Transcatheter patch occlusion of the left atrial appendage using surgical adhesives in high-risk patients with atrial fibrillation.

OBJECTIVES: The efficacy of left atrial appendage (LAA) occlusion using the Transcatheter Patch (TP) (Custom Medical Devices, Athens, Greece) in conjunction with surgical adhesives was assessed. BACKGROUND: The TP is a bioabsorbable device that can be adjusted for the shape and size of the LAA without the risk of perforation. It is attached by a surgical adhesive and is released in 45 min. METHODS: Occlusion of the LAA was performed in 20 high-risk patients, 59 to 89 years of age, with atrial fibrillation. A 2-stage polyethylene glycol surgical adhesive was applied to the distal half of the device. Activation of the adhesive was achieved by direct injection of alkaline solution. Fluoroscopy and transesophageal echocardiography only were used for device placement in 17 patients. In 3 patients, angiography was used as well. Follow-up transesophageal echocardiography was performed upon discharge. RESULTS: The procedure was successful in 17 cases. In the 3 patients in whom angiography was performed, the patch did not attach and was retrieved. In 1 case, the patch was placed beyond the mouth of the appendage, resulting in a residual opening. There was further improvement of the occlusion rate on the follow-up transesophageal echocardiography. There was 1 complication related to the procedure, namely, thrombus was released from the long sheath in the left atrium upon withdrawal and required treatment to be dissolved. No recurrent strokes were reported. CONCLUSIONS: Occlusion of the LAA by the TP is feasible and effective in most patients with atrial fibrillation at high risk for embolic stroke. Angiography before placement probably affects patch adhesion and is contraindicated.

Transcatheter patch occlusion of perimembranous ventricular septal defects.

Sixteen surgical candidates for ventricular septal defect correction were brought to the catheterization laboratory for transcatheter patch occlusion. There were 3 cases of nonrestrictive ventricular septal defects, including 2 with malalignment (tetralogy of Fallot). All patients, except those with tetralogy of Fallot who were cyanotic, had large left-right shunts. They were all corrected through the femoral vein. All defects with the exception of 2 were successfully occluded (12 full occlusions, 2 residual shunts). On follow-up, there were no embolizations, aortic insufficiency, or other complications. The method appears effective and relatively safe, and could challenge the current surgical standard of treatment.

Cardiac hypertrophy in hypertension: relation to 24-h blood pressure profile and arterial stiffness.

BACKGROUND: In subjects with essential hypertension peripheral blood pressure profile contributes to the pathogenesis of left ventricular hypertrophy. It is not known if central arterial pressure is superior to peripheral blood pressure profile for predicting left ventricular hypertrophy. In the present study 24-h blood pressure profile and central hemodynamics were examined to evaluate mechanical loading factors as determinants of cardiac hypertrophy in mild to moderate untreated essential hypertension. METHODS: Forty-eight untreated subjects with mild to moderate essential hypertension were examined by echocardiography for evaluation of left ventricular mass, 24-h ambulatory blood pressure monitoring (ABPM), and applanation tonometry of the radial artery with pulse wave analysis for evaluation of central hemodynamics. RESULTS: Left ventricular mass showed a statistically significant correlation with age, clinic systolic blood pressure, mean heart rate and heart rate variability during 24-h ABPM, augmentation pressure and index and central systolic blood pressure. In a multiple regression analysis including clinic systolic blood pressure, central systolic pressure, mean systolic pressure and pulse pressure during ambulatory monitoring as well as age, independent predictors of left ventricular mass were only age (P=0.006) and central systolic blood pressure (P=0.04). In conclusion, pulse wave analysis is a valuable method in predicting cardiac hypertrophy in untreated mild to moderate essential hypertension. Central systolic blood pressure should be taken into account for planning therapeutic strategies for prevention of left ventricular hypertrophy in hypertensive patients.

Transcatheter patch correction of secundum atrial septal defects.

The efficacy and safety of the transcatheter patch (TP) correction of a secundum atrial septal defect (ASD) was studied acutely and on short-term follow-up in 20 patients, successfully implanted with the device. TPs are made of polyurethane foam and require temporary balloon catheter immobilization on the atrial septum for 48 hours. Eighteen patients were not suitable for disk-device repair. The patient median age and ASD diameter were 37 years and 26 mm, respectively. Eighteen patients had immediate effective ASD occlusion; 2 patients had significant residual shunts. Premature leaks of the supportive balloons were responsible for the residual shunts. One of the patients with residual shunt received a second patch 6 months later with full occlusion. All patients with implants were doing well up to 24 months after implantation. Existing symptoms improved although residual shunts remained; septal anatomy was normalized, with the patched area becoming progressively indistinguishable from the rest of the septum. In conclusion, TP occlusion of secundum ASD is feasible and effective even for defects unsuitable for disk-device repair. The method appears safe acutely and on short-term follow-up, with symptomatic improvement and normalization of septal anatomy.