Amplatzer Septal Occluder Device Research Articles

Late erosion of Amplatzer septal occluder device 9 years after the implantation. A case report.

Cardiac erosion is a rare but life-threatening complication after the interventional closure of an atrial septal defect. We present the case of a patient who developed cardiac erosion 9 years after the placement of an Amplatzer Septal Occluder. The patient presented to our hospital with symptoms of tamponade. Surgical exploration revealed a tear in the roof of the left atrium. To our knowledge, this is one of the most delayed presentations reported. In these cases, diagnosis is difficult and a level of clinical suspicion is demanded.

S368 Chronic Tracheoesophageal Fistula Successfully Treated Using an Amplatzer Closure Device Under Endoscopic Visualization

Introduction: In tertiary care centers, where advanced endoscopic expertise is available, the placement of an Amplatzer septal occluder is practical and safe. This allows for potential fistula closure, especially in patients with severe comorbidities or in critical condition or those with chronic or recurrent tracheoesophageal fistulas (TEF). Case Description/Methods: A 72-year-old man with a history of gastroesophageal reflux disease (GERD) and well-differentiated esophageal adenocarcinoma who presented for dysphagia and cough. Social history was negative for smoking, smokeless tobacco, alcohol ingestion and illicit drug use. Home medications include famotidine. He had no known significant family history. The patient had undergone numerous esophagogastroduodenoscopies (EGD) since 2017 for recurrent strictures requiring TTS balloon dilations, intralesional triamcinolone acetonide injections and esophageal stenting complicated by formation of a tracheoesophageal fistula (TEF) at the anastomotic site. The TEF was initially treated with stenting 3 months prior to presentation. The patient underwent EGD and bronchoscopy with visualization of a 5 mm fistula. He was then evaluated by the surgery team for consideration of surgical repair, however the patient declined surgical intervention. Given the clinical condition of the patient with recurrent aspiration events, failed endoscopic management and refusal of surgical intervention, it was decided to remove the esophageal stent and attempt placement of an Amplatzer septal occluder. An 18 mm Amplatzer device (AD) was successfully placed with satisfactory closure of the TEF. Repeat endoscopy 5 months later, showed that the device had remained in the correct position and the patient remained asymptomatic following advancement of his diet. Discussion: Acquired TEF is a rare complication, the incidence in the US has yet to be reported. Amplatzer occluder devices, originally designed for transcatheter closure of cardiac defects, have shown promise in the treatment of TEFs. It is suggested that the placement of the AD induces granulation tissue formation around the device allowing for complete closure of the fistula without compromising airway patency. Upon review of current literature only one other case report was found where an AD was used for the management of refractory TEF. In the setting of large or difficult to manage TEFs and patients who are not surgical candidates, Amplatzer septal occluder devices can be used to successfully treat complicated TEFs. Watch the video at https://tinyurl.com/ACGAbstractS368Figure 1.: Amplatzer device deployed with successful tracheoesophageal fistula closure.

Immediate outcomes after transcatheter atrial septal defect closure by Amplatzer septal occluder in a large single centre cohort: The ASOlong study

Transcatheter closure of ostium secundum atrial septal defects (ASDs) with Amplatzer septal occluder (ASO) is the preferred technique when anatomically feasible. New devices, reported to be softer or with new design have been developed aiming to reduce the risk of adverse events. We aimed to assess the procedural outcomes after transcatheter closure of ASD with the ASO device in a large single centre registry including consecutively all children and adults ( n = 2280, median age, 27 years [11; 49]; weight, 56 kg [32; 70]) from 1998 to 2021 (ASOlong registry). Most patients had balloon ASD sizing using the pull-through technique. Since 2005, nearly all procedures were guided using transthoracic echocardiography allowing procedures under local anesthesia in older children and adults. In four (0.2%) patients, ASD was closed from a jugular approach. Median ASO size was 22 mm [18; 28]. ASD closure was obtained with two and three devices in 71 and 1 cases respectively. Device/weight ratio was 0.4 [0.3–0.6], with a ratio ≥ 1.5 in 25 children (0.1%). Overall procedural success rate was 97.1% (95% CI: 96.4–97.8%) underestimated by patients with ASD considered not eligible after balloon calibration only. Device migration occurred in 17 (0.7%) patients successfully retried transcatheter in 13 cases and surgically in 4. No death was observed. Major peri-procedural adverse events occurred in 7 (0.3% 95% CI: 0.1–0.6) patients including 4 repaired arteriovenous fistulas. Life-threatening adverse events occurred in 3 patients (2 acute aortic erosion with haemopericardium, on day 2 after catheterization and 1 sigmoid colon dissection of unclear mechanism, requiring emergency surgery). There was a trend toward a higher rate of major events among children with device/weight ratio ≥ 1.5 (4.0% versus 0.4%, P = 0.1). Transcatheter ASD closure using ASO is efficient in a large spectrum of patients. Long-term outcomes are awaited from this study.

