Persistent Fistula Closure After Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography by Postinfarct Ventricular Septal Defect Occluder.

A gastrogastric fistula is a delayed complication of the endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography. Endoscopic closure of these fistulae poses a significant challenge, and surgical intervention may be required in some patients. In this study, we discuss the case of a 69-year-old woman with persistent fistula following the endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography procedure. Despite the failure of conventional advanced endoscopic fistula closure methods, successful closure of the fistula was achieved using a postinfarct ventricular septal defect occluder.

An unusual site of ablation for a ventricular tachycardia.

Scar-related ventricular tachycardia (VT) ablation involves localizing the critical isthmuses by overdrive pacing maneuvers and three-dimensional activation mapping. Implantable prosthetic devices have been known to complicate this by covering sites of potential isthmuses. We herein present a sentinel report of scar-VT ablation with a protected isthmus localized over an endothelialized post-myocardial infarction ventricular septal defect occluder device.

Percutaneous Closure of Iatrogenic VSD and Paravalvular Leak: Two Complications of TAVR.

TAVR is increasingly becoming a common treatment for severe symptomatic aortic stenosis. Although there has been marked reduction in intra-procedural complications with evolution in the TAVR technology, these complications remain a challenge. We present a unique case of paravalvular leak (PVL) and iatrogenic ventricular septal defect as a result of closing attempts of PVL. We aim to highlight our procedural approach to percutaneously repair the aforementioned complications using our heart team approach for decision making.

Percutaneous closure of symptomatic large tricuspid paravalvular regurgitation using two muscular VSD occluders.

Paravalvular leaks are common following valve replacement surgery. Majority are benign and do not require any active intervention. However, occasionally severe paravalvular regurgitation can produce heart failure and/or hemolysis, needing closure of the defect. It is more commonly associated with aortic and mitral prosthesis, symptomatic tricuspid paravalvular regurgitation being a rare entity. In this report we present the successful percutaneous transcatheter closure of a large paravalvular tricuspid regurgitation in a 59-year old lady with history of multiple previous operations. The elongated crescent-shaped defect was closed using two muscular VSD devices without any residual leak and without hampering the bio-prosthetic tricuspid valve function. Patient had transient complete heart block during the procedure which recovered later. There was marked improvement in the symptomatic status of the patient at discharge (NYHA IV to NYHA II), which was sustained at follow-up.

Percutaneous closure of a prosthetic pulmonary paravalvular leak.

Paravalvular leak following prosthetic valve surgery has the potential to cause serious complications such as hemolysis and congestive heart failure. Successful percutaneous closures of prosthetic mitral and aortic paravalvular leaks have been performed as an alternative to reoperation. This case represents the first known report of successful percutaneous closure of a prosthetic pulmonary paravalvular leak in an adult patient with a history of congenital heart disease using two muscular ventricular septal defect occluder devices.

Transcatheter closure of perimembranous ventricular septal defect with the Amplatzer(®) membranous VSD occluder 2: initial world experience and one-year follow-up.

OBJECTIVES: To describe the initial world experience and mid-term follow-up of perimembranous ventricular septal defect (pmVSD) closure with a newly designed occluder. BACKGROUND: Transcatheter closure of pmVSDs has been associated with a substantial risk of complete heart block, prompting many centers to abandon this intervention. METHODS: A prospective multicenter cohort study was conducted on patients with pmVSD undergoing catheter closure using the Amplatzer(®) Membranous VSD Occluder 2 in the initial 4 pilot centers. RESULTS: Nineteen patients, median age 6 years (range 1.4-62 years), were enrolled and followed for 14 ± 3 months (range 8-20 months). The median weight was 26 kg (range 9.3-96 kg) and the mean Qp/Qs ratio was 1.8 ± 0.7. The defect on left ventricular side measured 9.9 ± 3.5 mm and the orifice on right ventricular side was 8.1 ± 2.8 mm by echocardiography. Mean device size was 9.4 ± 2.4 mm (range 5-14 mm). An eccentric device was employed in 9 patients (47%) and a concentric device in 10 (53%). Overall, 18 patients (95%) had successful device implants. Procedural time was 122 ± 39 min. There were no procedural complications. Mild residual shunting was initially observed in 14 (78%) patients. At last follow-up, mild residual shunting persisted in only 3 (17%) patients. There was no significant increase in aortic or tricuspid regurgitation. No patient had any degree of AV block, although one developed a transient left anterior fascicular block. Holter evaluation, obtained in all patients, was unremarkable in all. CONCLUSIONS: This early cohort experience using a novel adapted transcatheter closure device for pmVSD suggests that the procedure is feasible, safe, and effective.

