Occluder Device Implantation Research Articles

Cardiac Computed Tomography Angiography for Device-Related Thrombus Assessment After WATCHMAN FLX™ Occluder Device Implantation: A Single-Center Retrospective Observational Study

Background/purposeDevice-related thrombosis (DRT) is one of the greatest challenges of transcatheter left atrial appendage device occlusion. Due to the invasive nature of transesophageal echocardiography (TEE), cardiac computed tomography angiography (CCTA) is being increasingly utilized in several centers for assessing adequate left atrial appendage closure and monitoring for DRT. There is a paucity of data regarding the standardized definition of DRT on CCTA for the WATCHMAN FLX™ device. Methods/materialsA retrospective review was conducted on 43 patients receiving WATCHMAN FLX™ device implantation with CCTA performed at the first follow-up at our institution. A comparative review of DRT predictors was performed on 10 patients who had both CCTA and TEE at the time of follow-up. ResultsHypoattenuated thickening (HAT) was a common finding on CCTA and was noted to be present in 95.35% of the patients. The combination of a large device size, peridevice gap >4 mm, and HAT located on the device gutter and 1 shoulder were characteristics present on CCTA observed in 2 patients with confirmed DRT on TEE. ConclusionCCTA is a noninvasive imaging modality for DRT monitoring, with guidelines still in development. We report potential predictors of DRT on CCTA. Additional studies are needed to further determine standardized parameters for DRT detection on CCTA and the significance of HAT with multimodality correlation.

Short-Term Apixaban for Documented Left Atrial Appendage Thrombus in High-Risk Atrial Fibrillation Patients Undergoing Left Atrial Appendage Occlusion.

Stroke prevention with left atrial appendage (LAA) occlusion is an important alternative treatment for high-risk atrial fibrillation (AF) patients with contraindications to oral anticoagulation (OAC).[1] [2] The presence of LAA thrombus detected on preprocedural imaging usually precludes implantation of the endocardial device because of a prohibitively high periprocedural embolic risk.[3] Although successful resolution of LAA thrombus with OAC has been described, all previous reports are in patients without contraindications to OAC.[4] [5] [6] Furthermore, long-term data in these patients are lacking. We hypothesized that short-term OAC with apixaban could safely facilitate resolution of LAA thrombi even in a high-risk population, thereby allowing safe LAA occluder device implantation, with good outcomes over the long term.

A patient with permanent atrial fibrillation and very high bleeding risk – when is the optimal time to refer for left atrial appendage occluder device implantation?

A patient with permanent atrial fibrillation and very high bleeding risk – when is the optimal time to refer for left atrial appendage occluder device implantation?

Mechanical complications in patients with ST-segment elevation myocardial infarction: A single centre experience

BackgroundThe study aims to assess characteristics and outcomes of patients suffering a mechanical complication (MC) after ST-segment elevation myocardial infarction (STEMI) in a contemporary cohort of patients in the percutaneous coronary intervention era.Methods and resultsThis retrospective single-center cohort study encompasses 2508 patients admitted with STEMI between March 9, 2009 and June 30, 2014. A total of 26 patients (1.1%) suffered a mechanical complication: ventricular septal rupture (VSR) in 17, ventricular free wall rupture (VFWR) in 2, a combination of VSD and VFWR in 2, and papillary muscle rupture (PMR) in 5 patients. Older age (74.5 ± 10.4 years versus 63.9 ± 13.1 years, p < 0.001), female sex (42.3% versus 23.3%, p = 0.034), and a longer latency period between symptom onset and angiography (> 24h: 42.3% versus 16.2%, p = 0.002) were more frequent among patients with MC as compared to patients without MC. The majority of MC patients had multivessel disease (77%) and presented in cardiogenic shock (Killip class IV: 73.1%). Nine patients (7 VSR, 2 VFWR & VSR) were treated conservatively and died. Out of the remaining 10 VSR patients, four underwent surgery, three underwent implantation of an occluder device, and another three patients had surgical repair following occluder device implantation. All patients with isolated VFWR and PMR underwent emergency surgery. At 30 days, mortality for VSR, VFWR, VFWR & VSR and PMR amounted to 71%, 50%, 100% and 0%, respectively.ConclusionsDespite advances in the management of STEMI patients, mortality of mechanical complications stays considerable in this contemporary cohort. Older age, female sex, and a prolonged latency period between symptom onset and angiography are associated with the occurrence of these complications.

Overcoming Double Trouble in Single-Sitting: A Case of an 8-Year-Old Boy with Coarctation of Aorta and Patent Ductus Arteriosus

There are very few reports on successful management of young children with coexistence of two congenital heart defects, coarctation of aorta and patent ductus arteriosus. These lesions can be treated either simultaneously or sequentially. Herein, we present the first successful report of simultaneous balloon angioplasty and Amplatzer duct occluder device implantation in a single-sitting in an 8-year-old boy with severe aortic coarctation and patent ductus arteriosus. The coarctation gradient decreased from 70 mmHg to 10 mmHg and a complete closure of the ductus arteriosus was achieved without any complication. Fellow interventional cardiologists may consider single-stage transcatheter treatment in young children with combination of these two lesions.

