Successful Percutaneous Closure Research Articles

Role of speckle tracking echocardiography in assessing right ventricle function after percutaneous closure of atrial septal defect

Background; Atrial septal defect (ASD) is one of the most common congenital heart diseases. Right ventricular (RV) dysfunction is closely related to patient outcome in open and closed ASD closure. Aim of work; to quantify RV function in patients with chronic RV volume overload due to an ASD before and after its percutaneous closure. Subjects & methods; In this prospective study which included 40 patients with secundum type ASD and normal sinus rhythm who underwent successful percutaneous ASD closure procedure at Cardiology Department, Faculty of Medicine, Benha University; and Cardiology Department, national-heart-institute. All patients underwent full history taking, clinical examination, ecg & echocardiography including assessment of LA, LV, RA & RV functions & dimensions with special emphasis on TAPSE, RV MPI & 2D speckle tracking. Result: LA diameters (mm) were decreased significantly after ASD closure; Antero-posterior, Medio-lateral, and Apico-basal. RA diameters (mm) were decreased significantly after ASD closure; PASP was decreased significantly after ASD closure. LVEF% was increased significantly after ASD closure. TAPSE was increased significantly after ASD closure. RV end diastolic diameters were decreased significantly after ASD closure. Pulsed Doppler RV MPI was decreased significantly after ASD closure. RV longitudinal strain (%) was increased significantly after ASD closure. there was a positive correlation among delta RVSTE and delta LVEF and TAPSE. Also, there was a negative correlation among delta RVSTE and delta RV MPI, RV end diastolic diameter, RA diameters, and PASP. Conclusion; Our study demonstrated significant improvements in multiple echocardiographic measures of cardiac structure and function including reduced LA/RA diameters, decreased PASP, increased LVEF, higher TAPSE, reduced RVEDD, lower RV MPI, and increased RV longitudinal strain at one month post-procedure. These changes indicate reversal of the chronic volume and pressure overload on the right heart caused by the left-to-right shunt, resulting in measurable reverse remodeling and improved mechanics of the right ventricle.

Three-Dimensional Rotational Angiography as Guidance for Percutaneous Patent Ductus Arteriosus (PDA) Device Closure: A Case Report

Background: Patent Ductus Arteriosus (PDA) is a prevalent congenital heart defect characterized by the persistence of an open arterial connection between the aorta and the pulmonary. Percutaneous PDA closure involves deploying occlusion devices through catheter- based procedures. Case Presentation: We report a 1-year and 6-month-old girl diagnosed with Patent Ductus Arteriosus, presented with persistent complaints of failed to thrive , shortness of breath and recurrent cough. Physical examination revealed a continuous murmur at the upper left sternal border, and the Echocardiography examination confirmed a PDA with size of 4-7 mm, with diastolic shortening and dilatation of the Main Pulmonary Artery (MPA). The successful percutaneous PDA device closure procedure was performed using Three-Dimensional Rotational Angiography (3DRA), following an attempt with Two-Dimensional Angiography, which failed to determine the actual defect size in the patient. Conclusions: Confirming the morphology and size of a PDA can be difficult due to its location between the aorta and pulmonary blood vessels, making it a challenging congenital anomaly to assess accurately. 3DRA precisely delineates the PDA structure located between the aortic and pulmonary blood vessels and acts as a guidance tool for percutaneous PDA device closure.

Improvement Functional Capacity In Adult After Percutaneous ASD Closure

This case report describes a 24-year-old woman with a secundum atrial septal defect (ASD) who underwent successful percutaneous ASD closure with significant improvement in symptoms and functional capacity. The patient presented with easy fatigue and shortness of breath on exertion for 10 years. Echocardiography revealed a large secundum ASD with moderate to severe tricuspid regurgitation, mild mitral regurgitation, mild pulmonary regurgitation, and dilatation of the right atrium and ventricle. Right heart catheterization confirmed a large left-to-right shunt and pulmonary hypertension. The patient underwent ASD closure with a Figulla Flex II device, resulting in immediate improvement of hemodynamics. Follow-up at 3 and 6 months demonstrated decreased right ventricular size, improved left ventricular function, and increased exercise caapacity. This case highlights the benefits of ASD closure in improving symptoms and cardiac function, even in patients with longstanding right ventricular dilation.

