Echocardiographic predictors of cardiac erosion after amplatzer septal occluder placement

The risk of erosion after Amplatzer septal occluder (ASO) device placement in atrial septal defects is well described. Aortic rim deficiency and use of over‐sized device increase the risk of erosion. This study attempts to describe device characteristics, anatomical features and echocardiographic predictors that increase the risk of erosion. Methods : From 2005 through 2012, 12 new cases, with nine confirmed and three suspected device erosions where pre‐procedural, intra‐procedural, and/or post‐procedural echocardiograms were available and, were reviewed. Following parameters were evaluated: ASD location (high or low), rims deficiency and consistency, septal mal‐alignment, dynamic nature of the defect; device edge relationship toward the transverse sinus (TS), atrial free wall tenting and the size of the defect compared with the size of the device used for closure. Results : We found poor posterior rim consistency, aortic rim absence (in multiple views) and absent aortic rim at O degree in 100% of the patients. Septal mal‐alignment and dynamic ASD was present in nearly 50% of the cases. The device was over‐sized in three patients only. A 26‐mm device was the most common device that resulted in erosion. In cases, where patient had experienced bloody pericardial effusion and the device was in place, device tenting in the TS was observed. Surgical explantation of the device confirmed presence of erosion in all cases. Conclusion : Aortic rim absence in multiple views, poor posterior rim consistency, septal mal‐alignment, and dynamic ASD appear to be factors where erosion risk increases significantly. A thorough assessment of the device edge by echocardiography in short‐axis may show device tenting of the atrial free wall into the TS. This finding should be a strong indictor to recommend surgical removal of device after occurrence of pericardial effusion. © 2013 Wiley Periodicals, Inc.     

Transcatheter occlusion of an intrahepatic venovenous fistula after modified Fontan circulation by implantation of an Amplatzer atrial septal occluder.

We report two successful transcatheter closures of intrahepatic venovenous malformations observed after bidirectional cavopulmonary anastomoses. These malformations were detected immediately after surgery in one case and during a 10-year follow-up in the second case. These intrahepatic venovenous malformations were successfully occluded by the implantation of an Amplatzer atrial septal occluder.     

Dysfunction of an atrial septal defect occluder 8 years after implantation

Catheter interventional treatment of atrial septal defect (ASD) is widely accepted. The ASD occluder system (ASDOS) is no longer a widely used device nowadays. However, it is implanted in a substantial number of patients. We report a case of severe left-to-right shunt 8 years after catheter interventional closure of an ASD with an ASDOS device. The shunt was due to a membrane perforation, while the arms of the device were not dislocated. Microscopy, microbiology, and histology could not establish a proper explanation for the dysfunction; so long-term follow-up investigation may be required in patients with an implanted ASDOS device.     

Late esophagopleural fistula after left pneumonectomy: report on one case

Esophagopleural fistula is an uncommon complication of pneumonectomy. Late nonmalignant esophagopleural fistula after left pneumonectomy for lung cancer is exceedingly uncommon. We report on one patient who developed such a fistula 33 months after the operation. Signs and symptoms were first attributed to infection of the thoracotomy incision and diagnosis was made only after detection of some food coming from the pleural space. Thoracostomy, enteral feeding by a percutaneously placed gastrostomy tube and myoplasty allowed both closure of the fistula and obliteration of the pleural space.     

Retrieval of an embolized amplatzer septal occluder

Percutaneous closure of secundum atrial septal defect (ASD) by various devices has been proven to be an effective and safe treatment modality for patients with congenital heart diseases. However, we have to be aware of the potential early and late complications like device embolization and formulate plan for rescue procedures. We have reported a case of successful closure of a large secundum ASD in a 23‐year‐old woman by a 40 mm Amplatzer septal occluder (ASO), which embolized into the right ventricle 4 hr after the procedure. This had caused palpitation and nonsustained ventricular tachycardia. Patient safety was our most important concern and after discussion with the cardiac surgeons and the patient, we would like to make a percutaneous stepwise attempt for retrieval. We first applied an endocardial biopsy forcep to grap the disk of the ASO to fix and stabilize the dislodged device. This would prevent the device from obstructing the inflow and outflow tract and causing catastrophic consequences. Then, a 15‐mm Amplatz gooseneck snare was used to catch exactly at the connecting hub of the ASO disk, and the whole apparatus could then be cautiously and safely retrieved out from her body without complications. This had saved her from an unplanned emergency open heart operation that carried significant bleeding complication. © 2009 Wiley‐Liss, Inc.     

