ABSTRACT
Transcatheter closure of large secundum atrial septal defects with deficient rims is difficult. Several techniques have been described to improve delivery of the occluder in anatomically challenging cases. Among these is a recently described technique using a modified delivery sheath with the creation of a bevel. However, the initial case report was complicated by malfunction and longitudinal splitting of the sheath. We describe the successful use of a modified delivery sheath for closure of a large atrial septal defect with a deficient rim.
Subject(s)
Balloon Occlusion/instrumentation , Cardiac Catheterization , Heart Septal Defects, Atrial/therapy , Adult , Echocardiography, Transesophageal , Equipment Design , Fluoroscopy , Heart Septal Defects, Atrial/diagnostic imaging , Humans , Male , Treatment OutcomeABSTRACT
A 70-year-old woman presented with a persistent, nonmalignant esophagorespiratory fistula. Since other treatment options failed or were denied, an experimental nonsurgical therapy was performed. A self-expanding ventricular septal defect (VSD) occlusion device (Amplatzer; AGA Medical Corporation; Golden Valley, MN) was bronchoscopically introduced to close the fistula. The double umbrella-like occlusion device is made from nitinol mesh and closes luminal contact between the esophageal and bronchial walls, with its waist filling out the fistula itself. The geometry of the occluder system can in theory be designed according to individual purposes and needs. The performed treatment was safe and successful, and the patient remained asymptomatic for 1 year after the first presentation. The treatment of chronic nonmalignant esophagorespiratory fistulas can be difficult. The self-expanding VSD occluder system described in this case might be useful in patients who are not surgical candidates.
Subject(s)
Bronchoscopy/methods , Endoscopy/methods , Equipment and Supplies , Esophageal Fistula/surgery , Esophagoscopy/methods , Respiratory Tract Fistula/surgery , Aged , Female , Heart Septal Defects, Ventricular/surgery , Humans , Prostheses and ImplantsABSTRACT
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