Acute anterior myocardial infarction complicated by a large ventricular septal defect

Post-Infarction Ventricular Septal Defect (PIVSD) are a rare complication of Acute Myocardial Infarction (AMI). According to clinical guidelines, surgical repair of a PIVSD is the recommended acute-stage course of treatment. Nevertheless, thoracotomy is not always clinically suggested for patients with unstable hemodynamics and otherwise at high risk. Currently, percutaneous interventional closure of a PIVSD represents an alternative therapy, and an attractive option for particular patients [1,2]. Here we report a 67-year-old man was transferred to Shenzhen Sun yat-sen Cardiovascular Hospital to evaluate a PIVSD and undergo repair. Echocardiography confirmed a large Ventricular Septal Defect (VSD) and significant left-to-right shunt (Figure 1a). Few reports of the closure of a PIVSD at an acute/subacute stage have been previously published. An interventional closure treatment (Amplatzer Septal Occluder device) was successfully performed after bridging to a subacute stage through use of mechanical circulatory backup (Figure 1b).

The Amplatzer device and pedicle muscle flap transposition for the treatment of bronchopleural fistula with chronic empyema after lobectomy: two case reports

BackgroundBronchopleural fistula (BPF) refers to an abnormal channel between the pleural space and the bronchial tree. It is a potentially fatal postoperative complication after pulmonary resection and a complex challenge for thoracic surgeons because many patients with BPF ultimately develop refractory empyema, which is difficult to manage and has a major impact on quality of life and survival. Therefore, an operative intervention combined with conservative and endoscopic therapies may be required to control infection completely, to occlude BPF, and to obliterate the empyema cavity during treatment periods.Case presentationTwo patients who suffered from BPF complicated with chronic empyema after lobectomy were treated in other hospitals for a long time and did not recover. In our department, we performed staged surgery and creatively combined an Amplatzer Septal Occluder (ASO) device (AGA Medical Corp, Golden Valley, MN, USA) with pedicled muscle flap transposition. First, open-window thoracostomy (OWT), or effective drainage, was performed according to the degree of contamination in the empyema cavity after the local infection was controlled. Second, Amplatzer device implantation and pedicled muscle flap transposition was performed at the same time, which achieved the purpose of obliterating the infection, closing the fistula, and tamponading the residual cavity. The patients recovered without complications and were discharged with short hospitalization stays.ConclusionsWe believe that the union of the Amplatzer device and pedicle muscle flap transposition seems to be a safe and effective treatment for BPF with chronic empyema and can shorten the length of the related hospital stay.

Cardiac Erosions with the Amplatzer Septal Occluder: Adverse Events in the Manufacturer and User Facility Device Experience (MAUDE) Database since the 2012 FDA Review

ABSTRACT Background: Transcatheter closure is the preferred treatment for atrial septal defects. The available devices are effective and safe though concerns persist over cardiac erosion risk. A review of the FDA Manufacturer and User Facility Device Experience (MAUDE) database has not been performed since early reports covering the first decade of device experience. Methods: The FDA MAUDE database was queried for adverse event (AE) reports from 2012 through 2018 involving the Amplatzer Septal Occluder (ASO), Cribriform Occluder (ACO) and PFO Occluder (PFO) devices (Abbott Vascular, Santa Clara, California). Device and event descriptions were analyzed based on report classification, device type and event description. The incidence of AEs was analyzed over time for all event types and devices. Results: There were 732 MAUDE reports describing 764 AEs. The majority of AEs involved the ASO, and the most common AE was device embolization (n = 347). Ninety erosion events were reported (ASO 83, ACO 6, and PFO 1) and 4 erosions were associated with death. The annual number of AE and erosion reports declined from 2012 to 2015 but increased in 2018. Five ASO sizes accounted for 60% of erosions with the 26 mm ASO device being most common. Conclusions: The overall frequency of erosion events in the MAUDE dataset remains low and consistent with prior studies. Adverse events and erosions declined from 2012 to 2015 but have increased in recent years, necessitating future review of this database to ensure that real-world device performance remains consistent with the safety profile demonstrated elsewhere.