Major intrahepatic veno-venous fistula after modified Fontan operation treated by transcatheter implantation of amplatzer septal occluder

Patients with complex congenital cardiac malformations who have been converted to the Fontan circulation with partial exclusion of the hepatic veins may develop progressive cyanosis because of formation of intrahepatic veno-venous malformations. We describe transcatheter closure of a major intrahepatic fistula in such a setting using an Amplatzer septal occluder delivered by the left jugular venous approach in a 5 year old boy.     

Giant septal cavity due to coronary artery fistula and ventricular septal dissection after cardiac surgery

Ventricular septal dissection may rarely result from infectiveendocarditis, myocardial infarction or sinus of Valsalva aneurysmprogression. A rare case that developed in a 66-year-old femaleafter mitral valve replacement for severe mitral regurgitationwith cordal rupture is presented and discussed. It resultedfrom a coronary artery fistula, from a septal branch, to a 6cm wide saccular cystic cavity within the interventricular septum,which was detected by transthoracic echocardiography some monthsafter surgery. Coronary arteries were anatomically normal. Coronaryangiography was helpful to clarify the origin of the fistula.Later on the patient developed heart failure and atrial fibrillation,but she refused any further intervention. She has been followedup for more than 7 years and is presently stable on medicaltherapy. A review of the peculiar aspects of the case is done and themost relevant aspects and images are presented and discussed.     

Migration of an amplatzer septal occluder device for closure of atrial septal defect into the ascending aorta with formation of an aorta-to-right atrial fistula

The percutaneous closure of atrial septal defects is increasingly used. Serious complications of the procedure, such as cardiac perforation and tamponade, are rare and usually occur <72 hours after device placement. The investigators report the late development of the erosion of an Amplatzer septal occluder into the ascending aorta with associated aortic-to-right atrial fistula formation.     

Development of aorta-to-right atrial fistula following closure of secundum atrial septal defect using the Amplatzer septal occluder.

An aorta-to-right atrial fistula developed within 3 months after closure of an atrial septal defect using the Amplatzer septal occluder. Surgical correction was required. The cause of this complication appears to be erosion into the aorta by the right atrial disk.     

Thrombus formation during percutaneous closure of an atrial septal defect with an Amplatzer septal occluder

Percutaneous closure of an ostium secundum-type atrial septal defect is typically a safe and effective therapeutic option in the presence of significant shunting or paradoxical embolism. Infrequently, however, periprocedural sequelae occur.Herein, we report the cases of 2 patients, each of whom underwent transcatheter closure of an atrial septal defect with the use of an Amplatzer Septal Occluder under transesophageal echocardiographic guidance. In both patients, acute thrombi formed periprocedurally, despite preprocedural anticoagulation. In patient 1, the infusion of unfractionated heparin for 24 hours prevented the recurrence of thrombus; in patient 2, the thrombus was isolated under the arm of the occluder, and unfractionated heparin was infused. Both patients were asymptomatic and without detectable thrombus after the procedure and at follow-up. These reports highlight a rare early sequela and the importance of transesophageal echocardiographic monitoring during the percutaneous closure of an atrial septal defect.     