Arrhythmia risk factors after transcather closure of perimembranous ventricular septal defects / 介入放射学杂志

Objective To identify the risk factors resulting in arrhythmias after transcather closure of perimembranous ventricular septal defects in patients under 18 years old so as to decrease the incidence of arrhythmias after the interventional catheterization.Methods The types and risk factors of arrhythmias were analysed in 89 cases who underwent transcather closure of perimembranous ventricular septal defect from Jun. 2002 to Jun. 2004. Results Total procedures were attempted in 89 cases successfully. 11cases were developed various kinds of block conduct. The up margin of defects to the aortic valve

Transcatheter closure of perimembranous and muscular ventricular septal defects using the new Amplatzer VSD occluder and the effect of cardiac conductive system / 中国实用内科杂志

Objective To evaluate the feasibi1ity and efficacy of transcatheter closure of perimembranous and muscular ventricular septal defects (VSD) using the new Amplatzer membranous and muscular VSD occluder and observe the effect of membranous VSD occluding procedure on atrioventricular(AV) conductive system.Methods Twelve patients (7 males,5 females) with perimembranous VSD and two patients (1 male,1 female) with muscular VSD underwent an catheter closure using the new Amplatzer membranous and muscular VSD occluder.All patients who were eligible for device closure by means of cardiac Doppler echocardiography were routinely measured the parameters of blood dynamics before catheter closure. Artery-venous track was set up under the X-ray fluoroscopy,transesophageal (TEE) or transthoracic echocardiography (TTE) guidance. Devices were released in the right ventricular side.Twelve patients with perimembranous VSD underwent the cardiac electrophysiologic examination,including atrioventricular conductive time (AV interval) and atrioventricular nodal refractory time,before and after catheter closure.A11 patients were followed up at 2 weeks,1 month,3 months and 6 months after the procedures.Results The devices were deployed successfully in 14 patients.There was complete closure in 12 patients immediately,and tiny (

Catheter closure of membranous ventricular septal defects using a new Amplatzer membranous VSD occluder / 中国介入心脏病学杂志

Objective To evaluate the effectiveness and safety of transcatheter closure of membranous ventricular septal defect (MVSD) using Amplatzer membranous VSD occluder (AMVSO). Methods The patients, who were clinically diagnosed with VSD were recommended for further transthoracic echocardiographic assessment using multiple standard views. If there were left to right shunts across ventricular septum, the margin of defects to the aortic valve was more than 1mm and that to tricuspid valve was more than 3 mm. If there was an aneurysm, it should not interfere with the function of outlet of right ventricule. Finally, if the diameter of VSDs wasless than 14mm, catheter closure of VSDs was suggested in these patients. The patients, having residual shunt after surgical closure of VSD, were included. All procedures were performed under local or general anesthesia. Transthorac echocardiography and X ray were used continuously to monitor the procedure. Transthoracic echocardiography was performed immediately after the release of devices, 24 hours, and 3 months after the procedure, respectively.Results From June 2002 to March 2003, 32 consecutive patients (15 females), underwent transcatheter closure of MVSD. The mean diameters of VSDs measured by echocardiography was 5.1 mm (3～8 mm) and, while that by angiography was 4.4 mm (3～8 mm). The mean size of the occluder was 7.6 mm(4～12 mm). The successful rate of device implantation was 100% (32/32). The residual shunt immediately after the closure was 11.5%, whereas after 24 hours it was only 7.7%, which was not serious. After 3 months′ follow-up, only 3.8% trivial residual shunt existed. No death occurred during and after the procedure. Atrial tachycardia, ventricular tachycardia, and bundle (right and left bundle) branch block, which was considered to relate to catheter manipulation inside the chamber of ventricle, were common and transient. One aortic regurgitation and tricuspid insufficiency became severe after the procedure, but they were not serious. One patient developed III degree A-V block 24 hours after the procedure, and EKG became LBBB 3 days after the temporary pace making. Hemolysis was observed in one patient, and he recovered 7days after the medication therapy. Conclusion Transthoracic echocardiography was very much effective in catheter closure of MVSD. The asymmetric self-expanding nitinol double-disc Amplatzer device designed for the transcatheter closure of MVSD is implanted easily and stably. Due to low ratio of residual shunt and few serious complications, the Amplatzer device is a good choice for the transcatheter closure of MVSD.