Coronary cameral fistula treated by the Amplatzer vascular plug

Coronary artery anomalies occur in less than 1 % of the general population. With the advent of multidetector rows and 3D reconstruction, multidetector computed tomography has emerged as the modality of choice in the delineation of the complex coronary anatomy and diagnosis of coronary artery anomalies, helping in the institution of appropriate therapy. We report a case of coronary cameral fistula of the left anterior descending artery to the right ventricle, which was closed by an Amplatzer vascular plug. Coronary CT angiography was used to evaluate the patient prior to the procedure to locate the placement site for the vascular plug.     

Percutaneous embolization of a caroticoazygous fistula with the Amplatzer Vascular Plug 1

We present the case of a five-year-old boy with a caroticoazygous fistula, which is an extremely rare congenital vascular malformation. The patient also had patent ductus arteriosus, a common cause of continuous murmur. The murmur continued despite successful coil embolization of the ductus. Repeated catheter-angiography revealed a large caroticoazygous fistula. The fistula was successfully embolized using the Amplatzer(?) Vascular Plug 1. Transcatheter occlusion of caroticoazygous fistula was performed easily, safely, and efficiently with a vascular plug.     

Successful exclusion of a large bronchopleural fistula using an Amplatzer II vascular plug and glue embolization

We report a case of a 63-year-old man with a complicated postsurgical bronchopleural fistula (BPF), which was treated with a minimally-invasive hybrid procedure using fluoroscopy, bronchoscopy, and thoracoscopy. A previous surgical attempt had failed to seal the pathologic tract. An Amplazter II vascular plug was successfully deployed into the BPF, followed by autologous blood and glue injection. An adjunctive endoscopically-guided glue embolization was deemed necessary. The 14-month clinical and imaging follow-up confirmed the successful exclusion of the BPF. No migration of the device was noted and the patient remained asymptomatic. The combined endoscopic and fluoroscopic guided management of a BPF using the Amplatzer II vascular plug and glue was proven safe and effective after mid-term follow-up.     

术中应用Amplatzer封堵器关闭婴儿多发性肌部室间隔缺损

目的 报道1例小婴儿肌部多发性室间隔缺损（VSD）术中镶嵌治疗的初步经验。方法 正中胸骨切口开胸,在食管超声的导引下,在跳动心脏的右心室表面导入Amplatzer封堵器关闭2处肌部VSD。结果 成功封堵2处肌部VSD,术后恢复顺利。结论 将手术和介入治疗结合的镶嵌治疗小婴儿肌部VSD是一种安全、有效的方法。     

国产Amplatzer封堵器治疗室间隔缺损

目的　观察国产Ampatzer封堵器治疗室间隔缺损(VSD)的临床疗效及安全性。方法　2 0 0 3年1月至2 0 0 5年4月采用国产封堵器对16例VSD施行封堵术。患者年龄3.5～4 1(13.98±11.0 5 )岁,体重12 .5～5 9(32 .1±17.5 9)kg。超声心动图显示室间隔回声中断3.7～9mm(5 .34±1.75mm)。所有病人在透视及超声监测下完成VSD封堵治疗。结果　术中造影示漏斗部嵴内型2例,膜部14例。13例患者封堵器置入成功。2例分别采用6 8mm、4 6mm动脉导管未闭Amplatzer伞封堵,另外8例应用对称型室间隔封堵器,型号为4～10 (7±2 .39)mm。左心室造影测量室缺直径为3.2～11(4.9±1.8)mm,缺损上缘距主动脉根部距离0 .8～9(3.1±2 .2 )mm ,10例合并有膜部室间隔膨出瘤.11即刻无分流,1例术后即刻有流速达4 .5cm s的2mm的残余分流。3例失败,原因分别为嵴内型缺损、多孔型缺损、操作粗暴损伤右房室瓣。术后发生一过性束支传导阻滞3例,永久性左束支传导阻滞、右束支传导阻滞各2例,一过性机械性溶血1例。余无其他并发症发生。结论　国产Amplazer封堵器治疗室间隔缺损安全有效,近期效果良好,中远期疗效有待于进一步观察     