Procedural Outcomes of Watchman® Left Atrial Appendage Occluder Device Implantation and Longitudinal Toe Follow-Up of Peri-Device Leaks

Background: We describe our procedural outcomes and technical success rates of Watchman® LAA closure devices from our centre with a focus on peri-device leaks. Results: Fifty-three patients aged 65.5 ± 7.3 years (range 43–82 years, 72% male, CHADS2 score 1.94 ± 0.9, CHADSVASC score 2.8 ± 1.0) underwent successful implantation of a Watchman® LAA occluder device in our centre since Nov 2009. Forty-four patients had concomitant pulmonary vein isolation (44/53). The average device size was 24 ± 3 mm (range 21–30 mm). No acute procedural complications occurred. Post implant transoesophageal echocardiogram (TOE) was performed at six weeks, and again at six months if any persistent peri-device leaks seen at initial follow up. At implant, 4/53 patients had a small peri-device leak detected on colour flow Doppler by TOE ≤ 3 mm. At six week TOE, 12 patients had a peri-device leak (nine new, three persistent), with four of these showing persistent small leaks at six month TOE (two present since implant). There was no significant age or sex distribution of patients who developed new peri-device leaks, however all patients who demonstrated leaks at implant were male. At six week follow up, the interatrial septal puncture sites had healed in all but 12 patients, with no age or sex distribution observed. Conclusion: Despite high procedural success rates and low incidence of peri-device leaks at implant, we have observed development of small leaks at first TOE follow-up in approximately 17% of patients which then tend to close again. This may reflect a period of “seating” with the device.

Initial Experience with Watchman® Left Atrial Appendage Occluder Device Implantation—Lessons from Transoesophageal Echocardiographic Guidance

Initial Experience with Watchman® Left Atrial Appendage Occluder Device Implantation—Lessons from Transoesophageal Echocardiographic Guidance

Migraine Symptoms Related to the Percutaneous Closure of An Ostium Secundum Atrial Septal Defect: Report of Four Paediatric Cases and Review of the Literature

Several publications have recently suggested that atrial septal defect may be associated with the physiopathology of headache with migraine-type characteristics. We describe four previously asymptomatic paediatric patients with atrial septal defect who underwent percutaneous Amplatzer septal occluder device implantation and who subsequently developed symptoms compatible with migraine headache. The cases had normal echocardiograms after the intervention and a benign course with headache improvement after several weeks or months. There are paediatric patients with atrial septal defect who may dramatically develop migraine symptoms with or without aura following percutaneous correction of their defect. Large paediatric studies are needed to offer accurate prognoses for children and their families. The possibility of using clopidogrel to treat this type of headache is subject to debate.

Experience with 205 procedures of transcatheter closure of ductus arteriosus in 182 patients, with special reference to residual shunts and long-term follow-up

Between December 1987 and September 1991, 205 nonsurgical procedures for closure of patent ductus arteriosus were attempted in 182 infants, children, and young adults with use of the Rashkind double-disc ductal occluding device. The patients' ages ranged from 8 months to 26 years (median 5 years) with 18 aged less than 2 years. Their weights ranged from 7.4 to 55 kg (median 16 kg); in patients aged less than 2 years the mean weight was 10.2 +/- 1.5 kg, and in those aged more than 2 years mean weight was 19.5 +/- 9.6 kg. Successful occluder device implantation was achieved in 174 patients (96%) at the initial attempt. Device embolization to a pulmonary artery occurred in six patients; two of these devices were retrieved by grabber catheter and four at operation, all without adverse sequelae; there were two other technical failures. Follow-up studies included two-dimensional Doppler echocardiography with color flow mapping. The 6-week follow-up study revealed a small residual shunt in 27% (46/169) of patients. At the 6-month follow-up study, 22% (37/167) of the patients had a small residual shunt; this prevalence was 17% (24/145) in ducts with a narrowest diameter of less than 6 mm, and 59% (13/22) in ducts greater than 6 mm. Immediately after implantation of the occluder device and throughout the follow-up period, the mean narrowest ductal diameter of ducts with residual shunts was significantly larger than that of ducts in which total occlusion was achieved (range of p < 0.01 to 0.001). The use of the 17 mm occluder device, however, was significantly associated with an increased prevalence of residual shunt only immediately after implantation (p < 0.01). Implantation of a second occluder device was attempted in 21 patients with residual patent ductus together with a continuous murmur at the 6-month follow-up; embolization of one device to a pulmonary artery occurred immediately but it was retrieved by grabber catheter and another device was successfully implanted 1 month later. All 21 patients were seen for 6-month follow-up study, when only one (5%) had a small residual shunt that was subsequently successfully closed by the insertion of a third occluder device. Thus, after successful implantation of one or more occluder devices, complete closure of the ductus was achieved in 90% of all patients seen to date for their 6-month follow-up study. One patient had limited hemolysis. The maximum follow-up period is 50 months. These results confirm the efficacy, with low morbidity and no mortality, of the use of the Rashkind occluder device for nonsurgical closure of patent ductus arteriosus, especially in those with smaller diameters.