Transcatheter Occlusion Research Articles

Transcatheter occlusion of antegrade pulmonary flow in children after cavopulmonary anastomosis

To report our experience with transcatheter occlusion of antegrade pulmonary blood flow (APF) for postoperative complications of cavopulmonary anastomosis (BCPA). It has been suggested that limited APF enhances pulmonary arterial growth in patients undergoing BCPA. However, APF may result in suboptimal postoperative hemodynamics and sequelae such as SVC syndrome or prolonged chest tube drainage. For this subgroup, closure of APF may alleviate these problems. All BCPA procedures where APF was left open from 1995-2005 were reviewed. Symptomatic patients with APF who underwent a cardiac catheterization in the postoperative period comprised the study cohort. 179 BCPA procedures were performed during the study period. APF was left patent in 29/179. 6/29 patients (age 10-28 months, median 14 months) presented 12 to 130 day; (median 31 days) with persistent pleural effusions (5) or SVC syndrome (1, Five had a history of a previous pulmonary arterial band (PAB) and one pulmonary stenosis. PA pressure was elevated in all (range 17-27 mmHg; median 22 mmHg). Hemodynamic evaluation with temporary APF occlusion was repeated in all patients. APF was successfully closed in 4/6 patients. The Amplatzer POA occluder was used in 3 and the Amplatzer ASD occluder in 1. Pulmonary effusions resolved in all the patients who had transcatheter APF closure as did the case of SVC syndrome. There were no complications. Transcatheter APF occlusion seems both safe and feasible in patients with hemodynamic compromise following BCPA with residual APF. Temporary occlusion testing prior to permanent device closure is recommended.

Transcatheter occlusion of a classical BT shunt with the Amplatzer Duct Occluder II

We report on a 57-year-old woman who underwent transcatheter occlusion of a residual classical Blalock-Taussig shunt with the Amplatzer(R) Duct Occluder II (ADO II) 35 years following definitive surgical correction for tetralogy of Fallot.

The Impacts of Transcatheter Occlusion for Congenital Atrial Septal Defect on Atrial Volume, Function, and Synchronicity in Children: A Three‐Dimensional Echocardiography Study

To evaluate the impacts of transcatheter closure for atrial septal defect (ASD) on the atria. Thirty-four patients with ASD undergoing transcatheter occlusion were recruited in the study, and 34 patients undergoing surgical operation and 34 healthy children were age-matched as controls. A real time three-dimensional (RT3DE) echocardiography was used to measure the volume, function, and synchronicity of the atria. There was no difference in the atrial volume and function between the transcatheter occlusion group and healthy control group (P > 0.05). However, the parameters reflecting the atrial asynchrony were larger in the transcatheter occlusion group (P < 0.05). Compared to the surgical repair group, the transcatheter occlusion group had smaller maximum volume of the left atrium (21.0 +/- 5.2 ml/m(2) vs 24.3 +/- 5.8 ml/m(2), P = 0.01), smaller total emptying volume of the left atrium (12.7 +/- 4.3 ml/m(2) vs 15.1 +/- 3.8 ml/m(2), P = 0.014), smaller total emptying volume of the right atrium (13.5 +/- 5.2 ml/m(2) vs 16.1 +/- 4.7 ml/m(2), P = 0.029), and larger atrial systolic asynchrony indices. An atrial asynchrony is observed in patients with transcatheter closure of ASD, although little negative impacts on the atrial volume and function are demonstrated, which deserves more attention during follow-up of this specific population.

Real-time 3D transoesophageal echocardiography for guiding Amplatzer septal occluder device deployment in an adult patient with atrial septal defect

A 32-year-old male with secundum atrial septal defect underwent percutaneous transcatheter occlusion. The procedure was performed under general anaesthesia and guided by real-time 3D transoesophageal echocardiography (TEE) (i.e. 33, matrix probe 2-7 MHz). The device delivery system was advanced through a femoral vein catheter and placed in the left upper pulmonary vein. A 3D left atrial view was instantaneously obtained. The size of the septal occluder was chosen according to the balloon catheter method. A 12 mm Amplatzer device was deployed under real-time 3D TEE without fluoroscopy. The 3D views depicted the progression of the left-side disc from the left atrial cavity towards the septum. Left and right atrial views demonstrated the perfect application of the device to the atrial septum. Keeping a steady traction on the delivery rod, the right-side disc of the device was then deployed on the right atrial side of the defect. A pushing and pulling of the delivery cable ensured that the device was in a secure and stable position. Absence of peri prosthetic residual shunt was assessed by 2D colour Doppler TEE before release. Transthoracic echocardiography performed the day after ensured the right position of the device. Real-time 3D TEE is a very recent technology allowing on-line guidance of atrial septal occluder device deployment; such imaging should increase delivery safety and decrease fluoroscopy time.