A large type I right pulmonary artery to left atrium fistula: underwent successful percutaneous device closure with duct occluder—a rare case report

BackgroundPulmonary artery to left atrium fistula is an unusual structural cause of silent cyanosis. Only less than 100 cases have been reported so far. A high index of clinical suspicion and proper evaluation with bubble contrast echocardiography and cardiac computed tomography (CT) will help to detect this treatable anomaly. The advent of safer percutaneous closure methods has replaced the need for more invasive surgical closure.Case presentationWe report an adolescent boy, who presented with long-standing cyanosis and progressive dyspnea with normal clinical cardiovascular examination. On evaluation, echocardiography and bubble contrast study revealed a large right pulmonary artery (RPA) to left atrium (LA) fistula. Cardiac CT confirmed the same with normal pulmonary venous drainage s/o a large 20 mm Type I RPA LA Fistula. He underwent successful percutaneous closure of the fistula tract with a 22 × 24 mm Cera™ duct occluder via transseptal approach uneventfully.ConclusionOur case enlightens the methodological approach to diagnosing this rare anomaly as well as the feasibility of percutaneous intervention in such cases as it is one of the largest fistula tracts closed percutaneously to date.

Successful Percutaneous Closure of Large Aorto-Pulmonary Window in a 3-Year-Old Girl Using Occluder A DO I 6/8: A Case Report

This case report details the diagnosis, management, and successful percutaneous closure of a large aorto-pulmonary window with associated pulmonary hypertension in a 3-year-old female patient. The intervention involved the use of an Occluder ADO I 6/8 device. The report provides a comprehensive overview of echocardiographic findings and aortoangiography results, culminating in the therapeutic strategy and outcome.

Impact of a Successful Percutaneous Mitral Paravalvular Leak Closure on Long-term Major Clinical Outcomes

BackgroundPercutaneous mitral paravalvular leak (PVL) closure techniques are an effective and safe alternative to surgical treatment, but data regarding long-term outcomes are scarce. We aim to describe the impact of successful percutaneous mitral PVL closure on long-term outcomes. MethodsAll consecutive patients in whom a first-attempt percutaneous mitral PVL closure was performed in a single tertiary centre between January 2010 and October 2021 were included. Clinical variables, procedural details, and procedural success were collected. Patients were classified based on procedural success, defined as no more than mild residual leak. All-cause mortality was the primary endpoint. Cardiovascular death and heart failure hospitalizations (HFHs) were key secondary endpoints. ResultsNinety patients (median age 72.5 years [66.0-78.4]; median EuroSCORE-II 8.2 [5.3-12.46]) were included. Although reduction of at least 1 degree in PVL severity was achieved in 82 (91.1%), procedural success was achieved in 47 (52.2%). Chronic kidney disease, previous surgery for PVL, and the presence of multiple jets were independently associated with procedural failure. After a median follow-up of 3.2 (1.2-5.2) years, mortality rate was higher in the procedural failure group (27.3 per 100 patients-years) compared with the group with successful closure (8.2 per 100 patient-years). Procedural failure was associated with all-cause death (adjusted hazard ratio [aHR], 2.59; 95% confidence interval [CI], 1.41-4.78), cardiovascular death (aHR, 3.53; 95% CI, 1.67-7.49) and HFH (aHR, 3.27; 95% CI,1.72-6.20). ConclusionsA successful reduction in PVL to mild or absent is associated with improved rates of all-cause death, cardiovascular death, and HFHs.

