经皮导管左盘外包膜卵圆孔封堵器治疗卵圆孔未闭

目的 探讨经皮导管左盘外包膜卵圆孔封堵器治疗卵圆孔未闭的安全性和疗效.方法 在X线透视和超声心动图引导下经股静脉,通过10～12 F长鞘,采用左盘外包膜卵圆孔封堵器对有指征的卵圆孔未闭患者行介入治疗.术后口服阿司匹林(100 mg/d)6个月.术后24 h、1个月、3个月、6个月和1年分别行临床和超声心动图随访,以后每年随访1次.结果 共有25例卵圆孔未闭患者行卵圆孔封堵术,成功率为96%.没有发生院内不良事件和封堵器血栓形成、感染、心肌梗死等并发症.7例患者在术中出现频发性房性早搏或阵发性房性心动过速,术后很快终止.随访6～42(25±12)个月,封堵器位置正常,无房水平残余分流,未出现新发的心律失常和脑血管事件.结论 经皮导管左盘外包膜卵圆孔封堵器治疗卵圆孔未闭安全、有效.     

经导管封堵器置入术后迟发感染性心内膜炎临床特点分析

目的分析经导管封堵器置入术后迟发(术后≥6个月)感染性心内膜炎(IE)的临床特点。方法报道北京协和医院收治的1例封堵器置入术后8年发生IE的病例,并分析国内外数据库中经导管封堵器置入术后迟发IE的病例特点。结果北京协和医院1例23岁女性,房间隔缺损封堵术后8年出现发热,脑栓塞,超声心动图示封堵器左心房面赘生物,给予抗感染及手术移除封堵器。文献报道经导管封堵器置入术后迟发IE 16例(男10例/女6例),其中房间隔缺损封堵术后9例,卵圆孔未闭封堵术后3例,二尖瓣人工瓣瓣周漏封堵术后2例,动脉导管未闭封堵术后1例,室间隔缺损封堵术后1例。发生IE时间为封堵术后7个月~16年,发热和栓塞是最常见的临床表现。发生IE前有6例感染,3例行牙科治疗。血培养最常见细菌是金黄色葡萄球菌。14例行手术治疗,术中所见与术前超声心动图检查基本吻合,8例存在封堵器内皮化不全。结论经导管封堵器置入术后患者长期有IE的风险,特别是出现感染情况时,发生IE后多数需手术治疗。封堵器内皮化不全可能与封堵术后迟发IE相关。     

生物可完全降解封堵器封堵犬卵圆孔未闭的实验研究

目的 评估生物可完全降解卵圆孔未闭（patent foramen ovale，PFO）封堵器封堵犬PFO的可行性、安全性等。方法 右胸小切口开胸卵圆窝穿刺法建立犬PFO模型，即刻在直视及经胸超声心动图（TTE）引导下用生物可完全降解型PFO封堵器封堵PFO。在植入后分别于1、3、6、9和12个月各处死2只犬，进行肉眼和组织学检查。结果 10只犬成功建立PFO模型后并植入可完全降解PFO封堵器。随访见封堵器均未发生移位，表面无赘生物及血栓形成，大体解剖见内膜组织从边缘逐渐完全覆盖封堵器表面。组织病理学提示，术后6个月封堵器骨架几乎完全降解并和周围组织融为一体。结论 应用生物可完全降解PFO封堵器封堵犬PFO，降解后在体内无任何残留物，是一种安全、有效并且可行的封堵器。     

国产房间隔缺损封堵器的实验研究

目的　通过外科手术创建的房间隔缺损动物模型评价国产心健TM 房间隔缺损封堵器介入治疗的可行性、安全性、有效性。方法　体外循环下 ,在幼猪的房间隔剪一个缺损口形成房间隔缺损 (ASD)动物模型 ,7d后行房间隔缺损封堵术。术后进行超声心动图、大体解剖、扫描电镜和透射电镜检查。结果　共 8只猪建立了房间隔缺损模型并进行封堵术 ,封堵器放置的成功率为 10 0 % ,超声心动图随访无残余分流 ,动物生长发育正常 ,无严重并发症出现。 1～ 6个月大体解剖可见封堵器与房间隔组织紧密嵌合 ,表面被一层白色半透明组织覆盖 ,电镜证实为内皮组织。结论　国产心健TM 房间隔缺损封堵器关闭外科手术创建的ASD模型可行、安全、有效     

