经导管封堵主动脉窦瘤破口的初步临床应用

目的探讨经导管封堵主动脉窦瘤破口的可行性及有效性。方法4例患者,年龄7～57岁,均为主动脉右窦窦瘤破裂人右心室,破口直径2～10mm,其中3例为先天性,1例患者为获得性（医源性）。通过建立股动脉．主动脉窦瘤破口．右心室．右心房-股静脉的轨道,在透视和超声的引导下经股静脉顺行性置人合适的动脉导管未闭封堵器（Amplatzer duct occluder,ADO）,所选择的ADO直径较破口大1～2mm。结果主动脉窦瘤破口全部封堵成功,仅1例患者术后存在微量残余分流,次日超声证实分流消失。无并发症发生。随访3个月,4例患者症状和体征均消失,超声证实封堵器形态位置良好,无残余分流、栓塞、细菌性心内膜炎、主动脉瓣反流等发生。结论经导管主动脉窦瘤破口封堵术为一种微创、安全和有效的治疗方法,适合于不合并其他需外科处理心血管病变的主动脉窦瘤破裂。其近期疗效良好,中远期疗效有待于进一步观察。     

Transcatheter closure of a ruptured aneurysm of the sinus of Valsalva

A ruptured aneurysm of the sinus of Valsalva in a man of 34 was closed by a transcatheter technique with a 12 mm modified Rashkind umbrella device.     

Percutaneous closure of ruptured sinus of Valsalva aneursym with Amplatzer ductal occluder

Rupture of a sinus of Valsalva aneurysm (SVA) is clinically characterized by widening of an existing sinus of Valsalva aneurysm in time and its opening to other cardiac cavities, primarily to the right atrium and right ventricle. Increased biventricular filling appearing due to rupture causes symptoms of heart failure. Although classical treatment of ruptured SVA is surgical, various percutaneous closure devices are being used successfully for treatment of lesions in recent years. With this paper, we described a case about rupture of a sinus of Valsalva aneurysm causing a haemodynamically important left-to-right shunt and heart failure due to this, and we explained how we successfully repaired it with an Amplatzer ductal occluder device. Our clinical experience and early term results of similar cases in the literature suggest that percutaneous closure methods can be an alternative to surgical treatment to treat ruptured sinus ofValsalva aneurysms.     

Percutaneous closure of a ruptured sinus of Valsalva aneurysm using the Amplatzer Duct Occluder.

Sinus of Valsalva aneurysms are rare congenital anomalies. When they rupture, they can lead to the development of biventricular failure as a result of systemic-pulmonary shunting. Surgical repair has been the traditional treatment for these aneurysms. We present a case of a 54 year old man in whom a ruptured sinus of Valsalva aneurysm was successfully closed using a catheter-based approach with the Amplatzer Duct Occluder.     

7例主动脉窦瘤破入右心房介入封堵治疗的临床疗效和随访分析

Objective:To investigate the clinical effects,security and the recently follow-up outcomes of transcatheter occlusion of ruptured sinus of Valsalva aneurysm(RSVA).Methods:Seven patients including six with the rupture of the right coronary sinus of Valsalva and one with the rupture of the nonecoronary sinus of Valsalva shunting into the right atrial were involved in the study and had been undergone transcatheter interventional occlusion.Observvation on echocardiography,electrocardiography,blood and ruine rou...     

Sudden heart failure due to a ruptured posterior Valsalva sinus aneurysm into the right atrium: feasibility of catheter closure using the Amplatzer duct occluder.

Valsalva sinus aneurysms are usually congenital and relatively rare and tend to be more frequent in adults. Rupture of these aneurysms can result in sudden death or in an abrupt and rapid progressive heart failure. Surgical repair is the traditional treatment of choice. We report the case of a 48-year-old female with a ruptured posterior non-coronary Valsalva sinus aneurysm, resulting in an anomalous aorto-right atrial fistula. Successful percutaneous catheter closure of the massive left-to-right shunt by using the Amplatzer duct occluder is presented.     

Transcatheter closure of persistent ductus arteriosus in infants using the Amplatzer duct occluder

AIM—To evaluate whether transcatheter closure with the Amplatzer duct occluder offers an alternative to surgical treatment in infants with a persistent ductus arteriosus.
METHODS—12 patients under 1 year of age (age 1-11 months, body weight 2.6-8.7 kg) with clinical and echocardiographic findings of a significant duct were considered for transcatheter closure with the Amplatzer occluder. The device is made of a Nitinol and polyester fabric mesh and provides occlusion by stenting the duct. Measured angiographically, the narrowest diameter of the ducts ranged from 1.5-5 mm; in six patients pulmonary hypertension was also present.
RESULTS—The devices were implanted and complete duct occlusion was demonstrated during follow up in 10 patients. Procedure related difficulties occurred in nine of the 12 cases and led to relatively long procedure and fluoroscopy times (procedure time 50-180 minutes, median 80 minutes; fluoroscopy time 4.9-49 minutes, median 16 minutes). In two infants transcatheter closure could not be achieved and surgical duct ligation had to be carried out.
CONCLUSIONS—In small infants with a persistent ductus arteriosus the Amplatzer duct occluder offers an alternative to surgical treatment, but further improvement of the implantation system is necessary before the procedure can be recommended as the treatment of choice.


