Jianjun Tang

Transcatheter closure of large fistula between left main coronary artery and right atrium using Amplatzer duct occluder

A 4 year old girl was admitted with cyanosis after exercise. Physical examination found a continuous murmur which was loudest in the upper right parasternal region. The ECG was normal. Transthoracic echocardiography revealed mild right ventricular and atrial dilatation; it also revealed a fistula originating from the left main coronary artery (LMCA), rounding the ascending aorta and left atrium, …

Silent Embolization of an Atrial Septal Defect Occluder Into the Right Ventricle Detected 20 Months Post-Implantation

A 64-year-old woman, who had undergone transcatheter closure of a secundum-type atrial septal defect (ASD) with a 38-mm Amplatzer septal occluder (ASO) 20 months earlier, was admitted with palpitations for 1 day. She had not received routine follow-up after the procedure. Cardiac examination revealed a grade III/VI systolic ejection murmur at the left upper sternal border. Chest x-ray revealed that the ASO device was located in the right ventricular area (Fig. 1A). Immediate transthoracic echocardiography confirmed that the ASO device had become dislodged and embolized into the right ventricle. The embolized device was oriented in the longitudinal plane, parallel to the direction of blood flow across the tricuspid valve (Fig. 1B). Although the patient remained hemodynamically stable, she was referred for urgent surgical retrieval of the device and closure of the defect. In surgery, the embolized occluder was identified in the right ventricular inflow tract and appeared to be firmly adhering to the tricuspid valve apparatus (Fig. 1C). The inferoposterior rim of the ASD was also found to be inadequate. The endothelialization status of the retrieved device revealed that embolization must have occurred months earlier (Fig. 1D). The ASD was closed with a bovine pericardial patch through the right atriotomy, and the tricuspid valve was repaired with a 32-mm CosgroveEdwards annuloplasty band (Edwards Lifesciences, Irvine,

Spontaneous Coronary Artery Dissection Accompanied with Antiphospholipid Syndrome and Leukemia

We report a rare spontaneous coronary artery dissection (SCAD) case accompanied by antiphospholipid syndrome (APS) and leukemia which was treated successfully with drug-eluted stents (DES) implantation. This young SCAD patient was initially diagnosed of acute myocardial infarction (AMI); however, except for 6 pack-years of smoking, there were no risk factors or family history of coronary artery disease. Subsequently, we screened other clinical status like autoimmune diseases and finally found APS. In general, APS was associated with thromboembolism events, not coronary artery dissection. Our case indicated that SCAD could be a rare manifestation of APS which should draw our attention. In addition, our bail-out therapy acquired the expected effect.

Percutaneous Management of Iatrogenic Aortocoronary Dissection Complicating Diagnostic Angiography or Percutaneous Coronary Intervention

Mailing Address: Zhen-fei Fang • Department of Cardiology, The Second Xiangya Hospital of Central South University, N°.139, Middle Ren-min Road, Changsha, Hunan, 410011, China E-mail: fangzhenfei2012@126.com Manuscript received January 24, 2017, revised manuscript April 18, 2017, accepted April 18, 2017

Transcatheter closure of multi-hole perimembranous ventricular septal defect with aneurysm using two occluders

Corresponding author: Sheng-hua Zhou MD, PhD, Department of Cardiology, Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, China, phone: +86 731 85292012, fax: +86 731 85294038, e-mail: zhoushenghua_guo@163.com Received: 28.08.2016, accepted: 10.11.2016. Transcatheter closure of multi-hole perimembranous ventricular septal defect with aneurysm using two occluders

Severe Mechanical Hemolysis After Transcatheter Closure of a Traumatic Ventricular Septal Defect Using the Amplatzer Atrial Septal Occluder.

Traumatic ventricular septal defect (VSD) resulting from chest trauma, either penetrating or blunt, is a relatively rare occurrence. Herein, we describe the case of a previously healthy 26-year-old man who presented with congestive heart failure, which was secondary to a large traumatic VSD following violent blunt chest trauma. The traumatic VSD was initially closed percutaneously using an Amplatzer atrial septal defect occluder. Post-device closure, however, the patient developed severe intravascular hemolysis refractory to medical treatment. The patient subsequently underwent surgical removal of the Amplatzer device, with concomitant VSD patch closure.

Embolisation of perimembranous ventricular septal defect occluder and transcatheter retrieval.

AIMS In this study, we aim to summarise our experience with techniques used for the transcatheter retrieval of embolised devices. METHODS We retrospectively reviewed the transcatheter retrieval of embolised devices in seven patients who underwent an attempted transcatheter closure of perimembranous ventricular septal defects (PMVSDs) between October 2002 and October 2013. The incidence, the main causes for the devices embolisation, and the techniques for transcatheter retrieval of the embolised device are discussed. RESULTS The incidence of device embolisation in our centre was 0.82% (seven embolisations in 852 device placements). The main causes for device embolisation included undersized devices and inadequate subaortic rims. Among the seven embolisations, six of the devices were retrieved percutaneously without mortality, while one was retrieved during surgery. Of these patients, five had a HeartR(TM) Membranous VSD occluder of their PMVSDs, and the remaining two had surgical PMVSD closures. CONCLUSIONS Our approach to the transcatheter retrieval of the embolised devices is associated with good results.

GW24-e2209 Relationship between plasma N-terminal pro brain natriuretic peptide (NT-Pro BNP) level and SYNTAX score in patients with stable angina pectoris

Objectives Recently, the prognostic role of N-terminal pro-brain natriuretic peptide (NT-pro BNP) in heart failure and coronary diseases has been demonstrated in many studies. SYNTAX score was pioneered as an anatomical-based risk score that aided in this decision-making process in appropriately informing patients electing to undergo coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). However is not known if there is a relation between NT-pro BNP levels and SYNTAX score (SS). A present study came to investigate the relationship between plasma NT-pro BNP level and extent and complexity of coronary lesions assessed using SS in patients with stable angina pectoris candidate for coronary angiography. Methods The study population included 203 consecutive patients with stable angina and intend for selective coronary angiography. SS was calculated in all participants, According to SS value,all subjects were divided into three groups: low risk (< 22), intermediate risk (23-32), and high risk (≥ 33).blood samples were drawn from femoral or radial artery for NT-pro BNP measurement just before the catheterisation of left coronary. Results Regarding the role of N terminal pro BNP for assessing severity of coronary lesions based on SS, The NT pro BNP level increased significantly as risk classification of SS upgraded (P < 0.05). Linear regression analysis showed that plasma NT-pro BNP level was significantly associated with SS (r = 0.314, P < 0.01). Conclusions NT-pro BNP can be a good parameter for predicting severity of coronary lesions. NT-pro BNP level was significantly associated with the extent and complexity of coronary artery disease.