隐匿性异位促肾上腺皮质激素分泌的影像学检查：CT影像复习

异位促肾上腺皮质激素分泌（ectopic adrenocorticotrophin secretion,EAS）综合征较为罕见．是由非垂体性肿瘤分泌过量促肾上腺皮质激素（ACTH）所致。这类肿瘤可以是隐匿性的,其所在位置不明显,而且体积非常小,以致于影像检查困难。在临床及生化方面很难鉴别隐匿性EAS和Cushing＇s病。判断ACTH产生来源的首选检查方法为CT。本研究目的在于举例说明肿瘤可能的隐匿位置及其相关影像学表现。我们回顾了导致隐匿EAS肿瘤的CT表现及其相关文献。最常见的肿瘤是支气管类癌．     

Percutaneous treatment of a duodenocutaneous high-flow fistula using a new biological plug

Enterocutaneous fistula is a challenging entity and a gold-standard treatment is not settled so far. Here, we describe the successful closure of a duodenocutaneous fistula with the use of the Biodesign enterocutaneous fistula plug (Cook Medical), which is derived from a biological plug that has been used in recent years in order to close anorectal fistula tracts.Enterocutaneous fistula is defined as an abnormal communication between the small or large bowel and the skin. It is a well-known surgical complication associated with long hospital stay and high morbidity and mortality. Mortality rate varies between 5% and 20%, and it is frequently associated with sepsis and nutritional abnormalities. Spontaneous closure rate varies among studies, ranging from 7% to 70% (1). Patients unresponsive to conservative therapy require surgical repair, therefore, a treatment that could shorten fistula closure time avoiding a second operation would be highly beneficial.Recently, multiple attempts have been made to treat these patients using nonsurgical methods. Image-guided percutaneous drainage is one of the most used interventional radiological procedures, widely proven as a feasible, safe, and effective treatment of intra-abdominal abscess and fluid collections. However, the presence of a concomitant intestinal fistula remains a significant challenge and drainage has proven to be associated with a low success rate.Here, we present a case in which a biological plug was inserted percutaneously to close a duodenocutaneous fistula. This device is well known for its application in anorectal fistulas (2).     

MDCT evaluation after closure of atrial septal defect with an Amplatzer septal occluder

OBJECTIVE: The essay describes the protocol for and interpretation of MDCT scans in the evaluation of patients after insertion of an Amplatzer septal occluder. CONCLUSION: In anatomic regions that cannot be confidently evaluated with transthoracic echocardiography, MDCT is useful for evaluating Amplatzer septal occluders for protrusion, migration, and residual shunt. Radiologists should be familiar with the imaging protocol and interpretation.     

Peripheral vascular applications of the Amplatzer vascular plug

PURPOSE: To present our experience using the Amplatzer vascular plug in various arterial and venous systems, and follow-up results. MATERIALS AND METHODS: Between May 2005 and October 2006, 20 Amplatzer vascular plugs were used to achieve occlusion in 20 vessels in 12 patients (10 male, 2 female) aged between 24 and 80 years (mean age, 55 years). Localization and indications for embolotherapy were as follows: pulmonary arteriovenous malformations (n = 3; 9 vessels), internal iliac artery embolization before stent-graft repair for aortoiliac aneurysms (n = 4; 4 vessels), preoperative (right hemipelvectomy) embolization of bilateral internal iliac arteries (n = 1), bilateral internal iliac aneurysms (n = 1), large thoracic side branch of the left internal mammary artery coronary by-pass graft causing coronary steal syndrome (n = 1), closure of a transjugular intrahepatic portosystemic shunt (n = 1), and testicular vein embolization for a varicocele (n = 1). RESULTS: The technical success rate was 100%, with total occlusion of all the targeted vessels. Only one device was used to achieve total occlusion of the targeted vessel in all patients (device size range, 6-16 mm in diameter). No major complications occurred. Target vessel occlusion time after deployment of the Amplatzer vascular plug was 6-10 min in pulmonary arteries (mean, 7.5 min) and 10-35 min (mean, 24.4 min) in systemic arteries. Mean follow-up was 6.7 months (range, 1-18 months). CONCLUSION: Embolization with the Amplatzer vascular plug is safe, feasible, and technically simple with appropriate patient selection in various vascular territories.     