Keywords: persistent ductus arteriosus; transcatheter closure; infants; Amplatzer duct occluder     

高原地区用Amplatzer封堵器介入治疗动脉导管未闭

目的 :应用 Amplatzer封堵器在高原地区治疗动脉导管未闭 （PDA）并评价其疗效。方法 :本组 2 0例 ,年龄 1.5～ 44 （2 2± 14）岁 ,PDA最窄处内径 5～ 14（9± 3） m m,均用 Am platzer封堵器介入治疗。结果 :19例成功 ,1例严重阻力性肺动脉高压不适宜封堵。术后即刻降主动脉造影显示 15例封堵完全无残余分流 ,4例少量残余分流。 1例术后 1h封堵器脱落入右肺动脉 ,第三小时急诊外科手术关闭 PDA并取出封堵器。 2 4h彩色多普勒检查显示封堵 18例患者均无分流 ,随访 2月～ 1.5年 ,无 1例分流。结论 :用 Amplatzer封堵器治疗 PDA是高原地区 1种适应性强 ,安全有效的介入治疗方法。     

应用Amplatzer封堵器治疗动脉导管未闭的疗效评价

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Successful transcatheter closure of ruptured sinus of Valsalva aneurysm

We report a case in which a ruptured aneurysm of the sinus of Valsalva opening into the right atrium was successfully closed transcutaneously by an Amplatzer duct occluder.     

Transcatheter closure of ruptured sinus of valsalva aneurysm

Percutaneous transcatheter closure of ruptured sinus of valsalva aneurysm was attempted in eight patients between January 1995 and March 2003 as an alternative strategy to surgery as this technique at present is an accepted therapeutic modality for various intracardiac defects. The age range was 14-35 years, all were male, seven in symptomatic class III and one in class IV on medical treatment. Two-dimensional and color Doppler echocardiography revealed rupture of an aneurysm of right coronary sinus into right ventricle in five and noncoronary sinus into right atrium in three and none had associated ventricular septal defect. The echo estimated size of the defect was 7-12 mm. On cardiac catheterization left ventricular end-diastolic pressure ranged from 20 to 40 mmHg and the calculated Qp/Qs ratio was 2-3.5. In all patients the defect was crossed retrogradely from the aortic side and over an arterio-venous wire loop after balloon sizing, devices were successfully deployed by antegrade venous approach (Rashkind umbrella device in two and Amplatzer occluders in six, which included Amplatzer duct occluder in five and Amplatzer septal occluder in one). One patient who had residual shunt developed hemolysis on the next day and was taken up for reintervention. That patient continued to have intermittent hemolysis and was sent for surgical repair. On follow-up (2-96 months), there was no device embolization, infective endocarditis, and aortic regurgitation. One patient died of progressive congestive heart failure while other six are asymptomatic. These data highlight that transcatheter closure is feasible and effective, especially safe with the available Amplatzer devices. Definitely, it has the advantage of obviating open heart surgery but complete occlusion is mandatory to prevent hemolysis and infective endocarditis.     

Transcatheter closure of ruptured sinus of valsalva aneurysm

Congenital sinus of Valsalva aneurysm is a rare cardiovascular anomaly. Rupture of sinus of Valsalva (RSOV) is a rare occurrence, occurring in 10–20% of cases. Rupture into right atrium is further a rare occurrence. The rupture is usually a catastrophic event presenting as acute onset congestive cardiac failure in an apparently healthy individual in the 2^nd or 3^rd decade of life. Surgery used to be the mainstay of treatment of RSOV aneurysm, however, in past few years several reports of transcatheter closure of RSOV have come into light. We report a patient, who underwent device closure with a Duct Occluder device. Device was manipulated and deployed with an angle so as to prevent aortic valve dysfunction. © 2010 Wiley‐Liss, Inc.     

Transcatheter closure of the patent ductus arteriosus using an Amplatzer duct occluder in adults.

Patent ductus arteriosus (PDA) is a congenital heart disease that frequently escapes detection until the patient reaches adulthood. Percutaneous closure of the PDA has been established as a safe alternative to surgery, the Amplatzer duct occluder (ADO) is a new device that has been recently reported in paediatric patients. Our initial experience with an of ADO in an adult population appears to be encouraging and as good as in paediatric patients.     

Transcatheter closure of a ruptured sinus of valsalva aneurysm.

BACKGROUND: Ruptured sinus of Valsalva aneurysms (RSVA) can be associated with ventricular septal defects or isolated lesions. Surgical repair has been the traditional treatment of for the RSVA. The results of transcatheter closure of the RSVA in 4 patients are reported. METHODS AND RESULTS: From 2003 to 2004, 4 patients (2 males and 2 females) aged from 18 years to 47 years with RSVA were identified. The diagnosis of RSVA was made based on a combination of several imaging modalities. The drainage site of the RSVA was right ventricle in 2, and right atrium in remaining 2. All patients underwent general anesthesia and transesophageal echocardiographic (TEE) monitoring during the procedure. Transcatheter closure with an Amplatzer duct occluder was attempted in all 4 patients. The size of the Amplatzer duct occluder selected was up to 2 mm larger than the maximal diameter of the aortic opening site of the RSVA as measured on TEE images. The attempt to deploy an Amplatzer duct occluder was successful in 3 and a Gianturco coil was deployed in 1. Follow-up (3-18 months) echocardiography showed neither residual shunt nor aortic regurgitation in any of the patients. CONCLUSION: The transcatheter technique is a safe alternative in the treatment of RSVA; however, a longer follow-up is mandatory.     

Transcatheter closure of a coronary sinus defect with an Amplatzer septal occluder.

We report a successful transcatheter closure of a coronary sinus defect using an Amplatzer septal occluder in a 9.5-year-old boy suffering from a significant volume overload due to left-to-right shunt.     

Transcatheter closure of a large coronary artery fistula with the Amplatzer duct occluder.

We report the successful percutaneous closure of a large coronary artery fistula from the obtuse marginal artery to the right ventricle in an 8-month-old boy using the Amplatzer duct occluder. The device was positioned and deployed via the venous system, using a guidewire that had been advanced via the aorta, coronary artery, and fistula to the venous circulation. Cathet. Cardiovasc. Intervent. 48:188-190, 1999.