Concomitant transcatheter closure of post-myocardial infarction ventricular septal defect and inferior wall aneurysm: case report.

BackgroundThe incidence of the post-infarct ventricular septal defect (VSD) is 0.17%. Surgical repair is the definitive treatment and percutaneous closure is an alternative in high-risk patients. We report a case of post-myocardial infarction inferior wall aneurysm associated with a large ventricular septal rupture, with a communication between the aneurysm and right ventricle. Successful percutaneous closure of both the aneurysm and the post-infarct (VSD) was performed using two Amplatzer septal occluder devices. Case summaryA 76-year-old man was referred to the clinic 2 weeks after an inferior wall myocardial infarction. A harsh, pansystolic murmur was appreciated on his left parasternal area and across the pericardium. An echocardiogram demonstrated a large, true aneurysm in the mid-cavity inferior wall. The inferior septum was ruptured and dissected, with a large, left-to-right shunt. The patient’s coronary angiography revealed a multi-vessel disease. The patient was considered as high surgical risk and thus transcatheter closure of both the post-infarct VSD and inferior wall aneurysm was recommended. We crossed the VSD from the venous side. An Amplatzer septal occluder (18 mm) was deployed to close the VSD completely. We crossed the aneurysm mouth from the arterial side. Another Amplatzer septal occluder (26 mm) was deployed with the large disc inside the aneurysm, sealing it with no more flow. After discharge from the intensive care unit, the patient underwent complete revascularization for his right coronary artery, left main artery, proximal left anterior descending artery, and ramus intermedius. At his 3-month follow-up, the patient remained well with reasonable exercise tolerance.DiscussionPercutaneous closure of a post-infarct VSD and aneurysm is an option for patients whose comorbidities preclude surgical repair and whose septal anatomy is favourable to device placement.

Comparison of Two Percutaneous Atrial Septal Defect Occluders for Device Healing and Nickel Release in a Chronic Porcine Model

Aims To investigate the healing process and nickel release of the Hyperion occluder (Comed BV, Netherlands), as compared to the Amplatzer septal occluder (ASO) (St. Jude Medical Inc., St. Paul, MN, USA) in a chronic swine model. Background Some long-term complications occurring after percutaneous atrial septal defect (ASD) closure may be partially associated with an inappropriate healing of the device and increased nickel release. There is no direct comparative study of different occluders for healing and nickel release. Methods After percutaneous ASD creation, 12 pigs were implanted with 15 mm Hyperion (n = 6) and 15 mm ASO (n = 6) devices. After 1 month (n = 3 for each device) and 3 months (n = 3 for each device) of follow-up, device explantation was performed and healing was assessed using histopathological workup. Systemic and tissular nickel release was performed. Results Implantation was successful in 100% without complications. Device coverage was observed as early as 1 month after implantation and was almost complete after 3 months. A granulation tissue with a predominantly mononuclear inflammatory reaction was observed in contact with nitinol wires while an inflammatory reaction was seen in contact with textile fibers. We found no statistically significant difference between the 2 devices whether for histological grading scores or systemic nickel release, regardless to follow-up duration. Conclusions In this preclinical study, we demonstrated that Amplatzer septal occluder and Hyperion occluder were not significantly different for device healing and nickel release processes.

Atrial tachyarrhythmias following percutaneous device closure of secundum atrial septal defects

BackgroundAtrial tachyarrhythmias (ATs) are a major source of morbidity in the atrial septal defect (ASD) patient cohort. The optimal timing and approach of anti-arrhythmic intervention is currently unclear. Here, we sought to determine the overall rate of ATs following percutaneous ASD closure and risk factors that may predict this. MethodsA systematic search of the literature was performed using the search terms ‘(Secundum Atrial Septal Defects AND Atrial arrhythmias) AND (transcatheter closure or percutaneous closure or device closure)’. All studies in English reporting the rate of ATs following percutaneous closure of secundum ASDs in adult patients were included. The primary outcome was documented AT detection during follow-up ECG monitoring. A meta-regression was then performed to test for an interaction between demographic/procedural characteristics and the primary outcome. Results13 observational studies including 2366 patients were analysed. The overall post-procedure AT event detection rate was 8.6%. Multivariate meta-regression analysis revealed that only male gender was associated with a higher rate of post-procedure AT detection while utilisation of the Amplatzer Septal Occluder device was associated with a lower AT detection rate and comprised 96.2% of all devices used. A high level of heterogeneity was observed (I2-statistic 92.3%, Q value 156.8). ConclusionsOur study illustrates that despite percutaneous ASD closure, a high proportion of adult patients have ATs with male gender correlating with higher AT rates. While the Amplatzer Septal Occluder device correlated with lower AT rates, this was the overwhelmingly the predominant device used hence comparison to other devices remains challenging.