The Safety and Effectiveness of the Prostar XL Closure Device Compared to Open Groin Cutdown for Endovascular Aneurysm Repair.

The aim of this study is to compare the outcomes of percutaneous femoral closure with the Prostar XL for endovascular aneurysm repair (EVAR) to those of open femoral cutdown, and to evaluate factors which may predict the failure of percutaneous closure. Patients undergoing endovascular aneurysm repair for an infrarenal abdominal aortic aneurysm between 2005 and 2013 were included. Patient characteristics, anatomic femoral artery measurements, and postoperative complications were recorded retrospectively. Operator experience was defined with a cut-off point of >30 Prostar XL closures performed. Comparisons were made per access site. A total of 443 access sites were included, with percutaneous closure used in 257 cases (58.0%) and open cutdown in 186 cases (42.0%). The complication rate was 2.7% for the percutaneous and 4.3% for the open cutdown group (P = .482). No significant differences between groups were found with respect to 30-day mortality, wound infections, thrombosis, seromas, or bleeding complications. Fourteen failures (5.4%) of percutaneous closure occurred. The success rates were similar for experienced and unexperienced operators (94.2% vs 95.5%, P = .768). Renal insufficiency was more common in the failed than in the successful percutaneous closure group (64.3% vs 24.7%, P = .003). Common femoral artery calcification or diameter, BMI, sheath size, or operator experience did not predict failure. No further complications were seen in follow-up CT at 1-3years postoperatively. The use of the Prostar XL is safe compared to open cutdown. The success rate is 94.6%. Operator experience, sheath size, obesity, or femoral artery diameter or calcification do not appear to predict a failure of percutaneous closure. Complications seem to occur perioperatively, and late complications are rare.

Successful Percutaneous Closure of Complicated Residual Patent Ductus Arteriosus Shunts Resembling Pig Nostrils Following Second-Time Surgical Treatment

Successful Percutaneous Closure of Complicated Residual Patent Ductus Arteriosus Shunts Resembling Pig Nostrils Following Second-Time Surgical Treatment

Contemporary Management Strategies of Baffle Leaks in Adults with a Failing Systemic Right Ventricle Late after Atrial Switch: A Case Series and Literature Overview

Baffle leaks are a frequently encountered and often overlooked complication after the atrial switch procedure for transposition of the great arteries. Baffle leaks are present in up to 50% of non-selected patients, and while they initially may not cause clear symptoms, they can complicate the hemodynamic course and influence the prognosis in this complex patient group. A shunt from the pulmonary venous atrium (PVA) to the systemic venous atrium (SVA) can lead to pulmonary overflow and subpulmonary left ventricular (LV) volume overload, while a shunt from the SVA to the PVA can result in (exercise-associated) cyanosis and paradoxical embolism. We report three cases of baffle leaks in patients with systemic right ventricular (sRV) failure late after the atrial switch procedure. Two symptomatic patients who presented with exercise-associated cyanosis due to SVA to PVA shunting over the baffle leak underwent successful percutaneous baffle leak closure with a septal occluder device. One patient with overt sRV failure and signs of subpulmonary LV volume overload due to PVA to SVA shunting was managed conservatively, as baffle leak closure was expected to lead to an increase in sRV end-diastolic pressure and aggravation of sRV dysfunction. These three cases illustrate the considerations made, challenges faced, and necessity of a patient-tailored approach when addressing baffle leaks.

Device Closure of Left Circumflex Coronary Artery to Coronary Sinus Fistula

A coronary artery fistula (CAF) is defined as a direct connection between a coronary artery with right heart chambers including the right atrium, right ventricle, coronary sinus, superior vena cava, or pulmonary arteries. Elective closure of coronary artery fistula by surgery or percutaneous transcatheter technique is generally accepted in the presence of symptoms. We report a case of successful percutaneous transcatheter device closure of coronary fistula, originating from the circumflex artery and draining into the coronary sinus.