卵圆孔未闭封堵器在儿童多孔型房间隔缺损封堵治疗中的研究

目的:总结卵圆孔未闭(PFO)封堵器介入治疗儿童多孔型房间隔缺损(ASD)的疗效和经验。方法:对2017年1月至2018年11月,我院采用PFO封堵器进行介入封堵治疗儿童多孔型ASD的患儿共40例进行总结,术前经临床及经胸超声心动图诊断,术中心导管结合经胸超声心动图及术后随访,观察术后右心房前后径,左右径,右心室内径变化,观察封堵器位置,有无残余分流情况及并发症。结果:所有患儿均成功置入PFO封堵器,所有患儿术后未发现明显心律失常。术后封堵器位置良好,未出现移位,未出现心脏穿孔、封堵器脱落以及栓塞等不良反应。术后1、3、6个月行经胸超声心动图检查测量患儿右心房前后径,左右径,右心室内径,较术前均明显缩小,差异有统计学意义(P0.05)。术后即刻封堵行经胸超声心动图显示39例完全闭合,1例术后6个月仍有少量残余分流,但对血流动力学无影响。结论:PFO封堵器对于封堵儿童多孔型ASD,具有封堵器效率较高,短期疗效可靠的特点,在把握适应证的前提下具有较好的封堵效果。     

脑卒中患者经导管封堵卵圆孔临床资料分析

目的:探讨经导管封堵卵圆孔未闭(PFO),预防脑部矛盾栓塞并评价其疗效。方法:本组共6例,年龄16～67岁,均经临床经胸超声心动图或经食道超声心动图检查,证实为PFO合并右向左分流患者。6例术前均有缺血性脑梗死。患者选用PFO封堵器经导管置入,进行介入治疗。结果:本组封堵成功率为100%。所有患者均能成功置入并释放封堵器。术后1个月、3个月及6个月行经胸超声心动图检查,未见封堵器移位。术后未有脑卒中事件。结论:经导管封堵PFO是一种较有效的介入治疗方法,可用于预防由于DFO导的致脑部矛盾栓塞。     

Amplatzer和CardioSEAL封堵器上血栓形成的研究

Amplatzer和CardioSEAL是常用的房间隔缺损(ASD)封堵器。但封堵成功后患者仍具有危险性,其中以封堵装置上血栓形成最为严重,它能导致全身血栓栓塞。该研究目的是观察ASD和卵圆孔未闭(PFO)介入治疗1个月后,经食管超声心动图(TEE)观察封堵装置上血栓形成情况。     

Amplatzer和CardioSEAL封堵器上血栓形成的研究[英]／Anzai H…／／Am J Cardiol．

Amplatzer和CardioSEAL是常用的房间隔缺损(ASD)封堵器。但封堵成功后患者仍具有危险性，其中以封堵装置上血栓形成最为严重，它能导致全身血栓栓塞。该研究目的是观察ASD和卵圆孔未闭(PFO)介入治疗1个月后，经食管超声心动图(TEE)观察封堵装置上血栓形成情况。     

卵圆孔未闭介入封堵术后三度房室传导阻滞1例

本文报道1例卵圆孔未闭患者在外院选择34 mm房间隔缺损封堵器行卵圆孔未闭介入封堵后发生三度房室传导阻滞,经药物治疗无效,选择胸腔镜取出封堵器,同时行卵圆孔未闭修补治疗。术中患者即恢复窦性心律,卵圆孔未闭修补正常。     