Clinical Significance of Septal Malalignment for Transcatheter Closure of Atrial Septal Defect.

Background Septal malalignment is related to erosion and device embolization in transcatheter closure of atrial septal defect (ASD), but limited information is available. Objectives This study aimed to assess clinical significance of septal malalignment and to determine appropriate evaluation of ASD diameter, including the selection of device size. Methods Four hundred and seventeen patients with ASD who underwent transcatheter closure were enrolled. Septal malalignment was defined as separation between the septum primum and the septum secundum on transesophageal echocardiography. Results One hundred and eighty-four patients had septal malalignment. The frequency of septal malalignment increased with age reaching around 50% in adult patients. Septal malalignment was related to aortic rim deficiency. The distance of separation between the septum primum and the septum secundum was 5 ± 2 mm (range, 1–11 mm). In patients with septal malalignment, the ASD diameter measured at the septum primum was 19 ± 6 mm, while the ASD diameter measured at the septum secundum was 16 ± 6 mm. There was a difference of 4 ± 2 mm (range, 0–8 mm) between the ASD diameter measured at the septum primum and that measured at the septum secundum. For transcatheter closure, the Amplatzer Septal Occluder device size 2-3 mm larger and the Occlutech Figulla Flex II device size 4–7 mm larger than the ASD diameter measured at the septum primum were frequently used. During the study period, erosion or device embolization did not occur in all of the patients. Conclusions Septal malalignment is highly prevalent in adult patients with aortic rim deficiency. The measurement of ASD diameter at the septum primum can be valuable for the selection of device size in patients with septal malalignment.

P699 Atrial septum tearing due to balloon sizing in percutaneous closure of ASD

Abstract INTRODUCTION Percutanous closure of atrial septal defect (ASD) has become an accepted ,reliable procedure and alternative to surgical treatment.Various complications associated with this procedure have been identified but tear of atrial septal rim is a very rare complication.We report a case of atrial septal rim tear due to balloon sizing and diagnosed at the same time by transesophageal echocardiography (TEE). CASE A 64-year-old female patient was admitted to our clinic with dyspnea.Transthoracic echocardiography (TTE) was performed.Ejection fraction was %60 .Moderate tricuspit regurgitation was observed and pulmonary artery pressure was 45 mmHg. TTE revealed a left to right shunt and TEE was planned.2D and 3D-TEE was performed.Two separate secundum type ASD were observed and diameters of defects were measured as 15 mm and 14 mm.Measurement of rim between two defects was 7 mm.(Figure 1 A-B-C) It was observed that the aortic rim was absent but the other rims were sufficient for percutaneous closure.Percutaneous closure was planned .Balloon sizing with a 34-mm AGA balloon resulted in a stretched defect diameter of 26 mm using the stop-flow technique.After the measurement of ASD with sizing balloon flail structure was observed in atrial septal rim.We evaluate this image from various echocardiographic window and we diagnosed the atrial septal rupture. (Figure 1-E ) The patient was hemodynamically stable during the intervention and the atrial septal rupture diameter did not increase. Therefore it was decided to continue the process.ASD diameter was measured again after the rupture of the atrial septum and it was measured 26 mm by TEE and sizing balloon. A 28-mm Amplatzer septal occluder (ASO) was selected.In the same session 28 mm ASO device was successfully placed in the defect.In the TEE examination, it was found that the device was in correct place, there was no shunt from left to right and the torn was between the two discs of the device.(Figure 1-F) The procedure was successfully completed without complications. DISCUSSION Rupture of the interatrial septum or rim during percutaneous ASD closure is a very rare complication. Possible causes of rupture in the interatrial septum when using sizing balloon may be the manipulation of the sizing balloon, passing the guide wire through a small atrial septum fenestration , and the over-stretching of the sizing balloon.There are very rare case reports in the literature about this subject. The rupture of the atrial septum can be enlarged, and therefore surgical treatment has to be performed in these cases in the literature. CONCLUSION In this case, we tried to present the rupture of the interatrial septum, which is a rare complication that may develop when using sizing balloon, and successful percutaneous closure of ASD in the same session. Abstract P699 Figure.

