The immediate release patch in the correction of experimental atrial septal defects.

OBJECTIVES: The purpose of this study was to evaluate the safety and efficacy of the Immediate Release Patch (IRP) in the occlusion of experimental Atrial Septal Defects (ASDs). BACKGROUND: The IRP consists of a polyurethane foam patch, supported by a balloon catheter which incorporates a detaching mechanism. This mechanism allows for withdrawal of the catheter from the balloon/patch complex. After release, the device is held in position using a bioabsorbable safety thread, which is sutured subcutaneously at the groin. METHODS: Experimental ASDs, 10-14 mm in diameter, were created in ten piglets. The ASDs were then corrected using IRPs 12-16 mm in diameter, under fluoroscopy and echocardiography. The animals were followed for one to four months, and were then euthanized and autopsied. A RAST test, which detects the presence of IgE antibodies for latex, was performed in seven animals. RESULTS: All procedures, except for one, resulted in full occlusion of the defects, without serious complications. No devices embolized, and in less than two months, the balloons had deflated and the area of the device had decreased significantly. The autopsies revealed complete endothelialization as well as no thrombus formation on the device or the thread. The thread was absorbed after one month. In a single case, infection was detected on the right side of the device. Latex antibodies were not detected. CONCLUSION: The IRP was effective and safe in the animal model of an ASD. There was evidence of bio-absorption of the complete device over time, without adverse reaction to latex. Clinical application is justified.

Infective endocarditis after transcatheter closure of a patent foramen ovale.

Infection of devices for percutaneous transcatheter closure of atrial septal defects are exceedingly rare. Two cases of device-associated endocarditis have been reported, which were both operated on. We describe the successful treatment with antibiotics of a device-associated endocarditis.

Myocardial viability after primary coronary angioplasty: low-dose dobutamine stress echocardiography versus myocardial contrast echocardiography.

BACKGROUND: Successful reperfusion therapy in patients with acute myocardial infarction (AMI) improves survival. Indeed, after AMI myocardial dysfunction may be reversible (hibernating or stunned myocardium). Low-dose dobutamine stress echocardiography (LDDSE) provides us with the possibility of evaluating viable myocardial segments, while myocardial contrast echocardiography (MCE) allows the study of the microcirculation in the same myocardial areas. The aim of our study was to compare LDDSE and MCE, in the prediction of the recovery of segments in patients with AMI who were submitted to primary coronary angioplasty (PTCA). METHODS: We studied 14 patients with AMI. Both LDDSE and MCE with Levovist were performed after primary PTCA. The viability gold standard was a recovery of contractility detected at echocardiography 2 months later. RESULTS: For LDDSE, the sensitivity was 91%, the specificity 71% and the positive and negative predictive values were 93 and 64% respectively. For MCE, the sensitivity was 94%, the specificity 44%, the positive predictive value 89%, and the negative predictive value 59%. Two tests agreed in 81% of the cases. Stress echocardiography and contrast echocardiography agreed in 81% of cases. CONCLUSIONS: LDDSE has a very good positive accuracy, it has an acceptable negative predictive value and is relatively cheap. On the other hand, MCE has a good positive accuracy, but a low negative accuracy and carries a high cost. The integration of these two tests, which are too expensive in clinical practice, could improve our comprehension of the post-PTCA pathophysiology.

Vasculitis mimicking bacterial endocarditis.

Fever of unknown origin is one of the most intriguing issues in clinical practice. One of the most feared diagnoses, especially in patients with known valvular disease, is endocarditis. The differential diagnosis of fever is often complicated by the clinical-pathological overlap between the systemic inflammatory response in different types of pathologies such as infectious, autoimmune or neoplastic disorders. We report a case of a patient presenting with fever, cutaneous nodules and malaise, with a known mitral valve prolapse and moderate regurgitation, in which the diagnosis of Wegener's granulomatosis was finally made.