Is transcatheter occlusion of a persistent foramen ovale a possibility for the avoidance of a paradoxical embolism?

Cerebral embolism may have different causes with sometimes serious consequences. If no specific reason can be found, paradoxical embolization through a persistent foramen ovale (PFO) is increasingly as a cause of the cerebral ischaemia. This study was undertaken to ascertain whether in patients with cerebral embolism occlusion of a PFO with a transcatheter technique can prevent further cerebral emboli. Indications for transcatheter occlusion were based on neurological signs (ischaemic stroke), cardiovascular diagnosis, and coagulation tests. Between August 1991 and July 1996, transcatheter occlusion of a PFO was performed in 28 fully anticoagulated patients (median age 37.8 [15.4-65.4] years). The mean PFO diameter was 9.5 mm (3-17), mean duration of fluoroscopy 18.3 (8.7-43.1) min. The Rashkind device was implanted in three patients, the Sideris buttoned device in 25. During the follow-up period (2-64 months; mean 13 months) renewed neurological symptoms occurred in only one patient. Transoesophageal echocardiography excluded thrombi on the implanted device or in the left atrium, and a residual PFO. The cause of the one neurological episode is therefore not clear. All other patients have remained free of symptoms and recurrence without anticoagulation after placement of the device. Transcatheter occlusion of a PFO is a relatively simple and safe procedure. Our results suggest that it can at least lower the incidence of further cerebral embolizations. The clinical value of the method in comparison with anticoagulation requires further study.

Retrograde aortic perfusion dislodges a dislodged Amplatzer device

Retrograde aortic perfusion dislodges a dislodged Amplatzer device

Interventional treatments for stroke prevention in atrial fibrillation with emphasis upon the WATCHMAN device

Stroke is a leading cause of death and disability worldwide. Many strokes occur in patients with atrial fibrillation. Current guidelines recommend an antithrombotic regimen with warfarin to prevent thromboembolism in atrial fibrillation; however, a substantial number of patients are not eligible for this therapy. The exclusion of the left atrial appendage from circulation seems to be an alternative strategy for stroke prevention in atrial fibrillation. The review focuses on the different devices for stroke prevention in patients with atrial fibrillation. Recently, two devices developed for percutaneous transcatheter occlusion of the left atrial appendage have been studied: the PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) device and the WATCHMAN device. Safety and feasibility data are available for both devices. About 200 patients have received a PLAATO device. These patients were at high risk for thrombembolic stroke and were not candidates for oral anticoagulation therapy. The WATCHMAN device was implanted in 75 patients that were eligible for long-term anticoagulation therapy with a moderate risk for thrombembolic stroke due to nonvalvular atrial fibrillation. For both devices, a reduction in the risk of stroke was documented, and device implantation was shown to be safe and feasible. Provided the ongoing trials show noninferiority to oral anticoagulation, another therapeutic option will become available to prevent ischemic strokes.

Completely endoscopic removal of a dislocated Amplatzer atrial septal defect closure device

Surgical treatment of residual shunts after transcatheter occlusion of atrial septal defect or patent foramen ovale is reported in approximately one to two percent of these percutaneous interventions. Minimally invasive surgery on the atrial septum is getting more and more common but little data is available on Amplatzer device explantation through limited access. No completely endoscopic device removal has been described previously. We report a case of a 57-year-old woman in whom an Amplatzer device was removed in a robotic totally endoscopic fashion through ports only using the daVinci telemanipulation system.

Transcatheter closure of congenital coronary arterial fistulas in adults

We have described our experience with transcatheter occlusion of congenital coronary arterial fistulas in adults. Six symptomatic patients, mean aged 41+/-12 years (four men, two women) underwent transcatheter occlusion of fistulas. All had chest pain or dyspnea on exertion. Four of the patients had single fistula. Two of the patients had multiple fistulas. The fistulas originated from the left anterior descending coronary artery in four patients, and from the circumflex artery in two. They all drained into the pulmonary trunk. Graft stenting was used in two patients who had multiple fistulas, and coils in four who had a single fistula. The coils were implanted through a microcatheter, which was passed through a JL 4 8F guiding catheter. Coils were used to completely occlude fistulas. Two 3.0x20 mm coronary graft stents were deployed in the coronary arteries to occlude the fistulas. The procedures were uncomplicated. At follow up, all patients underwent coronary angiography, and one of the patients with coil embolization and one of the patients with graft stenting had small residual flow. Patient's chest pain or dyspneas have resolved after the procedure. Transcatheter closure in adults of congenital coronary fistulas with graft stents and coils are safe and effective, and can be regarded as an acceptable alternative to surgery.