378 VERY-LATE THROMBUS-RELATED STROKE AFTER PERCUTANEOUS PFO CLOSURE: MEDICAL MANAGEMENT OF A RARE COMPLICATION

Abstract In May 2020, a 45-years-old woman was admitted to the Emergency Department due to transient ischemic attack. The thrombophilia screening showed hemizygous prothrombin gene mutation (Factor II) and homozygous MTHFR mutation. The transthoracic echocardiography was normal, with a left ventricular ejection fraction of 60% and no morphological or functional valve disease. The 24-h Holter ECG and the past medical history did not show any specific cause of the neurologic manifestations. In the absence of a specific and plausible cause of the transient ischemic attack, a diagnosis of cryptogenic stroke was made. The patient then underwent transcranial Doppler, which showed a high-grade shunt (curtain effect), and transesophageal echocardiography with bubble test, which showed the presence of a massive right-to-left shunt through a patent foramen ovale (PFO) during the Valsalva maneuver. A therapy with warfarin (achieving a target INR between 2 and 3) was therefore started, and the indication for a percutaneous PFO closure was given. In January 2021 the patient underwent successful percutaneous PFO closure with the Gore Cardioform Septal Occluder 25/25 mm (W.L. Gore and Associates, Inc.) through intracardiac echocardiographic guidance with no complication and without any residual shunt. The patient was discharged on dual antiplatelet therapy with aspirin 100 mg daily plus clopidogrel 75 mg daily for six months, and pantoprazole 20 mg daily, followed by aspirin 100 mg daily chronically. After 6 months the patient underwent transcranial Doppler, which was negative for shunt. 12 months after the implantation the patient stopped aspirin by her own initiative. In August 2022, due to the diagnosis of an ovarian cyst, the gynecologist prescribed estro-progestogen pill: in that occasion, the patient did not mention her thrombophilia. After 10 days, sudden onset of weakness of the right upper limb and aphasia. The patient was then admitted to the Emergency Department, were the computer tomography showed two acute lesions on the left cerebral hemisphere. Therefore, the patient underwent intravenous thrombolysis, with complete regression of the neurological symptoms: a diagnosis of stroke was then formulated. To understand the origin of such stroke, the neurologist gave indication to cardiological evaluation. The patient did not have any palpitation in the previous months and the electrocardiogram showed normal sinus rhythm. However, the transthoracic echocardiographic evaluation showed a dubious image of a mass attached to the interatrial septum, for which the patient underwent transesophageal echocardiography, which showed a 10×9 mm fluctuating thrombus attached to the left side of the previously implanted PFO closure device. Therefore, an oral anticoagulation therapy with warfarin plus a subcutaneous therapy with enoxaparin 6000 UI twice daily (as bridge to obtain the desired INR between 2 and 3) was started. After ten days, the patient underwent a new transesophageal echocardiography, which showed a substantial reduction in the dimensions of the thrombus (4×3 mm). The patient was then discharged in warfarin therapy with no residual neurological symptoms.

Abstract 14176: Assessment of Atrial Septal Defect Dynamic Changes Within the Cardiac Cycle With Cardiovascular Computed Tomography