Amplatzer房间隔缺损封堵器置入体内后形态的变化

目的探讨Amplatzer房间隔缺损封堵器(ASO)置入人体后形态的变化及其可能的影响.方法全组共34例房间隔缺损患者,按常规方法置入ASO,于术后24～48 h、3个月及1年以计算机X线摄影系统(CR)进行X线平片检查.选择左侧位片,以CR自带测量系统测量封堵器左、右房盘状结构中心的不透X线的金属标记的间距(D1)、封堵器左、右房盘状结构的直径(D2、D3).同时,患者亦行经胸超声心动图(TTE)检查,以评价封堵效果及封堵器对毗邻结构的影响.结果 34例封堵器置入均获得成功.本组病例ASD直径为(20.09±6.00) mm(6～29 mm),选择的封堵器直径为(23.97±5.93) mm(10～34 mm).34例均完成了术后24～48 h及术后3个月的随访,10例完成了术后1年的随访.术后3个月D1较术后24～48 h缩小,提示封堵器厚度变薄,D2及D3则无明显改变;术后1年D1较术后3个月进一步缩小,提示封堵器厚度继续减小,而D2及D3未见显著改变.D1与封堵器的直径呈部分相关.随访中TTE示ASD均完全闭合,未见残余分流;ASD毗邻结构未见受到封堵器形态变化的影响.结论应用X线平片及TTE可对Amplatzer房间隔缺损封堵器置入体内后的形态进行无创性观察.封堵器的厚度与其直径部分相关,在随访中厚度逐渐减小,几何构形更趋良好.封堵器几何形态的改变对其疗效未产生影响.     

国产室间隔缺损封堵器与Amplatzer封堵器的疗效比较

目的比较国产室间隔缺损封堵器与Amplatzer封堵器在经导管室间隔缺损封堵术中的疗效。方法41例患儿采用Amplatzer封堵器,76例患儿采用国产封堵器进行室间隔缺损封堵术,对比两组的疗效、并发症和费用等情况。结果国产组75例封堵成功（成功率99%）,进口组40例封堵成功（成功率98%）。两组患儿术前各项临床指标、手术和X线曝光时间、封堵成功率及住院天数,术后各项并发症发生率比较差异无统计学意义,两组患儿治疗前后左室舒张末径、收缩末径及C/T值减少程度无明显差异,治疗总费用进口组明显高于国产组。结论国产室间隔缺损封堵器与Amplatzer封堵器相比较其疗效、并发症发生率无显著差异,治疗费用低,临床应用前景广泛。     

Cardiac perforation after device closure of atrial septal defects with the Amplatzer septal occluder

OBJECTIVES: Amplatzer septal occluder (ASO)-associated cardiac perforation (CP) at our institution prompted this retrospective review. BACKGROUND: Cardiac perforation is a rare complication after transcatheter atrial septal defect (ASD) closure. METHODS: To identify CP after transcatheter ASD closure with ASO, cardiac events (CE) describing definite CP, hemopericardium, pericardial effusion, cardiovascular collapse, or sudden death were analyzed. Cardiac events were identified from published literature (MEDLINE), medical device regulating agencies in North America and the European Commission, and AGA Medical Corporation (Golden Valley, Minnesota). Institutional cases were reviewed. Cardiac events were defined as early (pre-discharge) or late (post-discharge). RESULTS: Twenty-nine CEs were identified. Five were excluded because findings were inconclusive for device-related CP. Ten patients were <18 years of age. Late CEs occurred in 66.6%; 25% presented weeks later (longest, three years). Three deaths were reported. Cardiac perforation occurred predominantly in the anterosuperior atrial walls and/or adjacent aorta. CONCLUSIONS: Amplatzer septal occluder-associated CP uniquely involves the anterosuperior atrial walls and adjacent aorta. Pathophysiology remains poorly understood.     

Infective endocarditis on an occluder closing an atrial septal defect.

Closure of atrial septal defects be means of intravenous catheterisation has been undertaken using a variety of devices as an alternative to surgical closure. We describe the first case, to the best of our knowledge, of infective endocarditis complicating a successful transcatheter closure. This highlights the potential risk of this procedure, and emphasises the need for appropriate antibiotic prophylaxis until complete endothelialization of the device has occurred.