Renal artery stump to inferior vena cava fistula: unusual clinical presentation and transcatheter embolization with the Amplatzer vascular plug

Fistulous communication between the renal artery stump and inferior vena cava following nephrectomy is rare. We describe the case of a 52-year-old man with a fistula detected on investigation for hemolytic anemia in the postoperative period. The patient had had a nephrectomy performed 2 weeks prior to presentation for blunt abdominal trauma. The fistula was successfully occluded percutaneously using an Amplatzer vascular plug. The patient recovered completely and was discharged 2 weeks later.     

应用国产封堵器闭合室间隔缺损修补术后残余漏

目的 评价应用国产封堵器治疗室间隔缺损修补术后残余漏的可行性和疗效.方法 11例患者,经胸超声心动图测量室间隔缺损术后残余漏直径为3～9 mm,平均(5.82±2.09)mm.经股静脉通过6～9 F鞘管送入封堵器,在X线透视和超声引导下完成操作.结果 左心室造影8例为膜部瘤型,3例为漏斗型.造影显示单出口6例,多出口5例,缺损口直径3～9 mm,平均(6.09±1.58)mm.应用封堵器直径(8～12)mm.10例患者应用1个封堵器完全封堵.1例残余漏有4个漏口,应用2个封堵器后仍有少量残余分流.升主动脉造影均无主动脉瓣返流.1例术后第3天发生完全性房室传导阻滞,应用氢化可的松治疗2周后完全恢复.术中X线透视时间8～30 min,平均(16.91±4.23)min.术后随访1个月～4年,1例残余分流仍存在.全部患者无血栓栓塞、溶血、感染性心内膜炎,无封堵器移位,无主动脉瓣反流等并发症.结论 经导管封堵治疗室间隔缺损修补术后残余漏疗效可靠,操作安全.     

肺动脉左心房瘘封堵成功一例

患儿男,5岁.发现心脏杂音5年.出生时全身青紫,3岁时口唇紫绀加重,平时易患感冒,活动后气促,为进一步诊治入院.查体:体温36.8℃,脉搏110次/min,呼吸25次/min,血压90/60 mmHg,体重15.5 kg,身高108 cm.     

Percutaneous Transcatheter Embolization of a Large Pulmonary Arteriovenous Fistula with an Amplatzer Vascular Plug

Percutaneous transcatheter embolization has become the treatment of choice for pulmonary arteriovenous fistulas (PAVFs), in most cases replacing surgical intervention. However, while "classic" devices, such as intravascular coils and detachable balloons, have proved to be successful for interventional occlusions of small or medium-sized PAVFs, they are not ideal in larger fistulas because of the risk for embolization to the systemic circulation. We describe the case of a 61-year-old woman with a symptomatic huge solitary pulmonary arteriovenous fistula (4.5 cm in diameter), occupying part of the lung in the lower right lobe with two feeding arteries (10 and 4 mm in diameter, respectively), who underwent successful transcatheter closure with an Amplatzer Vascular Plug, a new device designed for the occlusion of vascular abnormalities.     

应用新型Amplatzer膜部室缺堵闭器关闭儿童膜周室间隔缺损的临床研究

目的　探讨经导管采用新型Amplatzer膜部室缺堵闭器关闭儿童膜周室缺的安全性及可行性。方法　 2 0 0 2年 6月～ 2 0 0 4年 7月 32例膜周部室间隔缺损的患儿接受经导管采用新型Amplatzer膜部室缺堵闭器的介入治疗 ,年龄 3～ 15岁 ,平均 (6 .1± 2 .8)岁 ,体重 12～ 31kg(18.9± 5 .1kg) ,所有病例术前检查证实为膜周部室间隔缺损 (PVSD) ,缺损大小 (8.91± 2 .2 6 )mm(4～ 13mm) ,分流口大小 (3.3±1.1)mm(2 .3～ 7.0mm) ,距离主动脉瓣 (4 .2 1± 2 .10 )mm(0 .5～ 8mm) ,有假性室隔瘤形成 7例 (其中 2个及以上分流口 2例 ) ,部分右房室瓣组织附着 19例。术后定期行TTE及临床检查随访。结果　本组封堵技术成功率 10 0 % ,堵塞后即刻完全封堵率 90 .6 % ,术后 6个月完全封堵率 96 .9% ,仅 1例存在无血流动力学改变的少许残余分流。除术中有一过性房性、室性早博 ,室性心动过速 ,房室传导阻滞 ,束支传导阻滞 ,无一例发生Ⅲ°AVB ,栓塞 ,溶血 ,封堵器脱落 ,心内膜炎等并发症 ,仅 2例 (6 .3% )有轻微主动脉返流 ,2例有轻度右房室瓣返流 ,术后病理生理及血流动力学有明显改善 ,LVDd、LVDs、LA术后明显缩小 ,MPA流速、MV流速术后明显减慢。随访时间 6个月至 1年零 10个月。结论　经导管采用新型Amplatzer膜部     

