.0% vs 0,RR=4.29,95%CI(0.77,23.95)](P=0.10).Incidence of complication of Amplatzer device occlusion was lower than cardiac surgery[5 CT,343 cases,3.1% vs 38.0%,RR=0.11,95%CI(0.05,0.23)](P

Cierre percutáneo de conducto arterioso y de comunicación interventricular muscular con dispositivos de Amplatzer en paciente con hipertensión pulmonar acentuada / Percutaneous closure of ductus arteriosus and muscular ventricular defect with Amplatzer occluder in a patient with severe pulmonary hypertension

El tratamiento quirúrgico de la comunicación interventricular muscular múltiple con lesiones asociadas e hipertensión arterial pulmonar severa tiene una alta morbilidad y mortalidad. El cierre de estos defectos con dispositivo Amplatzer para comunicación interventricular muscular es una alternativa a la cirugía, evitando la utilización de circulación extracorpórea. Presentamos el caso de una mujer de 38 años de edad con signos de falla cardíaca en clase funcional IV (NYHA), con dos comunicaciones interventriculares de tipo muscular, persistencia de conducto arterioso e hipertensión arterial pulmonar severa, que fueron ocluidos con tres dispositivos Amplatzer específicos para cierre de comunicación interventricular muscular, lográndose disminución importante de la presión pulmonar y mejoría de su clase funcional.

Surgical treatment of multiple muscular ventricular septal defects with associated lesions and severe pulmonary hypertension has a high morbility and mortality. Closure of these defects by the Amplatzer muscular VSD occluder is an alternative to surgery, avoiding the need of cardiopulmonary bypass. We present the case of a 38 year-old woman with signs of heart failure in NYHA functional class IV, with two muscular ventricular septal defects, patent ductus arteriosus and severe pulmonary hypertension, that were treated with three Amplatzer muscular VSD occluders, with significant reduction of pulmonary pressure and functional class improvement.

Cierre percutáneo de la comunicación interventricular perimembranosa con el dispositivo de Amplatzer®: Resultados inmediatos y a mediano plazo / Percutaneous closure of ventricular septal defect by Amplatzer occluder: Immediate and mid-term follow up results

Objetivos: Reportamos los resultados inmediatos y seguimiento a mediano plazo de la implantación del dispositivo Amplatzer® para el cierre percutáneo de la comunicación interventricular perimembranosa (CIVpm). Antecedentes: El cierre percutáneo de la CIVpm se considera aún un método experimental en el que se han probado diversos tipos de dispositivos. Hasta la fecha, se han implantado mundialmente más de 500 dispositivos Amplatzer® con resultados alentadores. Métodos: Se incluyeron 6 pacientes (1 hombre y 5 mujeres), con edad promedio de 9.9 años (límites, 3 a 17.5), en quienes se intentó el cierre percutáneo de la CIVpm. Resultados: En una de las pacientes, no fue posible la colocación adecuada del dispositivo (tasa de éxito con intención de tratamiento 83.3%). En los cinco pacientes restantes el defecto fue único. El diámetro promedio de la CIVpm medido con el ecocardiograma fue de 7 ± 1.7 mm (límites, 5.1 a 9) y medido con angiografía de 6.9 ± 1 (límites, 6 a 8). La presión pulmonar media promedio fue de 20.2 ± 7.7 mm Hg (límites, 12-30) y el Qp/Qs de 1.69 ± 0.65 (límites, 1.2-2.8). Se colocó un dispositivo en todos los pacientes. El control inmediato con angiografía mostró oclusión completa de los defectos en dos pacientes, fuga trivial en uno y fuga ligera en dos. En dos pacientes se registró insuficiencia aórtica residual trivial, preexistente en uno y en tres insuficiencia tricuspídea trivial a ligera, preexistente en todos. En el seguimiento de por lo menos 4 meses, sólo una paciente persiste con cortocircuito residual trivial, en el resto los defectos se observan completamente ocluidos con el ecocardiograma transtorácico. Conclusiones: El diseño especial del dispositivo oclusor Amplatzer® para CIV perimembranosa permite el cierre percutáneo de este defecto de una manera eficaz y segura, con buenos resultados a mediano plazo. En casos seleccionados, puede ser una técnica alternativa a la cirugía para el tratamiento de esta cardiopatía.

