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ABSTRACT: We report the transcatheter closure of six ruptured sinus of Valsalva aneurysms (RSVAs) in five patients aged 18-51 years. The RSVA extended into the right atrium in three patients, into the right ventricular outflow tract in one, and into the pulmonary artery in one. In all patients, the RSVA was entered from the aorta, an arteriovenous loop was created, and the Amplatzer occluders were implanted using a venous approach. Six procedures were performed in five patients. Five Amplatzer duct occluders and one Amplatzer atrial septal occluder were implanted. In one patient who had a left RSVA after deployment of an Amplatzer duct occluder, ST-segment depression was observed on the ECG and the procedure was abandoned. In the other four patients, complete closure of the RSVA was confirmed by color Doppler echocardiography. No complications were observed during 9-19 months of follow-up. Percutaneous closure of an RSVA is feasible and can be used as an alternative to surgery.
Revista Espa de Cardiologia 11/2009; 62(11):1317-21. · 2.53 Impact Factor
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ABSTRACT: According to our previous observation application of Muscular Amplatzer Ventricular Septal Occluder (MVSDO) in the closure of perimembranous Ventricular Septal Defect (VSD) can produce less rhythm disturbances than use of asymmetric VSD device (due to longer waist of MVSDO?). Application of MVSDO in adult patients with muscular VSD should be done with precaution in the case of thicker interventricular septum because of the risk of subsequent embolization.
International journal of cardiology 06/2009; 145(1):69; author reply 70. · 7.08 Impact Factor
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ABSTRACT: Transcatheter closure of atrial septal defects (ASDs) was performed mainly in children and adolescents. Information about outcome and complications in adults was limited. From November 1997 to November 2005, percutaneous closure of ASDs using the Amplatzer septal occluder was attempted in 650 consecutive adult patients. Median patient age was 45.8 +/- 16.2 years (range 18 to 90), mean systolic artery pressure was 33.3 +/- 10.6 mm Hg (range 11 to 85), and mean pulmonary and systemic blood flow (Qp/Qs) ratio was 1.9 +/- 0.7 (range 0.8 to 6.6). Mean stretched diameter of the ASD was 21.2 +/- 5.1 mm (range 3.1 to 43). Seventy-eight patients (12%) had multiple defects. Of 572 patients with a single ASD, device implantation was successful in 563 patients (98%). During follow-up, complete closure could be achieved in 96% of patients with a single ASD and 71% of patients with multiple defects. Mean systolic artery pressure decreased to 28.3 +/- 10.1 mm Hg and mean Qp/Qs ratio decreased to 1 +/- 0.3. The 3 complications that occurred during the procedure were device embolization (2 patients; 0.3%) and transient ST depression (1 patient; 0.2%). The most common complication immediately after the procedure and during follow-up was new-onset atrial fibrillation (28 patients; 4.3%). Electrical cardioversion was successfully in most. Complications requiring emergency or elective surgery occurred in 6 patients (0.9%; hemopericardium, 2 patients, 0.3%; device embolization, 3 patients, 0.5%, and pericardial tamponade, 1 patient, 0.2%). In conclusion, closure of ASDs using the Amplatzer septal occluder in adults was efficient and safe, with excellent long-term success rates. Serious complications were rare.
The American journal of cardiology 03/2009; 103(4):550-4. · 3.58 Impact Factor
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ABSTRACT: Increased prevalence of patent ductus arteriosus (PDA) at high altitude (HA) is a known occurrence. Transcatheter treatment of patients with PDA living at a HA is assessed in this study. Thirteen consecutive patients (all habitants of La Paz, Bolivia) underwent transcatheter closure of PDA. The minimal diameter of PDA was 5.8 (1.5-11) mm and the mean pulmonary artery pressure was 37 (7-80) mm Hg. In 12 patients, the Amplatzer Duct Occluder (ADO) was used; in one child with PDA with a 1.5-mm diameter, a detachable coil was implanted. All procedures, except for one, were completed successfully. The ADO (diameter: 12/10 mm) implantation failed in one child with pulmonary hypertension because the device could not be properly secured in position in a 6-mm PDA. Subsequent surgery was performed without any complications. No residual shunt after 24 h was observed in any case after treatment. No complications were encountered during the procedure and follow-up of 1.5 (from 0.1 to 2.8) years. PDA in native residents of high land have different physiopathologies and anatomies. ADO appears to be a suitable device for transcatheter occlusion for most such patients. Interventional cardiology in countries with residents at high altitudes can be helpful in addressing this issue.