Oclusão percutânea dos defeitos do septo atrial utilizando mais de uma prótese

INTRODUÇÃO: O fechamento percutâneo das comunicações interatriais (CIAs) é uma alternativa à cirurgia, aceita em todo o mundo. O uso de mais de uma prótese tem sido descrito, mas ainda há poucos estudos sobre o assunto, especialmente no que diz respeito ao seguimento a longo prazo. Neste trabalho, apresentamos nossa experiência com o uso de mais de uma prótese para o fechamento dos defeitos atriais múltiplos, e discutimos as diferentes condições em que isso se faz necessário. MÉTODO: Este é um estudo retrospectivo, em que foram analisados todos os casos submetidos a fechamento percutâneo de CIAs, no período de abril de 1999 a dezembro de 2007. Do total de casos, selecionamos aqueles portadores de defeitos múltiplos, concentrando nosso relato nos que necessitaram de mais de uma prótese para sua oclusão. Incluímos, também, dois casos de pacientes com shunt residual após o implante prévio de uma primeira prótese e que necessitaram de um segundo dispositivo. Os casos foram todos selecionados por meio de ecocardiogramas transesofágicos (ETE). RESULTADOS: No período mencionado, 211 pacientes foram submetidos a fechamento percutâneo de CIAs. Em 12 (5,6%) desses pacientes foi preciso utilizar duas próteses para oclusão de seus defeitos, como se segue: oito pacientes tinham dois orifícios; dois tinham três orifícios; e dois tinham quatro orifícios. A média das idades foi de 27,5 ± 14,6 anos. Dois casos apresentaram acidentes isquêmicos cerebrais prévios. Foram utilizadas 24 próteses, sendo 23 Amplatzer para CIAs e uma Amplatzer para forame oval (FOP). O implante foi possível em todos os casos. O diâmetro dos orifícios menores era de 10,5 ± 4,0 mm e dos maiores, de 20,6 ± 5,5 mm. O diâmetro central das próteses de CIA variou de 5 mm a 34 mm (16,8 ± 7,6 mm). Não houve complicações graves ou óbitos. Shunt residual imediato estava presente em dois (16,6%) pacientes. Foram acrescentados à casuística mais dois casos de shunt residual significativo, fechados, com sucesso, com uma segunda prótese Amplatzer para CIA. CONCLUSÕES: Apesar de tecnicamente mais complexo, o fechamento das CIAs com duas próteses é possível, seguro e eficaz. Até o presente momento, o uso de duas próteses metálicas não parece ser danoso ao septo atrial ou a estruturas vizinhas. Apesar disso, mais estudos são necessários para definir a segurança desse procedimento, especialmente em crianças.

Unsuccessful Percutaneous Transcatheter Occlusion of A Patent Ductus Arteriosus and Surgical Treatment

The traditional percutaneous transcatheter approach is not ideal in closing some types of patent ductus arteriosus due to morphological abnormalities. The anatomic changes of the patent ductus arteriosus in adult patients, such as being short or sometimes friable, could complicate its transcatheter occlusion. In this study, we reported successful surgical closure of our case with patent ductus arteriosus of abnormal morphology under the light of literature who underwent an unsuccessful attempt of transcatheter occlusion.

Usefulness of Transesophageal Echocardiography in Percutaneous Transcatheter Repairs of Paravalvular Mitral Regurgitation

This study was conducted to assess the usefulness of transesophageal echocardiography (TEE) as a guide in the percutaneous transcatheter occlusion of paravalvular defects and in subsequent follow-up. In 27 consecutive patients with mitral paravalvular leaks with significant regurgitation considered to be poor surgical candidates who were treated with percutaneous closure of the defects, TEE was performed before and during the procedure. If the device was successfully positioned, a reevaluation was made 1 month later. Events occurring during the procedure and 1-month follow-up were recorded. The device was correctly positioned in 17 of the patients (63%). TEE enabled the detection of complications (intraprosthetic insufficiencies due to passing the guide through the prosthesis, blockade of the prosthesis, etc.). It also confirmed the correct canalization of the leak with the catheter and the position of the device. In 8 patients (47% of patients with successful implantation), the degree of regurgitation was substantially reduced after 1 month. In conclusion, TEE is a fundamental technique when considering the percutaneous treatment of paravalvular leaks in patients with high surgical risk. It provides essential information on the characteristics of the dehiscence during implantation and follow-up.

