Delivery sheath tear after modification for ASD closure.

During transcatheter closure of an atrial septal defect with insufficient aortic rim, a standard delivery sheath was modified by cutting a bevel at the distal tip to improve device orientation. The sheath split longitudinally when attempting to recapture the closure device. Troubleshooting allowed a device to be implanted successfully. Pitfalls regarding our sheath modification and methods to overcome prolapse of the left atrial disk into the right atrium are discussed.     

Transcatheter closure of a large ASD from the femoral vein in a patient with Budd–Chiari syndrome

Anomalies of the inferior vena cava are rare in patients with isolated atrial septal defect (ASD). When present, they usually preclude successful transcatheter closure of the ASD using the femoral route. We report a case of a large secundum ASD in a 3‐year‐old child, who had a chronic Budd–Chiari syndrome incidentally detected on the cardiac catheterization table. We were able to successfully deploy the device from the femoral route itself using a collateral channel to reach the heart and then using the pulmonary vein deployment technique to successfully close the defect. © 2012 Wiley Periodicals, Inc.     

Spontaneous closure of esophageal tear in Boerhaave's syndrome.

An unusual case of spontaneous rupture of the esophagus is reported in which the patient survived without surgical closure or drainage procedure. The site of perforation and subsequent closure are documented radiologically.     

Suture-mediated closure of a patent foramen ovale during surgery without cardiopulmonary bypass.

A patent foramen ovale (PFO) is associated with an increased risk of recurrent ischemic strokes and transient ischemic attacks due to paradoxical emboli in patients with prior neurological events. We report a case of a surgical suture-mediated of a PFO closure without cardiopulmonary bypass in a patient with recurrent cerebral ischemic events, who was intolerant of medical therapy, was a poor candidate for catheter-based PFO closure, and presented as a potentially high risk for poor wound healing from traditional surgical closure.     

房间隔缺损封堵中、远期疗效分析

经皮介入治疗继发孔型房间隔缺损(ASD)日益增多,正成为外科修补术后的另一条治疗途径。其短期、近期疗效与外科手术相似,但手术致死率、致残率明显降低。由于应用时间不长,中、远期疗效仍有待进一步观察、评价。1资料与方法     

国产封堵器闭合房间隔缺损过程中的短暂ST段抬高2例（英文）

目的国产房间隔封堵器闭合房间隔缺损的安全性和有效性已得到证实。我们报告在使用国产封堵器闭合房间隔缺损过程中出现的短暂ST段抬高现象2例。方法适合进行经皮封堵术的房间隔缺损患者35例,使用北京华医圣杰公司生产的房间隔封堵器进行封堵。术前经胸超声充分评估缺损的大小、位置、与周围结构的距离以及房间隔的软硬边缘等,选择封堵器要与缺损的伸展直径相匹配。手术过程在局部麻醉或者基础麻醉下进行,术中使用经胸超声引导。封堵器释放后有效闭合缺损、位置稳定且不影响周边结构视为手术成功。术后3,6,12月进行随访。结果在35例患者中有2例在封堵器释放过程中,出现短暂性ST段抬高超过2mV,伴有心绞痛发作。心电图改变和症状发作平均持续时间（4.2±2.2）min,2例心电图改变均发生于II,III和aVF导联,此过程伴有心率减慢和血压降低。静脉注射硝酸甘油后心电图和症状没有得到即刻改善,但封堵器沿鞘管被收回后心电图立即改善、症状逐渐消失。换用较小型号的封堵器闭合房间隔缺损后,没有引起任何血流动力学异常和短暂性心电图改变。随访3,6,12月没有发现心肌缺血和心绞痛发作。结论经导管闭合房间隔缺损过程中出现的短暂ST段抬高现象,可能与所选封堵器直径过大,刺激房间隔有关。     

Unusual tear in inoue balloon during percutaneous balloon mitral valvuloplasty in a patient with calcific mitral stenosis

An unusual tear in an Inoue balloon during dilatation of calcific mitral stenosis is presented and its mechanisms discussed. An abnormal sequence of inflation indicates a possible tear.     

Use of a straight, side-hole delivery sheath for improved delivery of Amplatzer ASD occluder.

The Amplatzer ASD occluder may be difficult to position in some patients with a large atrial septal defect (ASD) or deficiency of one or more atrial septal rims. We developed a method to modify a Mullins transseptal sheath to enhance delivery. The resulting sheath is straight and has an exit orifice essential in the side of the distal portion of the sheath-a straight, side-hole (SSH) delivery sheath. We have used this modified delivery sheath in 140 successive patients with excellent results. The techniques of sheath modification and delivery of the device using the modified sheath are described.     

Floating thrombus on an ASD occluder device in a patient with hemophilia A

The case presented is that of a 29-year-old man with a history of hemophilia A who was admitted with recurrent onsets of transient cerebrovascular ischemia; he had undergone a transvenous closure of an atrial septal defects with an occluder device (Cardioseal Starflex) two months ago. Due to a factor-VIII deficiency, no further anticoagulation therapy was initiated. On admission, transesophageal echocardiography revealed a floating thrombus on the left atrial side of the umbrella. The device was explanted via a right minithoracotomy, and the atrial septal defect was closed. The patient had an uneventful recovery.     