Pediatric Cardiology 06/2008; 29(3):624-7. · 1.30 Impact Factor
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ABSTRACT: Aims: To report our experience and strategies with transcatheter closure of residual patent ductus arteriousus (RPDA) in patients with previous surgical ligation. Methods and results: Transcatheter closure of residual patent ductus arteriousus after surgical ligation was attempted in 19 patients. In 13 patients the residual patent ductus arteriosus was closed with detachable coils, in four with Rashkind umbrella and in two with Amplatzer occluder. In order to cross the recanalised duct with the delivery system a vascular loop was required in six patients. Complete closure of residual ducts were achieved in all but one patient. Conclusion: Transcatheter closure appears to be a safe and effective treatment for residual persistent duct. Coil implantation seems to be the best option in the case of smaller ducts, and in larger ones the Amplatzer Duct Occluder appears to be superior. Taking a meticulous approach to choosing the correct device should prevent ineffective treatment.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 04/2008; 3(5):584-7. · 3.29 Impact Factor
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ABSTRACT: Rupture of the interventricular septum is an uncommon and often fatal complication of myocardial infarction. Herein, we report the successful deployment of the Amplatzer Multi-Fenestrated Septal Occluder-"Cribriform" (AGA Medical Corporation; Plymouth, Minn) during 2 procedures to close multiple postinfarction ventricular septal defects in a severely ill patient. We show that, in selected patients who have multi-fenestrated multiple postinfarction ventricular septal defects, transcatheter implantation of the Amplatzer Cribriform Occluder can be a good therapeutic option.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 02/2008; 35(3):362-4. · 0.65 Impact Factor
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ABSTRACT: We carried out transcatheter procedures to close postinfarction ventricular septal defects (PIVSDs) in 19 patients: two had recanalization after surgical closure, and 17 had a primary PIVSD. In three of the latter patients, who had acute PIVSDs, the procedure was carried out in the first 3 weeks after infarction; in the 13 patients with subacute PIVSD, it was carried out 3.5-12 weeks after infarction. There was another procedure in one patient with chronic PIVSD. In total, 22 procedures were completed: 17 using an Amplatzer atrial septal occluder, two using an Amplatzer postinfarction ventricular septal defect occluder, and two using an Amplatzer muscular ventricular septal defect occluder. The procedure was successful in 14 patients: in 11 with subacute PIVSD, one with chronic PIVSD, and two with postsurgical PIVSD. Transcatheter closure of PIVSDs using an Amplatzer atrial septal occluder is probably the treatment of choice in patients undergoing surgery more than 3.5 weeks after myocardial infarction and in those with recanalization after previous surgical closure.
Revista Espa de Cardiologia 06/2007; 60(5):548-51. · 2.53 Impact Factor
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ABSTRACT: Large pulmonary arteriovenous fistulas (PAVFs) are difficult for transcatheter treatment. This report presents 5 patients aged 3 to 73 years with large PAVFs who underwent successful transcatheter closure with the Amplatzer duct occluder (ADO), designed for the occlusion of patent duct arteriosus. The procedures were performed without complications and provided sustained improvement in arterial oxygen saturation and exercise tolerance on follow-up examination in all patients. The transcatheter closure of large PAVFs with the ADO is effective and can eliminate the need for surgical intervention. The newly designed Amplatzer vascular plug is undergoing clinical trials.
The American Journal of Cardiology 08/2005; 96(1):127-9. · 3.37 Impact Factor
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ABSTRACT: Transcatheter closure of single secundum atrial defects has become the standard of treatment. The purpose of our study was to analyze the results of using a single Amplatzer device for closure of double atrial septal defects. Such defects were diagnosed in 41 out of 363 patients with atrial septal defects (ASDs) closed by transcatheter method. In 39, a single Amplatzer device was used. The size of the larger defect ranged from 5 to 18 mm, the smaller defect from 2 to 7 mm, with the distance between the borders of the communications ranging from 2 to 12 mm. We performed sizing and closure of only the larger defect. The mean size of implanted devices was 16.5 +/- 5.5 mm, equal to the stretched diameter of the main defect or 1-4 mm larger. The closure rate assessed by color Doppler flow examination was 61% after 24 hr, 78% after 1 month, 83% after 3 months, 86% after 1 year, and 95% after 2 years. If the distance between the two defects exceeded 7 mm, residual leaks were observed but tended to decrease and disappear with time. Selected patients with double atrial septal defects can be effectively treated with implantation of a single Amplatzer device.