Objectives: Successful and safe percutaneous closure of atrial septal defects (ASD) is contingent upon the accurate measurement of defect size and adjacent rim tissue, as well as the spatial relationship to other cardiac structures. Previous studies utilizing three-dimensional echocardiography have found significant changes in ASD defect size throughout the cardiac cycle. Cardiac computed tomography (CT) provides excellent spatial and temporal resolution of cardiac structures. Our study examines the efficacy of cardiac CT as a modality for evaluating dynamic changes in ASD defect size throughout the cardiac cycle. Methods: Thirty patients with an ostium secundum ASD underwent cardiovascular CT imaging prior to percutaneous or surgical repair. Cardiovascular CT was performed with a multidetector scanner and images were analyzed using a GE Advantage Workstation capable of advanced image processing and manipulation. ASD defect size was measured in the axial, coronal, and sagittal views at (end-systolic phase) 35% and (end-diastolic phase) 95% of the cardiac cycle. Results: In 30 participants the mean defect size was not significantly different across the three planes, axial mean was 22.4±15.3, coronal 23.7±16.2, and sagittal at 22.3±16.9, p=0.923. However, the change in defect size during the cardiac cycle was significantly different in all three views, P<0.0001 for all. On the axial view, the mean change from 35% to 95% was 6.5±4.9, while the coronal view change was 7.4±5.7, and the sagittal view change was 4.3±3.9. Additionally, the change in size increases with the defect size (figure 1). Conclusions: Cardiac CT imaging accurately depicts dynamic changes in ASD defect size throughout the cardiac cycle, and as such, may be considered a valuable and non-invasive imaging modality for patients undergoing pre-procedural evaluation.

Abstract 12995: Use of Percutaneous Septal Closure Device for Paradoxical Cerebral Fat Emboli in a Young Female With Patent Foramen Ovale

Introduction: Cerebral fat emboli (CFE) is a rare (0.9-2.2%) and fatal complication (up to 10% mortality) after burst fractures of the long bones. Studies have reported a worse prognosis with the concomitant presence of a patent foramen ovale (PFO) by allowing a portal to reach systemic circulation, which could be preventable with closure devices; however, it remains unexplored. Clinical Case: 23-year-old female without any medical history, admitted to trauma ICU after a high-energy motor vehicle collision resulting in left femur open fracture, ribs, vertebral fractures, and left-sided pneumothorax. She was intubated due to poor mental status. CT head was unremarkable, but subsequent brain MRI showed multiple punctate foci of hyperintensity in the bilateral white matter of cerebral hemispheres, corpus collosum, cerebellum and brainstem, representing fat embolism (Figure). Transthoracic and transesophageal echocardiography confirmed a small PFO. After a multidisciplinary team discussion, PFO closure via Amplatzer device was done to reduce the risk of systemic embolism burden. Discussion: In patients with long bone fractures, right-to-left shunts from PFOs have been shown, by transcranial doppler (TCD), to be associated with larger and frequent micro embolic signals (MES) in the brain. TCD has also shown decreased embolic load and significant reductions in the size of emboli that make it to cerebral circulation after successful percutaneous closure of PFOs. Similar results are seen in prospective high-risk long bone fractures before orthopedic interventions. This suggests there could be a potential role of closure devices in such trauma patients with PFO. Conclusion: There could be a potential role of closure devices in selected trauma patients with paradoxical cerebral embolism and a PFO, however, the benefits of long-term outcomes need to be explored in larger cohorts.

Persistent Left Superior Vena Cava Resulting in Right-to-Left Cardiac Shunt: When to Treat?

Persistent left superior vena cava (PLSVC) is one of the most common thoracic venous anatomical variations. A PLSVC commonly drains into the right atrium via the coronary sinus. Anomalous drainage of a PLSVC into the left-sided circulation can occur, presenting as a stroke or hypoxia consequent to a right-to-left shunt. Herein, we describe a symptomatic patient with PLSVC communicating to the left upper pulmonary vein who had successful percutaneous closure with clinical improvement.

Percutaneous Patent Foramen Ovale Closure in a Patient With Anomalous Aortic Origin of the Left Coronary Artery

Percutaneous Patent Foramen Ovale Closure in a Patient With Anomalous Aortic Origin of the Left Coronary Artery

Echocardiography-Guided Percutaneous Patent Ductus Arteriosus Closure: 1-Year Single Center Experience in Indonesia.