Transcatheter Closure of Patent Ductus Arteriosus Among Native High-Altitude Habitants

Increased prevalence of patent ductus arteriosus (PDA) at high altitude (HA) is a known occurrence. Transcatheter treatment of patients with PDA living at a HA is assessed in this study. Thirteen consecutive patients (all habitants of La Paz, Bolivia) underwent transcatheter closure of PDA. The minimal diameter of PDA was 5.8 (1.5-11) mm and the mean pulmonary artery pressure was 37 (7-80) mm Hg. In 12 patients, the Amplatzer Duct Occluder (ADO) was used; in one child with PDA with a 1.5-mm diameter, a detachable coil was implanted. All procedures, except for one, were completed successfully. The ADO (diameter: 12/10 mm) implantation failed in one child with pulmonary hypertension because the device could not be properly secured in position in a 6-mm PDA. Subsequent surgery was performed without any complications. No residual shunt after 24 h was observed in any case after treatment. No complications were encountered during the procedure and follow-up of 1.5 (from 0.1 to 2.8) years. PDA in native residents of high land have different physiopathologies and anatomies. ADO appears to be a suitable device for transcatheter occlusion for most such patients. Interventional cardiology in countries with residents at high altitudes can be helpful in addressing this issue.

Transcatheter Closure of Bilateral Multiple Huge Pulmonary Arteriovenous Malformations with Homemade Double-Umbrella Occluders

A 28-year-old man underwent successful transcatheter occlusion of three huge pulmonary arteriovenous malformations (PAVMs) using homemade double-umbrella occluders and stainless steel coils. Thoracic CT with three-dimensional reconstruction and pulmonary angiography were used for treatment planning and follow-up. The diameters of the feeding vessels were 11 mm, 13 mm, and 14 mm, respectively. This report demonstrates the novel design and utility of the double-umbrella occluder, an alternative tool for treatment of large PAVMs.

Short- and mid-term outcomes of arrhythmia after transcatheter and surgical closure of membranous ventricular septal defects: a comparative analysis

To evaluate the short- and mid-term outcomes of arrhythmia in patients undergoing transcatheter and surgical closure of membraneous ventricular septal defect (VSD). 358 VSD patients, 161 male and 197 female, aged (11 +/- 8), underwent transcatheter closure and 50 sex, age, body weight, size of membranous VSD, and percentage of complicated membranous aneurysm-matched VSD patients underwent surgical closure. Electrocardiography was conducted 1, 3, 6, and 12 months after VSD closure. Except bundle branch block other kinds of arrhythmia were resolved in all the patients prior to discharge. The arrhythmias occurring in the patients who underwent transcatheter closure of VSD included complete right bundle branch block (CRBBB, 4 5%), incomplete right bundle branch block (IRBBB, 10.1%), left anterior fascicular block (LAFB, 2.8%), IRBBB complicated with LAFB (1.7%), and CRBBB complicated with LAFB (0.6%), while in the patients who underwent surgical closure included CRBBB (26%) and IRBBB (28%). At the end of 12 months of follow-up, of the 180 patients who had undergone interventional therapy 6 showed CRBBB (3.3%), 6 showed IRBBB (3.3%), 3 showed CRBBB complicated with LAFB (1.7%) and one showed third degree auriculo-ventricular block (0.56%) s, however, no significant change in the ECG findings occurred in the patients who had undergone surgical closure. Transcatheter occlusion of membraneous VSD is safer than surgical closure. IRBBB and LAFB caused by interventional therapy are benign, the majority of which may resolve itself 6 - 12 months after the procedure. However, CRBBB and CRBBB complicated with LAFB need a long-term follow-up.

Transcatheter Occlusion of a Modified Blalock–Taussig Shunt Using the Amplatzer Vascular Plug with the Catheter–Snare Technique

A 16-month-old boy with previous repair of a critical pulmonary stenosis had persistence of a right modified Blalock-Taussig shunt. Transcatheter occlusion of the modified Blalock-Taussig shunt was achieved using the Amplatzer vascular plug with the catheter-snare technique.

Spontaneous Development and Rupture of Pulmonary Artery Aneurysm: A Rare Complication in an Infant with Peripheral Pulmonary Artery Stenoses Due to Mutation of the Elastin Gene

We present a 3-year-old boy with an elastin gene mutation and multiple peripheral pulmonary stenoses, who developed aneurysms of the pulmonary arteries spontaneously. We performed transcatheter occlusion of the aneurysms with detachable coils. While pulmonary arterial aneurysms may develop following pulmonary balloon angioplasty, spontaneous development is exceedingly rare. To the best of our knowledge, this is the first report describing spontaneous development of pulmonary artery aneurysms in a patient with peripheral pulmonary artery stenoses due to mutation of the elastin gene or Williams-Beuren syndrome.