SIMULTANEOUS MULTIFOCAL PARADOXICAL EMBOLISM IN AN ELDERLY PATIENT WITH PATENT FORAMEN OVALE: A CASE REPORT

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Paradoxical embolism (PDE) refers to an embolus of venous origin which is carried directly into the arterial circulation, or vice versa through an arteriovenous shunt such as a patent foramen ovale (PFO). PFO is usually asymptomatic; however, it may play a role in the development of a cryptogenic stroke (CS). About one-third of the cryptogenic strokes may be associated with a PFO. PDE has a diverse clinical presentation and the nature and complications of this pathology can be potentially life-threatening. CASE PRESENTATION: A 68-year-old female with a medical history of hypertension was admitted with complaints of acute visual disturbances, manifested as partial hemianopia without headache. On physical examination, she had no neurological dysfunction. Heart sounds were normal. A computed tomography (CT) scan of the brain showed a 7mm hyperdensity in the left cerebellar area. Tissue plasminogen activator was not given due to uncertainty about the time of onset of the symptoms. The patient was started on aspirin and atorvastatin. The next day, the patient had a sudden onset of hypoxia, with an oxygen saturation of 80%, as well as a left-sided facial droop and left-sided motor weakness. D-dimers were high, at 17,900 μg/ L (NL <500, ng/mL). CT angiography (CTA) of chest revealed a saddle pulmonary embolus. Agitated saline contrast exam showed significant right to left shunting across the interatrial septum, which was mobile, but appeared to be structurally intact, with only a small PFO. Subacute infarcts were seen in the right occipital-parietal area posteriorly on CT brain. She was anticoagulated with intravenous unfractionated heparin and was subsequently transitioned to argatroban. While recovering, the patient developed an acute abdomen. CT angiography revealed a nearly occlusive thrombus in the superior mesenteric artery that required embolectomy and small bowel resection. After recovery from bowel surgery, the patient underwent a planned percutaneous closure of PFO. The PFO was closed with a #28 Amplatzer septal occluder device. DISCUSSION: Simultaneous multifocal systemic embolization across a PFO is not a common occurrence. However, when multiple sites of systemic embolization occur, paradoxical embolization across a PFO should be strongly suspected. Evaluation of the interatrial septum with transesophageal echocardiography can identify several high risk features for recurrent paradoxical embolism CONCLUSIONS: Closure of PFO should be employed as a long term solution to prevent recurrence of stroke and other forms of paradoxical systemic embolization in selected patients with high risk features of the interatrial septum. Reference #1: Rakhit RD (November 2003). "Case 2: Patent foramen ovale (PFO) and paradoxical embolism". Heart. 89 (11): 1362. https://doi.org/10.1136/heart.89.11.1362. PMC 1767929. PMID 18069145. DISCLOSURES: No relevant relationships by Malik Ahmad, source=Web Response No relevant relationships by Taha Ahmed, source=Web Response No relevant relationships by Joanna Ghobrial, source=Web Response No relevant relationships by HASSAN MEHMOOD LAK, source=Web Response No relevant relationships by Anjli Maroo, source=Web Response

Patent foramen ovale with complex anatomy: Comparison of two different devices (Amplatzer Septal Occluder device and Amplatzer PFO Occluder device 30/35)

BackgroundPatent foramen ovale (PFO) closure after a cryptogenic cerebral ischemic event is a routinely procedure. The most used device is Amplatzer™ PFO Occluder 25 mm, but PFOs with complex anatomy require larger device for closure. We compared Amplatzer™ Septal Occluder (ASO) device versus Amplatzer™ PFO Occluder 30 or 35 mm (A-PFO 30/35) about the safety of procedure and the presence of residual shunt during the follow-up. MethodsFrom June 2002 to July 2016, 355 patients (pts) with PFO undergone closure at our institution. Among these ones, 70 pts (19.7%) had a PFO with complex anatomy and a single device with greater diameter was implanted. In these cases, the following devices were used: Gore® Septal Occluder (GSO) in 4 pts; ASO device in 33 pts (group I) and A-PFO 30/35 in 33 pts (group II). Patients treated with GSO device were excluded by our analysis. ResultsComparing group I and group II, there weren't complications during the procedures. Two patients of group II were lost at follow-up. At last follow-up, 1 pt of group I (3%) and 10 pts of group II (32.3%) had a residual shunt (p < 0.01). 7 of 10 pts of group II and the only 1 of group I with residual shunt underwent a complete closure by Amplatzer™ Vascular Plug (AVP) devices. ConclusionsASO devices and A-PFO 30/35 devices are both safe to close complex PFO; but A-PFO 30/35 is associated with a more incidence of residual shunt.