IntroductionSince the first successful percutaneous closure under transesophageal echocardiographic (TEE) guidance, many centers explored transcatheter procedures without fluoroscopy. This single-center study is aimed to show the feasibility and safety of percutaneous patent ductus arteriosus (PDA) closure under echocardiography-only guidance during our 1-year experience.MethodsPatients with PDA were recruited for percutaneous PDA closure guided by either fluoroscopy or echocardiography-only in National Cardiovascular Center Harapan Kita (ClinicalTrials.gov Identifier: NCT05321849, clinicaltrials.gov/ct2/show/NCT05321849). Patients were evaluated clinically and radiologically using transthoracic echocardiography (TTE) at 6, 24, and 48 h after the procedure. The primary endpoint was the procedural success. Secondary endpoints were the procedural time and the rate of adverse events.ResultsA total of 60 patients underwent transcatheter PDA closure, 30 patients with fluoroscopy and 30 patients with echocardiography guidance. All patients had successful PDA closure. There were only residual shunts, which were disappeared after follow-up in both groups, but one patient with a fluoroscopy-guided procedure had moderate tricuspid regurgitation with suspected thrombus in the tricuspid valve. The procedural time was not significantly different between the fluoroscopy and echocardiography groups.

Percutaneous Closure of Patent Foramen Ovale after Anterior Spinal Cord Infarction

In patients with a patent foramen ovale (PFO) who have had a cryptogenic ischemic stroke, percutaneous closure reduces its recurrence risk. However, its role in spinal cord infarction (SCI) is less well-established. A few case reports describe the putative causative role of PFO in SCI. We present a case of a teenager with cryptogenic anterior SCI in the setting of a deep vein thrombosis and a high risk-PFO who underwent successful percutaneous closure.

Large Ostium Secundum ASD Occlusion with Memopart ASD Occluder

Transcatheter occlusion of ASD with device is an effective,alternative to surgical repair : feasible and safe procedure with minimal complication rate and short hospital stay, as well as excellent short and long term outcome .However, large ASDs (>38 mm) and defects with deficient rims are usually not offered transcatheter closure but are referred for surgical closure. Transcatheter closure also remains controversial for other complicated ASDs with comorbidities, additional cardiac features and in small children. Previous studies have shown high success rate, low complication rate and less discomfort[1,2] . With the devices and technology currently available, several cohort studies have reported successful percutaneous closure in the above-mentioned complex cases. However the feasibility and safety of transcatheter technique needs to be confirmed through larger studies and longer follow-up.

79 Platypnea–orthodeoxia syndrome as an uncommon cause of dyspnoea in a nonagenarian with aortic dissection

Abstract Methods and results Platypnea–Orthodeoxia syndrome (POS) is an uncommon but challenging clinical condition characterized by positional dyspnoea (platypnea) and arterial desaturation (orthodeoxia) in the upright position that improve in the supine position. POS can occur insidiously, as progressive unexplained oxygen desaturation for months or years, or as acute life-threatening unexplained hypoxaemia. The most common cause is the presence of an intracardiac shunt (patent foramen ovale and other interatrial defects) associated with a secondary anatomic or functional defect that serve as substrate for a right to left intracardiac shunt leading to oxygen desaturation. Conclusions Herein we present the case of a nonagenarian with a known history of ascending aortic aneurysm, that was admitted to the emergency department of our institution with a complaint of intermittent chest pain and dyspnoea. POS was then diagnosed, and the patient underwent a successful percutaneous closure with an Amplatzer™ device (25/25 mm) with minimal residual right-to-left shunt leading to a significant relief of the dyspnoea and improvement of arterial saturation. We also herein revise the clinical presentation, pathophysiology, diagnostic work-up, and management of patients with POS, aiming at increasing the awareness of this uncommon but often misdiagnosed treatable condition.

Successful Percutaneous Closure of an Iatrogenic Ventricular Septal Defect Following TAVR With the ACURATE neo2

Successful Percutaneous Closure of an Iatrogenic Ventricular Septal Defect Following TAVR With the ACURATE neo2