Object: To report the immediate and mid-term follow-up results of the Amplatzer® membranous VSD occluder for the percutaneous occlusion of the perimembranous VSD. Background: Percutaneous perimembranous VSD occlusion is still considered an experimental method where a variety of devices have been tested. Nowadays, more than 500 membranous Amplatzer® devices have been implanted worldwide with encouraging results. Method: We included 6 patients (1 man and 5 women) with a mean age of 9.9 years (range, 3 to 17.5) in whom percutaneous perimembranous VSD closure was attempted. Results: In one of the patients, positioning of the device was not possible (intention to treat success rate, 83.3%). In the remaining five patients, there was a single defect. The VSD mean diameter with echo was 7 ± 1.7 mm (range, 5.1 to 9) and with angio was 6.9 ± 1 (range, 6 to 8). Mean pulmonary pressure was 20.2 ± 7.7 mm Hg (range, 12-30) and Qp/Qs was 1.69 ± 0.65 (range, 1.2-2.8). A single device was use in all cases. Immediate angiographic control showed complete occlusion in two patients, trivial shunt in one, and mild shunt in two. Follow-up was at least 4 months. Only one patient has residual trivial shunt, the rest of the defects are completely closed. Conclusion: The special design of the Amplatzer® membranous VSD occluder allows percutaneous closure of this defect in a safe and effective way, with good mid-term results. In se lected cases, this is a good alternative to surgery in the treatmen of this cardiac defect.

Cierre percutáneo de foramen oval permeable con dispositivo de Amplatzer: Presentación de dos casos / Percutaneous closure of patent foramen ovale with Amplatzer device: Report of two cases

Propósito: Se presentan los 2 casos de foramen oval permeable tratados con dispositivo de Amplatzer por vía percutánea. Método: El primero del sexo femenino de 48 años y con antecedentes de enfermedad de Ebstein moderada a severa y de 3 accidentes vasculares cerebrales, siendo el último bajo efecto anticoagulante, manejada con antiarrítmicos a pesar de lo cual presentó bloqueo auriculoventricular (a-v) de primer grado, aumento del automatismo supraventricular y ventricular de diferente foco y bloqueo de rama derecha. El segundo paciente masculino de 22 años con antecedente de un evento embólico cerebral a los 21 años con secuelas de crisis convulsivas. Ambos fueron tratados por vía percutánea para implante de dispositivo de Amplatzer, el primero para foramen oval permeable (FOP) y el segundo con dispositivo para comunicación interatrial por el diámetro del foramen. Los dos pacientes se encuentran asintomáticos. Conclusiones: El cierre de FOP por vía percutánea está indicado en pacientes con antecedentes de eventos cerebrales transitorios o permanentes y se sospeche esta vía como fuente embolígena. La técnica es fácil de realizar pero se requiere de un mayor número de pacientes para concluir.

Objective: We present two cases of Patent Foramen Ovale (PFO) treated with percutaneous Amplatzer device. Method: The first case corresponds to 48 years old woman with Ebstein's disease with moderate to severe hemodynamic repercussion and three cerebrovascular accidents, the last one under coumarin treatment, she received antiarrhythmic medication and despite of it developed 1st degree AV block, supraventricular and ventricular ectopia, rigth branch block. The second case corresponds to a 22 years old man with antecedents of cerebrovascular accident at the age of 21 with sequelae of convulsive crisis. Both patients were percutaneously treated with Amplatzer devices. The first patient was treated with a foramen ovale device and second with septal occluder due to the diameter of the foramen. Both patients have remained asymptomatic during the follow-up period. Conclusions: The PFO devices are indicated for patients with a history of cerebrovascular accidents.

Transcatheter closure of secundum atrial septal defect and patent ductus arteriosus using Amplazter device: a report of 23 cases / 中国介入心脏病学杂志

Objective To evaluate the therapeutic effect of transcatheter closure of secundum atrial septal defect (ASD) and patent ductus arterious (PDA) using Amplatzer device Methods Twenty third patients (19 ASD, 4 PDA) were treated with Amplatzer device through the pecutaneous procedure under fluoroscopy,angiography and TTE Results The success rate was 100% No residual shunts were found in 21 cases after the procedure 24 hours and 1 week later TTE and X ray examination showed that no residal shunts in all cases and both pulmonary vascularity and cardiac silhouette were improved after the procedure half a year Conclusion Transcatheter closure of ASD and PDA using Amplatzer device is an efficent method, the operation is simple with a high sucess rate and a good occlusion effect