Catheterization and Cardiovascular Interventions 03/2004; 61(2):237-41. · 2.29 Impact Factor
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ABSTRACT: We prospectively compared closure and complication rates in 91 children with secundum atrial septal defects: 44 (mean age, 8.1 +/- 4.7 years) were treated surgically and 47 (mean age, 10.1 +/- 4.9 years) were treated by percutaneous Amplatzer septal occluder Complications were classified as mild, moderate, or severe. The closure rate was similar in the 2 groups: 42/44 children (95.5%) in the surgical group versus 46/47 patients in the device group (97.5%). Mild complications were observed in 17/44 patients in the surgical group vs 2/47 in the device group; moderate, 11/44 in the surgical vs 1/47 in the device group; and severe, 2/44 in the surgical group vs none in the device group. Blood products were administered to 18 patients in the surgical group and to 1 patient in the device group (P < 0.001). Transcatheter closure of secundum atrial septal defects with the Amplatzer device has the advantage of fewer complications, shorter hospitalization, and reduced need of blood products. Nonetheless, the surgeon's ability to close any atrial septal defect regardless of its size or location remains an important advantage of surgery.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 02/2004; 31(3):220-3. · 0.65 Impact Factor
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ABSTRACT: The purpose of our paper is to assess the prognostic value of balloon occlusion as a test for patients with various types of functionally single ventricle after different palliative surgical procedures who were candidates for further modifications of a cavo-pulmonary operation. In all patients, there were at least two sources of pulmonary arterial supply. Our hypothesis was that, using balloon occlusion temporarily to produce changes in the haemodynamic situation, we could simulate the potential state subsequent to surgical palliation. We used balloon occlusion in 19 patients during diagnostic catheterisation, followed by interventional and or surgical procedures as considered necessary. This test was applied for temporary closure of the pulmonary valve in 8 patients, and a Blalock-Taussig anastomosis in 11 patients.
Cardiology in the Young 09/2003; 13(4):323-7. · 0.76 Impact Factor
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ABSTRACT: This study was designed to compare reduced heart rate variability (HRV) in children with atrial septal defect (ASD) after surgical ASD closure with interventional (Amplatzer device) closure. Reduced HRV was observed in all children with ASD before treatment. HRV was further impaired 1 month after surgical ASD closure but not after catheter device closure. Three months after treatment, HRV indexes tended to normalize in both groups.
The American Journal of Cardiology 09/2003; 92(3):356-8. · 3.37 Impact Factor
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ABSTRACT: Percutaneous closure of atrial septal defects (ASD) is becoming more frequent.
From October 1997 to October 2002, 209 patients, age 0.4-70 (mean 19.5) years, were catheterized to close an ASD or patent foramen ovale (PFO). Transesophageal echocardiography was performed simultaneously in all patients. Two hundred and six patients had ASD (25 multiple ASDs) and 3 had PFO. Three devices were used, the Amplatzer Atrial Septal Occluder (ASO), CardioSeal (CS), and Starflex (SF).
Device implantation was achieved in 181 patients (87%) but had to be abandoned in 28 patients, generally because the ASD was too large. One hundred and seventy-four ASOs were implanted in 172 patients with ASD (2 ASOs were implanted in 2 patients with double ASD) and CS/SF in 9 patients (3 patients with PFO and 6 with ASD). The procedure was effective in 166/172 (96%) ASO implantations and in 8/9 (89%) CS/SF implantations. The procedure was unsuccessful in 7 patients and the device had to be removed (6 ASO and 1 SF). The occlusion rate with ASO was 88% after 24 hours, 91% after 1 month, 95% after 1 year, 97% after 2 years, and 100% after 4 and 5 years. All defects treated with SF/CS were closed successfully after 24 hours. In one case the ASO device was embolized to the aorta. In the first month after ASO implantation, supraventricular tachycardia appeared in 2 patients and transient left ventricular failure in 2 patients. No late complications were observed.
Percutaneous catheter closure of selected types of ASD using the Amplatzer Atrial Septal Occluder, CardioSeal, or Starflex should be offered to patients as non-surgical alternative. The type of device used depends on the defect size and morphology as well as the surgeon's experience. The presence of multiple defects does not exclude the possibility of a successful percutaneous catheter closure.
Revista Espa de Cardiologia 05/2003; 56(4):383-8. · 2.53 Impact Factor
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ABSTRACT: Transcatheter closure of patent ductus arteriosus is routinely performed using various devices. After the withdrawal of the Rashkind umbrella device from the market, the wide window-type patent ductus arteriosus has been difficult to close percutaneously. Two patients with this condition are presented: a 17-year-old man and a 62-year-old woman with short (4.5- and 5.2-mm-diameter, respectively) ductus. We successfully implanted a 17-mm CardioSEAL device in the 1st patient and a 23-mm STARFlex in the 2nd, with no residual shunt at follow-up (22 and 8 months, respectively). Although these devices (which follow the general design of the Rashkind umbrella) are usually applied to atrial septal defect closure, we believe that CardioSEAL and STARFlex implants could be the treatment of choice in percutaneous treatment.of window-type patent ductus arteriosus.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 02/2003; 30(3):236-9. · 0.65 Impact Factor
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ABSTRACT: A 13-year-old girl with middle aortic syndrome caused by Takayasu's disease was treated by balloon angioplasty of the right renal artery stenosis and the implantation of 3 stents, 2 in the stenosed thoracic segment and 1 in the abdominal segment of the aorta. Spiral computed tomography one and two years after the stents were inserted showed that the disease had progressed despite treatment with immunosuppressants.
Revista Espa de Cardiologia 07/2002; 55(6):682-5. · 2.53 Impact Factor
