Jacek Białkowski

Atrioventricular block after transcatheter closure of perimembranous ventricular septal defects

Objective: To look at the presentation, treatment and outcome of patients who developed atrioventricular block after transcatheter closure of a perimembranous ventricular septal defect (PMVSD) with the Amplatzer PMVSD device. Setting: Three tertiary referral centres for paediatric cardiology in two countries. Results: All three patients presented within 10 days of the procedure. All three patients were treated with intravenous steroids. A permanent pacemaker was inserted in all patients but no pacemaker required activation after two months. Conclusion: Complete atrioventricular block occurring in the weeks after device occlusion of a PMVSD appears to resolve quickly. Continued involvement in multicentre device databases is required to monitor safety.

Transcatheter closure of double atrial septal defects with a single Amplatzer device

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. Catheter Cardiovasc Interv 2004;61:237–241.

Use of the Amplatzer muscular ventricular septal defect occluder for closure of perimembranous ventricular septal defects

Background: Transcatheter closure of a perimembranous ventricular septal defect (PmVSD) is usually performed with an asymmetric Amplatzer occluder, which is not an ideal device. Experience with the use of the Amplatzer muscular ventricular septal defect occluder (MVSO) to close selected PmVSDs is presented. Setting: Two tertiary referral centres for paediatric cardiology in two countries. Objective: To look at the safety and efficacy of the application of the MVSO in patients with appropriate PmVSD anatomy. Patients and intervention: The procedure was performed in 10 patients aged 3.2–40 (mean 12.5) years. All had a PmVSD with a mean diameter of 5.4 (range 4–11) mm, with an extension towards the muscular septum. The mean distance of the defect from the aortic valve was 5.4 (range 4–6) mm. In all but one patient, the MVSO was introduced in routine antegrade transvenous fashion (4-mm device in one patient, 6-mm device in five, 8 mm in two, 10 mm in one, and 12 mm in one). In one patient, the device was deployed by retrograde implantation. Results: All procedures except one were performed without complications, and complete closure of the VSD was achieved. One patient with a residual shunt developed haemolysis, which resolved over 10 days. In three patients, trivial, non-progressive tricuspid regurgitation appeared after the procedure. No other complications were observed over 1.7 (range 0.2–3.5) years of follow-up. Conclusion: Application of the MVSO for closure of selected PmVSDs seems to be a safe and effective treatment option.

Cierre percutáneo de la comunicación interauricular. Resultados a corto y medio plazo

Introduccion El cierre percutaneo de la comunicacion interauricular (CIA) es una alternativa de tratamiento cada vez mas utilizada. Pacientes y metodo Entre octubre de 1997 y de 2002 se realizo cateterismo cardiaco, con la intencion de cierre de una comunicacion interatrial (CIA) o foramen oval permeable (FOP), en 209 pacientes con edades comprendidas entre 0,4 y 70 anos (media, 19,5 anos). En todos los casos se realizo ecocardiografia transesofagica (ETE) simultanea. En 206 casos existia CIA (25 con defectos multiples) y en tres un FOP. Se utilizaron 3 dispositivos: Amplatzer Atrial Septal Occluder (ASO), CardioSeal (CS) y Starflex (SF). Resultados Se acepto para cierre percutaneo a 181 pacientes (87%). Se rechazaron 28 casos, en su gran mayoria por el excesivo tamano del defecto. En 172 pacientes con CIA se utilizaron 174 ASO (en 2 casos con 2 defectos alejados se implantaron 2 ASO) y en 9 pacientes (seis con CIA y tres con FOP) los dispositivos CS/SF. El implante percutaneo del ASO fue efectivo en 166/172 (96%) pacientes, y el de CS/SF en 8/9 (89%) pacientes. En 6 casos de ASO y uno de SF el cierre no se pudo realizar por posicionamiento incorrecto del dispositivo. El porcentaje de cierre completo de la CIA con ASO fue del 88% despues de 24 h, del 91% al mes, del 95% a un ano, del 97% a los 2 anos y del 100% a los 4 y 5 anos de su implante. Todos los defectos tratados con dispositivos CS/SF se cerraron completamente despues de 24 h. Como complicaciones destaca un caso de embolizacion de ASO en la aorta, extrayendose el dispositivo con cirugia, 2 casos con episodios de taquicardia supraventricular y otros dos con insuficiencia cardiaca izquierda transitoria durante el primer mes tras la colocacion de un ASO. Conclusion El cierre percutaneo en los pacientes portadores de CIA o FOP es una atractiva alternativa al tratamiento quirurgico. La eleccion del implante depende de la anatomia del defecto y la experiencia del medico. La existencia de multiples defectos no excluye la posibilidad de su cierre percutaneo eficaz.