大孔型房间隔缺损封堵治疗的疗效和安全性

目的探讨经导管介入治疗大孔型房间隔缺损(ASD)的疗效和安全性。方法选择经胸超声心动图确诊的大孔房间隔缺损患者46例,年龄8~71岁,平均37.6岁。术前超声心动图检查ASD最大直经25~38(30±8)mm,术前心功能(NYHA分级)Ⅱ级15例,Ⅲ级5例,其中肺动脉平均压力>25mmHg者28例,封堵前肺动脉压力(32±8.2)mmHg。所有患者均在局麻下,应用X光透视,和经胸心脏超声引导下经导管置入国产封堵器,封堵ASD,对部分ASD残端薄弱者采用“肺静脉法”操作技术完成封堵。结果44例封堵成功,技术成功率95.6%。选择封堵器直经为30~42mm,封堵后肺动脉压降低至(18.4±5.8)mmHg。术中未发生任何重要并发症,无急诊手术病例。失败2例患者ASD伸展径分别为36mm和38mm,缺损后缘缺乏有效房隔组织。术后即刻超声显示6例仍存在微量至少量残余分流,分流束直径小于4mm;术后6月超声心动图检查时无1例残余分流,房间隔封堵器位置稳定。术后6~38个月随访,右心房、右心室缩小,心功能明显改善。无封堵器相关并发症。结论国产封堵器介入治疗大孔房间隔缺损具有操作简便、安全、费用低、技术成功率高及封堵效果好等优点。     

Transcatheter closure of patent foramen ovale using the Amplatzer septal occluder to prevent recurrence of neurological decompression illness in divers

OBJECTIVE: Large flap valve patent foramens may cause paradoxical thromboembolism and neurological decompression illness in divers. The ability of a self expanding Nitinol wire mesh device (Amplatzer septal occluder) to produce complete closure of the patent foramen ovale was assessed. PATIENTS: Seven adults, aged 18-60 years, who had experienced neurological decompression illness related to diving. Six appeared to have a normal atrial septum on transthoracic echocardiography, while one was found to have an aneurysm of the interatrial septum. METHODS: Right atrial angiography was performed to delineate the morphology of the right to left shunt. The defects were sized bidirectionally with a precalibrated balloon filled with dilute contrast. The largest balloon diameter that could be repeatedly passed across the septum was used to select the occlusion device diameter. Devices were introduced through 7 F long sheaths. All patients underwent transthoracic contrast echocardiography one month after the implant. RESULTS: Device placement was successful in all patients. Device sizes ranged from 9-14 mm. The patient with an aneurysm of the interatrial septum had three defects, which were closed with two devices. Right atrial angiography showed complete immediate closure in all patients. Median (range) fluoroscopy time was 13.7 (6-35) minutes. Follow up contrast echocardiography showed no right to left shunting in six of seven patients and the passage of a few bubbles in one patient. All patients have been allowed to return to diving. CONCLUSION: The Amplatzer septal occluder can close the large flap valve patent foramen ovale in divers who have experienced neurological decompression illness. Interatrial septal aneurysms with multiple defects may require more than one device.     

Closure of a coexisting ostium secundum atrial septal defect and patent foramen ovale using a single Amplatzer patent foramen ovale occluder device

We report the case of a 59-year-old man with cryptogenic stroke who was found to have both an ostium secundum atrial septal defect and a patent foramen ovale (PFO) by intracardiac echocardiography. Both defects were successfully occluded using a single 35-mm Amplatzer PFO occluder device inserted through the atrial septal defect.     

Inflammatory, abscess-forming foreign body reaction mimics a thrombus formation on an atrial septal defect closure device: A commented case report.

We are presenting a case of floating left and right atrial formations on an atrial septal defect occluder system (23mm StarFLEX)-Occluder) initially supposed to be thrombotic appositions in a 57-year-old man. The closure was performed on the background of left hemispheric stroke and atrial septal aneurysm (ASA) with patent foramen ovale (PFO). The suspect structures were detected in the 6-month follow-up by transesophageal echocardiography (TEE). The patient underwent a successful surgical explantation of the closure device and closure of the patent foramen ovale (PFO) using a pericardial patch. The pathological evaluation of the biatrial device associated appositions revealed hytrophic heart muscle tissue with perifocal scarring and purulent abscess-forming, granulating and foam-cell including inflammatory foreign body reaction instead of the expected thrombus formation.     

