[Catheter closure in atrial septal defects and open foramen ovale using the Sideris buttoned device]. / Katheterverschluss bei Vorhofseptumdefekt und offenem Foramen ovale mit dem "Sideris buttoned device".

Percutaneous nonsurgical closure is an alternative to surgical repair of a significant atrial septal defect (ASD) or a patent foramen ovale (PFO) associated with systemic embolism without other cause. We report the results of the first 35 patients (19 ASDs, 16 PFOs) in whom transcatheter closure was attempted. Diagnosis and follow-up were based on transesophageal echocardiography in the majority of cases. In all patients the "Sideris buttoned device" was used. A total of 19 patients (13 women) were treated for symptomatic ASD of the secundum type. The mean defect size before the intervention was 17 mm by echocardiography and 24 mm measured by balloon in the catheterization laboratory (stretched diameter) with a reduction to 4 mm after treatment measured by echocardiography. A total of 16 patients (5 women) underwent transcatheter closure of a PFO; 14 patients had had cerebral embolic events and 2 peripheral. During follow-up of 104 patient months, only one patient had a recurrent embolic event. He had at that time no occluder protecting the PFO after early embolization and extraction of the device.

[Mitral valvuloplasty using the Inoue balloon]. / Mitralvalvuloplastie mit dem Inoue-Ballon.

Percutaneous mitral balloon valvuloplasty (PMBV) is an accepted alternative treatment to open and closed mitral commissurotomy or mitral valvular replacement. The Inoue technique has become standard in most centers. In our first 24 percutaneous balloon mitral valvuloplasties by the Inoue technique, 23 procedures were technically successful. The mean age of the patients was 53 (24-75) years. There were 22 women. Four patients had a history of closed mitral commissurotomy, one of previous mitral balloon valvuloplasty, and one of aortic metallic valve replacement. The mean echocardiographic mitral Wilkins score was 7.3 (range 4-13). PMBV resulted in significant improvement of hemodynamic values. The mean mitral pressure gradient fell from 12 +/- 5 to 5 +/- 3 mm Hg (p = 0.0001) and the cardiac index increased from 2.7 +/- 0.7 to 3.0 +/- 0.8 l/min/m2. The valve area by the Gorlin formula increased from 1.2 +/- 0.3 to 2.1 +/- 0.6 cm2 (p = 0.0001). Doppler and planimetric echocardiography data were in keeping with hemodynamic data. Mitral valve regurgitation increased by more than 1 grade in 3 patients, 2 of whom subsequently underwent valve replacement. No tamponade occurred with the Inoue technique. There was 1 fatal outcome following tamponade and emergency heart surgery after mitral valvuloplasty with a Trefoil balloon employed in a subsequent intervention due to impossibility of placing the Inoue balloon. Left-to-right shunting at the atrial level after the intervention was not significant in any patient. 21 patients (88%) had improvement in their functional class. One of the patients with unchanged functional class had late onset of severe mitral regurgitation, another had a technical failure with the Inoue technique, and in 1 patient with calcified valve leaflets significant mitral stenosis persisted. At 3 to 15 months follow-up echocardiography was performed in 19 patients: mitral valve areas had not changed significantly compared to post-interventional values. One patient had a new mitral regurgitation compared with the situation immediately after PMBV. Mitral balloon valvuloplasty by the Inoue technique is an effective treatment with low risk in patients with symptomatic mitral stenosis.

Increase in circulating insulin induced by atrial natriuretic peptide in normal humans.

To search for possible metabolic interactions of alpha-human-atrial natriuretic peptide (alpha hANP), we evaluated in 20 normal subjects blood levels of alpha hANP, glucose, insulin, cortisol, electrolytes, catecholamines, free fatty acids, carnitine and amino acids, blood pressure (BP), and heart rate before, during, and after a 45-min infusion of synthetic alpha hANP. Group A [n = 10] was studied on liberal and Group B on three consecutive sodium (Na) intakes of 17, 140, and 310 mM/day. Plasma alpha hANP was slightly but not significantly higher following 5 days on "normal" or high than on low Na+ intakes. alpha hANP infused at 0.1 microgram/kg/min produced on all Na+ intakes comparable percentage increases in plasma insulin (+34 to 63%, p less than 0.001), norepinephrine (+76 to 155%, p less than 0.001) and heart rate (p less than 0.001), and a similar fall in diastolic BP (p less than 0.001). Plasma glucose tended to be decreased slightly and cortisol was reduced; epinephrine, dopamine, and potassium levels were not significantly modified. As evaluated in group A, serum free fatty acids were increased (p less than 0.01), plasma free carnitine levels were reduced (p less than 0.001), and amino acids were not consistently altered. These findings indicate that in normal humans alpha hANP may, on various sodium intakes, modulate insulin secretion and/or metabolism and elicit a possibly baroreflex-mediated sympathetic activation and lipolysis.

Plasma arginine-vasopressin levels during infusion of synthetic atrial natriuretic peptide on different sodium intakes in man.

The mechanisms involved in the diuretic action of the recently discovered group of atrial natriuretic peptides (ANP) are not entirely clear. To determine whether the diuresis and the changes in blood pressure produced by alpha-human ANP (alpha-hANP) involved a concomitant modification of circulating arginine-vasopressin (arg-VP), we evaluated the effects of synthetic alpha-hANP on plasma alpha-hANP, arg-VP, electrolytes, protein, haematocrit, blood pressure and urinary sodium and water excretion in 10 normal subjects on daily sodium intakes of 16, 140 and 310 mmol, respectively. Plasma alpha-hANP levels before and during a 45-min alpha-hANP infusion (0.09 micrograms/kg per min) tended to be slightly, though not significantly, higher on 'normal' or high sodium intake than on low sodium intake. Alpha-human ANP produced a fall in diastolic blood pressure (P less than 0.001) and to a lesser extent mean blood pressure, and a rise in heart rate (P less than 0.001) at all levels of sodium intake. The induction of diuresis, natriuresis and plasma volume contraction caused by alpha-hANP was greater on a high sodium intake than on 'normal' or low sodium intakes (P less than 0.001). Plasma arg-VP concentrations were lower (P less than 0.05) on a high than on a low sodium intake, but were not altered by an alpha-hANP infusion. The data indicate that in healthy humans circulating arg-VP may tend to decrease in response to a high salt diet. However, marked changes in plasma alpha-hANP concentrations have, regardless of sodium intake, no relevant influence on circulating arg-VP.(ABSTRACT TRUNCATED AT 250 WORDS)