Covered Stent Deployment for a Thoracic Aortic Pseudoaneurysm Associated with Pseudocoarctation of the Aorta

An 11-year-old girl presented to our unit after transcatheter occlusion of a patent arterial duct (PDA) with a Rashkind device at 1 year of age. She had been treated for osteomyelitis and also had previously undergone a repeat Nissen fundoplication. She was hypertensive with diminished femoral pulses. Two-dimensional transthoracic echocardiography showed a diastolic tail on spectral Doppler. However, no discrete coarctation of the aorta was observed. Diagnostic cardiac catheterization demonstrated a bilobed saccular protrusion from the descending thoracic aorta (Fig. 1a) with a pullback gradient of 30 mmHg across the defect. Magnetic resonance imaging confirmed a bilobed pseudoaneurysm of the thoracic descending aorta with a smaller upper component and a larger lower component (Fig. 1b). Both methods demonstrated the close relationship of the posterior intercostal arteries to the presumed false aneurysm. Left and right eighth and tenth intercostal arteries arose from a normal aorta very close to the margins of the defect. Left and right ninth intercostal arteries arose from the abnormal aorta, the left ninth from the upper surface of the larger lobe of the aneurysm. The importance of this region lies in the arteria radicularis magna (of Adamkiewicz), which usually arises from a lower intercostal or upper lumbar branch of the aorta. Because the radicular arteries, and particularly this artery, may be the only blood supply to large portions of the spinal cord, the consequent risk of cord infarction must be considered before intervention. In this case, the eighth and tenth posterior intercostal vessels supplied relatively large vessels running into the spinal vasculature. We deployed a 38-mm covered stent (Jomed International, Helsinborg, Sweden) mounted on a 10 mm · 4 cm Powerflex balloon (Cordis Europe, Roden, The Netherlands). Angiography after deployment demonstrated a good result, and although several intercostal vessels were excluded from the aorta (Fig. 1c), there was no spinal cord compromise with normal lower limb neurology. A followup computed tomography (CT) scan demonstrated residual flow into the pseudoaneurysm inferiorly. An overlapping 28-mm covered stent was deployed, resulting in complete resolution of the residual leak (Fig. 2). True and false aneurysms of the descending thoracic aorta are well described in the setting of aortic coarctation after both surgical repair [1, 2] and transcatheter endovascular stenting [3]. The etiology of this lesion remains debatable. Although we favor trauma as a cause during the previous cardiac catheterization, mycotic aneurysm secondary to osteomyelitis or indeed damage during the Nissen fundoplication also may provide alternative explanations. Deployment of covered stents for thoracic aortic aneurysms is well described [4] and may be preferable to surgery with little or no compromise of the spinal vessels reported.

Hemoptysis Complicating Scimitar Syndrome: From Diagnosis to Treatment

We report the case of a 24-year-old patient with known scimitar syndrome presenting with hemoptysis. Multidetector CT angiography showed the scimitar vein draining the right lung to the inferior vena cava associated with right lower lobe bronchopulmonary sequestration. The presence of hemoptysis associated with scimitar syndrome is likely secondary to an anomalous systemic arterial blood supply. We treated this patient successfully with transcatheter occlusion of the anomalous feeding arterial vessels.

WATCHMAN ® Left Atrial Appendage System for Stroke Prevention in Atrial Fibrillation: A percutaneous-device Delivery Approach

Sick PB, Schuler G, Hauptmann KE et al.: Initial worldwide experience with the WATCHMAN left atrial appendage system for stroke prevention in atrial fibrillation. J. Am. Coll. Cardiol. 49(13), 1490-1495 (2007). Left atrium appendage (LAA) occlusion is a potential alternative to warfarin in patients with atrial fibrillation who have contraindications to anticoagulation. Currently, there are two devices specifically designed for LAA occlusion: the percutaneous LAA transcatheter occlusion (PLAATO System, ev3 Inc., MN, USA) and the WATCHMAN LAA system (Atritech Inc., MN, USA). Initial results from a study with the WATCHMAN device suggest that the LAA occlusion may reduce the long-term risk for stroke. Available data are still very limited and although occluding the LAA appears to be technically feasible, its long-term safety and ability to reduce stroke incidence remains to be proven. Only prospective randomized studies will be able to tell us if the LAA occlusion devices can be used as an alternative treatment strategy to the standard long-term anticoagulation.