彩色多普勒血流显像经胸超声心动图对室间隔缺损介入封堵治疗的价值

 目的探讨彩色多普勒血流显像(Color doppler flow imaging,CDFI)经胸超声心动图(Transthoraic echocardiogram,TTE)在室间隔缺损(Ventricular septal defect,VSD)介入封堵术前、术中及术后的应用价值.方法首先使用CDFI经胸超声心动图扫查选择适合做封堵术的VSD患者,然后监测导管引导Amplatzer封堵器治疗VSD的全过程,在监测过程中认真观察导管及封堵器的位置,配合封堵器的释放,观察封堵器是否已封堵好室间隔缺损处,周边有无残余分流.结果 CDFI经胸超声心动图扫查选择VSD 11例,均为膜部缺损.除1例因VSD上缘距主动脉瓣右冠瓣1.9～2.0mm,缺损口6.0 mm,并有胸骨畸形,封堵术改为经胸手术外,其余10例封堵成功,CDFI未见残余分流.结论 CDFI经胸超声心动图扫查对VSD封堵适应证的选择,封堵术中监测及封堵术后判断及追访均有着重要价值.     

Vascular percutaneous transcatheter embolisation with a new device: Amplatzer vascular plug

PURPOSE: The aim of this study was to evaluate the effectiveness of the new Amplatzer vascular plug (AVP) for the occlusion of vascular abnormalities and peripheral vessels, especially those with a large diameter. MATERIALS AND METHODS: The new device was used for the occlusion of five internal iliac arteries to prevent retrograde endoleak following endograft repair, three left subclavian arteries for the treatment of type II endoleaks after positioning thoracic aorta stent-grafts, one pulmonary arteriovenous malformation, one haemodialysis fistula in a patient with forearm oedema and one large gastric varix in a patient who had undergone transjugular intrahepatic portosystemic shunt (TIPS) for haemorrhage. RESULTS: The five internal iliac arteries and the three left subclavian arteries were successfully occluded within 8 and 5 min, respectively. The pulmonary arteriovenous fistula was closed within 3 min and percutaneous oxygen saturation rose from 73% to 93%. The haemodialysis fistula was closed with one device within 4 min. The gastric varix was embolised with two AVPs and two coils within 12 min. CONCLUSIONS: The AVP is an effective device for occluding large diameter vascular abnormalities and peripheral vessels. It is inexpensive and enables safe and low-risk embolisation, with saving of time and requiring only low X-ray dose.     

Recurrent rupture of a hypogastric aneurysm caused by spontaneous recanalization of an Amplatzer vascular plug

A patient with a ruptured hypogastric aneurysm was treated via an endovascular approach with coils in the outflow vessels and an Amplatzer vascular plug (AVP) in the main trunk. After 4 weeks, the patient was readmitted with a recurrence of rupture of the hypogastric aneurysm caused by recanalization of the AVP. Final occlusion of the hypogastric artery was achieved by placement of a stent-graft and additional coils. In consideration of this experience, it is recommended that additional coils or several AVPs be used and early contrast medium-enhanced computed tomography follow-up be performed.     

Spontaneous closure of an intracranial middle cerebral arteriovenous fistula

Summary This case report concerns the spontaneous closure of a middle cerebral arteriovenous fistula, lesions which are normally treated by surgery or interventional therapy. We have been unable to find any previous report of spontaneous closure of a similar fistula.