A Case of Difficult RV Lead Placement of Single Chamber Implantable Cardioverter-Defibrillator (ICD) with Atrial Septal Defect (ASD) Amplatzer Septal Occluder Device Delivery System

Introduction: A case of difficult RV lead placement of single chamber ICD with (ASD) Amplatzer septal occluder device delivery system. Implantation of pacemaker leads can be challenging sometimes. Various non-conventional tools have been used in such difficult cases. Case report: We report a case of single chamber ICD implantation in a patient with severe LV dysfunction as primary prevention strategy where RV lead placement was done with the use of 80 cm 10 F delivery system of ASD septal occluder amplatzer device. Conclusion: Innovative lead placement strategies with the use of appropriately selected tools is helpful in facilitating difficult cases.

Transcatheter closure of coronary sinus atrial septal defect by Amplatzer septal occluder device

Coronary Sinus Atrial Septal Defect (CS-ASD) are the rarest defects of the atrial septum, comprising <1% of the five different types of ASDs. Despite the widespread adoption of percutaneous device closure of ASD, till date surgical closure remains the treatment of choice for such defects. A very few isolated case reports of successful percutaneous closure of such defect with covered stent or amplatzer septaloccluder (ASO) device has been reported in world literature. However, uncertainty regarding safety and efficacy limits widespread application of trans-catheter intervention. Here we report a successful trans-catheter closure of a CS- ASD by ASO device in a 4year old boy.

Increasing propensity to pursue operative closure of atrial septal defects following changes in the instructions for use of the Amplatzer Septal Occluder device: An observational study using data from the Pediatric Health Information Systems database

A retrospective observational study was performed using data from the Pediatric Health Information Systems database of all patients with isolated ASD undergoing either TC-ASD or operative ASD closure (O-ASD) from January 1, 2007, to September 30, 2015, hypothesizing that the propensity to pursue O-ASD increased beginning in 2013. A total of 6,392 cases from 39 centers underwent ASD closure (82% TC-ASD). Adjusting for patient factors, between 2007 and 2012, the probability of pursuing O-ASD decreased (odds ratio [OR] 0.95 per year, P = .03). This trend reversed beginning in 2013, with the probability of O-ASD increasing annually (OR 1.21, P = .006). There was significant between-hospital variation in the choice between TC-ASD and O-ASD (median OR 2.79, P < .0001). The age of patients undergoing ASD closure (regardless of method) decreased over the study period (P = .04). Cost of O-ASD increased over the study period, whereas cost of TC-ASD and length of stay for both O-ASD and TC-ASD was unchanged. Although TC-ASD remains the predominant method of ASD closure, the propensity to pursue O-ASD has increased significantly following changes in instructions for use for ASO. Further research is necessary to determine what effect this has on outcomes and resource utilization.

Simultaneous Transcatheter Device Closure of ASD, VSD and PDA in an Infant with Down Syndrome

Incidence of congenital heart defects in Down syndrome varies from 40% to 60%. Atrioventricular septal defect is most common defect seen, followed by isolated Ventricular Septal Defect (VSD). Multiple defects can be found in 5% to 10% of Down syndrome babies. Such patient usually presents with Pulmonary Hypertension (PAH) early in life and can develop rapid progression. An infant with Down syndrome weighing 6.5 kg presented with recurrent lower respiratory tract infections. A Transthoracic echocardiogram showed 10 mm secundum Atrial Septal Defect (ASD), 5 mm peri membranous Ventricular Septal Defect (VSD) and 3.5 mm conical shaped Patent Ductus Arteriosus (PDA) with Pulmonary Arterial Hypertension (PAH). As all the defects were suitable for transcatheter closure, patient underwent successful device closure of VSD by 6/4 mm Amplatzer duct occluder II (ADO II) device, PDA closure by 6/4 mm Amplatzer duct occluder (ADO) device and ASD closure by 12 mm Amplatzer septal occluder device. PA pressures of patient reduced significantly after the procedure and possible post-operative morbidity was avoided by transcatheter intervention.