Platypnea-orthodeoxia of a 69-year old woman with a patent foramen ovale

Platypnea-orthodeoxia is a rare syndrome that is often associated with interatrial shunting through a patent foramen ovale (PFO) or atrial septal defect. We describe the case of a 69-year-old woman with progressive dyspnea and hypoxia when standing, which was relieved by assuming the recumbent position. After detection of a PFO by transesophageal echocardiography the diagnosis was confirmed by transthoracic echocardiography using saline contrast injection while lying supine and standing upright. This maneuver demonstrated a large right-to-left shunt through a patent foramen ovale while the patient was in a upright position and no significant shunt while being in a recumbent position. The patient showed a rapid improvement after closure of the PFO. This case demonstrates that platypnea-orthodeoxia caused by a patent foramen ovale can be easily demonstrated by the technique of contrast transthoracic echocardiography and a simple positioning maneuver.     

Live three-dimensional transthoracic echocardiographic assessment of transcatheter closure of atrial septal defect and patent foramen ovale

We report the usefulness of live three-dimensional transthoracic echocardiography in the accurate assessment of the morphology and efficacy of Amplatzer transcatheter devices used for closure of atrial septal defect and patent foramen ovale.     

Usefulness of three-dimensional echocardiographic reconstruction of the Amplatzer septal occluder in patients undergoing atrial septal closure

Eighty-eight patients referred for transcatheter closure of atrial septal or patent foramen ovale defects underwent 3-dimensional transesophageal echocardiography to correlate preclosure anatomy with the morphology and positioning of the atrial septal occluder. Despite the effectiveness of the trancatheter closure and absence of complications, 2 linear indentations of the aortic root by the 2 discs of the device were clearly demonstrated in 16 cases, suggesting caution in the choice of very large occluders.     

Stroke due to late device thrombosis following successful percutaneous patent foramen ovale closure

We report a case of stroke due to device thrombosis occurring three years following percutaneous patent foramen ovale (patent foramen ovale) closure with an Amplatzer atrial septal occluder device. We discuss risk factors that may have contributed to device thrombosis and raise concerns regarding the lack of a dedicated PFO closure device for clinical use in the United States.     

Use of the transseptal puncture in transcatheter closure of long tunnel-type patent foramen ovale

Two patients with long tunnel-type patent foramen ovale presented for elective transcatheter closure following transient ischaemic attack and stroke. Right to left shunting was confirmed on transthoracic and transoesophageal echocardiography. A new technique that used a transseptal procedure was devised to enable closure of the tunnel-type patent foramen ovale using the CardioSEAL transseptal occluder to avoid “bunching up” of the device and residual transatrial shunting.     

Single centre experience with GORE-HELEX septal occluder for closure of PFO

Several devices are available for percutaneous patent foramen ovale (PFO) closure. Over the past 3 years our planned treatment strategy of PFO closure has been routine use of the GORE-HELEX septal occluder device, followed by 6 months of aspirin therapy. We present the safety and feasibility of routinely using this device for all patients undergoing percutaneous PFO closure, with 3-month transthoracic echocardiogram (TTE) follow up. In total, 75 adult patients (44.0+/-11.7 years; 45.3% male) were referred for PFO closure during the study period. All patients underwent echocardiography prior to PFO closure. In 5 patients no PFO was found, and 1 patient had an atrial secundum defect closed using the Amplatzer septal occluder. Of the 69 remaining patients with PFO, 68/69 (98.6%) underwent closure with the GORE-HELEX device. Six of 69 cases required device retrieval and 5 of 6 were replaced successfully with a second GORE-HELEX device. One of the 6, a large PFO associated with atrial septal aneurysm, was replaced using the Amplatzer septal occluder. There were no major complications. At 3-month follow up, 65/68 (95.6%) had no residual shunt on TTE, and 3 patients had small residual shunts thought to be related to incomplete endothelialisation at 3 months. In conclusion, percutaneous PFO closure using the GORE-HELEX septal occluder device is safe and feasible, with no major peri-procedural complications and excellent short-term results at 3-month follow up.