Transcatheter Closure of Postinfarction Ventricular Septal Defects Using Amplatzer Devices

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.

Cierre percutáneo de comunicaciones interventriculares postinfarto mediante los dispositivos de Amplatzer

Se intento el cierre percutaneo de la comunicacion interventricular postinfarto (CIVPI) en 19 pacientes: 2 con recanalizacion tras el cierre quirurgico y 17 con CIVPI primaria. En estos ultimos, el procedimiento se realizo en 3 pacientes con CIVPI aguda dentro de las primeras 3 semanas postinfarto, en 13 con CIVPI subaguda 3,5-12 semanas postinfarto y en uno con CIVPI cronica. Se llevaron a cabo 22 intervenciones mediante la utilizacion de 17 oclusores Amplatzer auriculares, 2 ventriculares postinfarto y 2 ventriculares musculares. El procedimiento fue satisfactorio en 14 pacientes: 11 con CIVPI subaguda, uno con CIVPI cronica y 2 posquirurgicos. El cierre percutaneo de CIVPI con el Amplatzer Atrial Occlusor es probablemente el tratamiento de eleccion en pacientes con mas de 3,5 semanas despues del infarto de miocardio y en casos con recanalizacion tras el cierre quirurgico.

Major intrahepatic veno-venous fistula after modified Fontan operation treated by transcatheter implantation of amplatzer septal occluder.

Patients with complex congenital cardiac malformations who have been converted to the Fontan circulation with partial exclusion of the hepatic veins may develop progressive cyanosis because of formation of intrahepatic veno-venous malformations. We describe transcatheter closure of a major intrahepatic fistula in such a setting using an Amplatzer septal occluder delivered by the left jugular venous approach in a 5 year old boy.

Stent implantation for post-Mustard systemic venous obstruction

In this paper, we report on the use of stents in the treatment of late-onset post-Mustard systemic venous obstruction in three patients with clinical signs of obstructive caval syndrome. After unsuccessful balloon dilation, Palmaz-Schatz stents were implanted at the veno-atrial junction. Further dilation has been achieved using high-pressure balloons. Vessel diameter increased from 4.4+/-1.8 to 13+/-1.7 mm (P < 0.05) and the trans-stenotic pressure gradient dropped from 8+/-6 to 0 mmHg (P < 0.01), with clinical improvement. After 26+/-4 months of non-invasive follow-up, no signs of recurrent stenosis were observed. Stent implantation is effective in the treatment of systemic venous obstruction after Mustard operation.

Síndrome de la aorta media causado por enfermedad de Takayasu: tratamiento con stents y seguimiento a medio plazo

A 13-year-old girl with middle aortic syndrome caused by Takayasus 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.

Late follow-up of occlusion of the patent ductus arteriosus with the Rashkind device with emphasis on long-term efficacy and risk for infections.

During the last decade, the Rashkind device (RD) has been used in many countries for the closure of the patent ductus arteriosus (PDA). However, long-term follow-up has not been extensively studied and the need for continuous surveillance is still controversial, in particular in the case of patients with a persistent residual shunt and denying further intervention. Moreover, the risk for infective endarteritis after PDA closure has not been definitively evaluated. The aim of this study was (1) to present long-term data on a large group of patients treated with RD implantation, and (2) to provide data regarding the risk for infective complications and the need for extended follow-up and antibiotic prophylaxis in case of low- and high-risk events.