Jacek Kusa

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.

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.

Few comments regarding transcatheter closure of congenital perimembranous and muscular ventricular septal defects

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.

Cierre transcatéter de rotura de aneurismas del seno de Valsalva con oclusores Amplatzer

El objetivo fue evaluar el poder predictivo para diagnosticar hipertrofia del ventriculo izquierdo (HVI) de la concentracion urinaria del fragmento N-terminal del propeptido natriuretico tipo B (NT-proBNP) en 160 pacientes asintomaticos diagnosticados de hipertension esencial (HT). Las concentraciones urinarias de NT-proBNP/creatinina estuvieron incrementadas en pacientes con HVI al compararlos con no hipertroficos (p odds ratio = 4,074; p = 0,009). En conclusion, la concentracion de NT-proBNP en orina es un nuevo marcador que puede ser de utilidad para detectar HVI en sujetos con HT esencial.

Percutaneous closure of previously surgical treated arterial ducts.

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.

The radiologist's tragedy, or Bland-White-Garland syndrome (BWGS). On the 80(th) anniversary of the first clinical description of ALCAPA (anomalous left coronary artery from the pulmonary artery).

In 1933, three doctors from the Massachusetts General Hospital in Boston, Paul Dudley White, William Franklin Bland, and Joseph Garland, described a case of an anomalous origin of the left coronary artery arising from the pulmonary artery (ALCAPA) in a three-month-old boy. The infant died following two weeks of hospitalization. The childs father was Dr. Aubrey Hampton, a radiologist and colleague of White, Bland, and Garland. The paper presents a perspective view on the occasion of the 80th anniversary of the first clinical description of ALCAPA.