Asymptomatic late embolization of Amplatzer septal occluder device

Atrial septal defects of Ostium Secundum type with suitable anatomy and margins are commonly closed with septal occluder devices. With the increasing number of catheterization laboratories and increasing availability of different devices, the device closure procedure is very commonly performed in different institutes. Embolization of the septal occluder is one of the most dreaded complications of this procedure, which usually occurs in the early hours or days after the procedure. We report a case of silent embolization of the Amplatzer septal occluder, detected seven months after its use to close an Ostium Secundum atrial septal defect, which was detected during pre-anaesthetic evaluation and echocardiography for non-cardiac surgery. The patient denied having any symptom in-between. The device was retrieved and the defect was closed surgically.

Early Endocarditis and Delayed Left Ventricular Pseudoaneurysm Complicating a Transapical Transcatheter Mitral Valve-in-Valve Implantation: Percutaneous Closure Under Local Anesthesia and Echocardiographic Guidance.

A 72-year-old man was referred because of suspected infective endocarditis. Fifteen years earlier, he had undergone mitral valve replacement with a 33-mm Hancock valve for severe mitral regurgitation. Three months ago, he presented with a first episode of congestive heart failure caused by severe mitral regurgitation reflecting degeneration of the bioprosthetic valve without sign of endocarditis. Because of a high surgical risk based on an estimated Euroscore I of 42.96% and The Society of Thoracic Surgeons (STS) score of 29% (main comorbidity is an advanced Parkinson disease), valve-in-valve implantation was planned. A 29-mm Edwards Sapien 3 (S3) balloon-expandable valve was successfully implanted through transapical puncture of the left ventricle (LV) after direct surgical exposure by mini thoracotomy. Patient was discharged 10 days after the procedure without complications. On his admission, the patient was febrile and examination revealed a purulent discharge at the site of thoracotomy. Transthoracic echocardiography (TTE) and transesophageal echocardiography showed a 15-mm mobile vegetation on the leaflet of the S3 (Movie I in the Data Supplement) and a pseudoaneurysm at the apex of the left ventricle (LVPA) flowing by a large apical defect (Figure 1; Movie II in the Data Supplement). Computed tomographic (CT) scanning confirmed the LVPA free from any thrombus and identified the surgical suture tip in its deep (Figures 1 and 2; Movie III in the Data Supplement). 18F positron-emission tomography demonstrated an uptake on the S3 and LVPA (Figure 2). Blood cultures were positive for Staphylococcus aureus . Antibiotherapy with co-trimoxazole for 6 weeks and clindamycin for 1 week was started, and a quick clinical and biological …

Simultaneous Transcatheter Closure of Multiple Atrial Septal Defects Using Dual Amplatzer Septal Occluder Devices

BackgroundTranscatheter closure has been a recognised treatment strategy for multiple atrial septal defects (mASDs). This study aimed to examine the feasibility, effectiveness, and safety of transcatheter closure of mASDs using dual Amplatzer septal occluder (ASO) devices. MethodsWe retrospectively reviewed 34 patients who underwent transcatheter closure of mASDs using dual ASO devices from April 2005 to December 2014. ResultsEight men and 26 women who successfully underwent transcatheter closure of mASDs were included. Ten (29.4%) patients had 3 defects or more. The mean diameters of the larger and smaller defects were 14.0±3.9 mm (8–20 mm) and 9.1±2.6 mm (4–15 mm), respectively. The mean diameters of the larger and smaller devices were 22.2±4.8 mm (13–30 mm) and 17.3±4.1 mm (10–26 mm), respectively. Devices were deployed by the “sandwiches” technique or an interleaved pattern. Immediately after the procedure, 23 (67.6%) patients had complete closure and 11 patients had a residual shunt (6 trivial, 3 small, 1 moderate, 1 large). During the 6 months of follow-up, 30 (88.2%) patients had complete closure of the shunt and 4 patients had a residual shunt (1 large, 3 small). Complications included 2 cases of pericardial effusion, which disappeared at 3 months. ConclusionsSimultaneous device implantation in transcatheter closure of mASDs is feasible and effective. The incidence rate of residual shunts is slightly high in the short term, but tends to decrease during mid-term follow-up.