Portal vein resection without reconstruction during Appleby operation in a patient with pancreatic body carcinoma with cavernous transformation.

The prognosis of pancreatic body carcinoma has been poor due to cancerous invasion of major vessels. Resection of the involved vessels may improve resectability and prognosis. We report a patient who had a pancreatic body carcinoma with cavernous transformation of the portal vein, in whom the portal vein was resected without reconstruction during an Appleby operation. A 67 year-old man was admitted for evaluation of back pain. Enhanced computed tomography showed no main trunk of the portal vein but a developed collateral circulation. Celiac angiography revealed encasement of the common hepatic, splenic and celiac artery. Venous angiography revealed obstruction of the portal and splenic veins with cavernous transformation surrounding these veins. Pre-operative diagnosis was carcinoma in the pancreatic body, which invaded the portal vein, the celiac and common hepatic arteries. The Appleby operation combined with resection of the portal vein without reconstruction could be performed, by preserving collateral vessels and monitoring hepatic venous oxygen saturation (ShvO2) to prevent hepatic ischemia caused by occlusion of the portal vein. The post-operative course was uneventful.     

Acute two-vessel coronary closure in a patient with Down's syndrome

Myocardial infarctions are rare in patients with Down's syndrome. This paper reports an unusually aggressive presentation of two-vessel simultaneous coronary occlusion during an intended percutaneous intervention. Since survival in patients with Down's syndrome is improving, encounters with late (and perhaps unusual) sequelae of coronary artery disease are expected to increase. (Int J Cardiovasc Intervent 2003; 5: 95-97)     

Open heart closure of atrial septal defect in a patient with idiopathic thrombocytopenia.

A case of atrial septal defect with idiopathic thrombocytopenia was successfully operated with the aid of heart-lung machine. The operation was performed under the administration of platelet rich plasma, fresh blood and adrenocorticosteroids before, during and after the operation. With the aid of these treatments, no severe hemorrhagic diasthesis was encountered.     

Reduction of discomfort at sheath removal during transradial coronary procedures with the use of a hydrophilic-coated sheath.

Some patients experience discomfort at sheath removal during transradial procedures. We hypothesized that the use of a hydrophilic-coated sheath (HCS) would reduce the traction force needed at withdrawal and therefore the pain experienced by patients. Patients referred for coronary intervention were randomized to undergo transradial procedure with the use of HCS or with nonhydrophilic sheath (NHS). At removal of the sheath, peak traction force was recorded using an electronic traction gauge and patients were asked to quantify their pain. A total of 90 patients participated in the study. The mean +/- SD peak traction force at sheath removal was 265 +/- 167 g and 865 +/- 318 g in the HCS and NHS groups, respectively (69% reduction; P < 0.001). Mean maximal pain score was 0.6 +/- 1.2 and 4.8 +/- 2.9 in the HCS and NHS groups, respectively (88% reduction; P < 0.0001). Use of HCS for transradial procedures reduces considerably the traction force needed for sheath removal as well as pain experienced by patients when compared to NHS.     

Percutaneous suture-mediated closure of femoral access sites deployed through the procedure sheath: initial clinical experience with a novel vascular closure device.

The objective of this study was to assess the initial safety and feasibility of a novel suture-mediated device for closure of femoral access sites immediately after diagnostic or interventional cardiac catheterization. In a prospective study, 150 patients (mean age, 61.5 years; 109 male) underwent femoral access closure with a novel suture closure device (Superstitch, Sutura) immediately after diagnostic (n = 106) or interventional (n = 44) catheterization procedures, independently of the coagulation status. All patients were monitored for 24 hr after the procedure. The closure device was successfully deployed in 92% of patients. Immediate hemostasis was achieved in 77% of patients with no differences between patients undergoing diagnostic catheterization or coronary interventions (79% vs. 73%; P = 0.659). After 2 min of additional light manual compression, hemostasis was achieved in 92% of patients. There was one major complication requiring vascular surgery (0.7%). The novel suture closure device is a safe and effective device that allows for immediate closure of femoral puncture sites after both diagnostic and interventional procedures with a low rate of major complications.     

A modified Cook sheath for closure of a large secundum atrial septal defect.

Transcatheter closure of large secundum atrial septal defects with deficient rims is difficult. Several techniques have been described to improve delivery of the occluder in anatomically challenging cases. Among these is a recently described technique using a modified delivery sheath with the creation of a bevel. However, the initial case report was complicated by malfunction and longitudinal splitting of the sheath. We describe the successful use of a modified delivery sheath for closure of a large atrial septal defect with a deficient rim.     

Transcatheter closure of a traumatic VSD in an adult requiring an ASD occluder device

Traumatic ventricular septal defects (VSD) can occur after blunt or penetrating chest trauma or cardiac procedures. There are few publications reporting the safety and efficacy of transcatheter closure of traumatic VSDs. We report a case of a large VSD resulting from penetrating chest trauma that was not repaired at the initial surgical procedure on the disrupted right ventricle. Because of the late identification of the VSD postoperatively, transcatheter closure after the original surgical procedure was recommended and performed requiring an Amplatzer atrial septal defect occluder device because of defect size and configuration. This case describes the technique and postprocedure imaging leading to a cautionary note regarding VSD closure device techniques. © 2009 Wiley‐Liss, Inc.