Endoscopic closure of a bronchopleural fistula after pneumonectomy with the Amplatzer occluder: a step forward?

Abstract OBJECTIVES A bronchopleural fistula after pneumonectomy is a relatively rare but very serious complication. The development of endoscopic methods of treatment opens a new page in treating this condition. The goal of this paper was to confirm that the atrial septal defect Amplatzer device can be used for bronchopleural fistula closure in properly selected patients. METHODS A retrospective study of 13 patients with bronchopleural fistula after pneumonectomy was performed. There were 11 men and 2 women aged 26–70 years. Right-sided fistulas occurred in 10 patients and left-sided fistulas occurred in 3. The underlying disease was lung cancer in 7 patients and pulmonary tuberculosis in 6. Video-assisted thoracoscopic surgery (N = 7) and open-window thoracostomy (N = 6) were used to treat the empyema. To treat occlusion of the bronchial fistulas, we used Amplatzer atrial septal defect occluders originally intended for closure of ventricular and interatrial septal defects. The occluder was inserted from the bronchus by flexible bronchoscopy with the patient under local anaesthesia, with the help of video-assisted thoracoscopy or through a window thoracostomy from the pleural cavity. RESULTS We noted 3 complications after the procedure. In 2 patients, displacement of the occluders required re-installation in 1 patient and latissimus dorsi muscle coverage in the other. In the third patient, the occluder became dislodged during severe exacerbation of tuberculosis that occurred after the patient violated the treatment regimen. She died of tuberculosis 6 months after the occluder was inserted. The course in the remaining 10 patients was uneventful. CONCLUSIONS Our experience suggests that the use of an atrial septal defect occluder for the treatment of a bronchial fistula after pneumonectomy is a reliable option.

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Video-assisted thoracoscopic surgery in device closure of atrial septal defect

Annals of Thoracic Medicine ◽

10.4103/1817-1737.118498 ◽

2013 ◽

Vol 8 (4) ◽

pp. 234

Author(s):

Hua Cao ◽

Qiang Chen ◽

Gui-Can Zhang ◽

Yun-Nan Hu ◽

Fan Xu

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Thoracoscopic Surgery ◽

Device Closure ◽

Video Assisted ◽

Video Assisted Thoracoscopic Surgery

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Treatment of atrial septal defects in symptomatic children aged less than 2 years of age using the Amplatzer septal occluder

Cardiology in the Young ◽

10.1017/s1047951100008234 ◽

2000 ◽

Vol 10 (5) ◽

pp. 534-537 ◽

Cited By ~ 39

Author(s):

Michael Vogel ◽

Felix Berger ◽

Ingo Dähnert ◽

Peter Ewert ◽

Peter E. Lange

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Pulmonary Stenosis ◽

Balloon Dilation ◽

Amplatzer Septal Occluder ◽

Residual Shunt ◽

Septal Defects ◽

Atrial Septal Defects ◽

Amplatzer Device ◽

Amplatzer Occluder

AbstractAimsTo assess results of closure of atrial septal defects within the oval fossa by devices delivered by catheterisation in symptomatic infants and children under 2 years of age.Methods and resultsThe Amplatzer septal occluder was used. Results, and complications of transcatheter device treatment in patients aged below 2 years were compared to previous results from our institution.PatientsWe attempted closure in 12 consecutive patients below the age of 2 years who presented with an atrial septal defect between May 1997 and 1999. Symptoms were failure to thrive in 6, frequent chest infections in 5, and the need for treatment of heart failure in the other. All were thought to have a defect suitable for interventional closure. The atrial defects were seen in isolation in 10 children, but 2 had associated pulmonary stenosis which had been treated by balloon dilation prior to placement of the Amplatzer occluder.ResultsThe Amplatzer septal occluder was implanted at a mean age of 1.4 ± 0.4, with a range from 0.8 to 1.8 years. Ratios of pulmonaryto-systemic flow had been 2.1 ± 0.5, with a range from 1.6 and 3.2, and the defect was measured at 12 ± 4 mms. Fluoroscopy time was 12.8 ± 10.2 minutes, with a range from 5 to 43 minutes, and the time of the overall procedure was 162 ± 70 minutes, with a range from 85 to 360 minutes. It proved necessary to remove the device in 2 patients (16%) because of a residual shunt and movement after release. One of these developed transient neurological complications. Both subsequently underwent surgical treatment.ConclusionSymptomatic patients less than 2 years of age can undergo successful closure of an atrial septal defect using the Amplatzer device, but the rates of success are less, and procedure time longer, than in older children or adults.

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P1671 Freehand and rotational transthoracic 3-dimensional echocardiography enable exact quantification of atrial septal defect size prior to amplatzer occluder implantation

European Heart Journal ◽

10.1016/s0195-668x(03)94809-3 ◽

2003 ◽

Vol 24 (5) ◽

pp. 314

Author(s):

J KASPRZAK

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Defect Size ◽

3 Dimensional ◽

Amplatzer Occluder ◽

Dimensional Echocardiography ◽

Exact Quantification

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Triport periareolar thoracoscopic surgery versus right minithoracotomy for repairing atrial septal defect in adults

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa246 ◽

2020 ◽

Author(s):

Xiang-Xiang Zheng ◽

Ze-Yu Wang ◽

Lu-Yao Ma ◽

Hong- Liu ◽

Huan- Liu ◽

...

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Rating Scale ◽

Thoracoscopic Surgery ◽

Operation Time ◽

Numeric Rating Scale ◽

Hospital Death ◽

Aortic Cross Clamp Time ◽

Atrial Septal Defect Closure ◽

Satisfaction Scale

Abstract OBJECTIVES Our goal was to investigate the safety and feasibility of triport periareolar thoracoscopic surgery (TPTS) and its advantages in repairing adult atrial septal defect. METHODS Between January 2017 and January 2020, a total of 121 consecutive adult patients underwent atrial septal defect closure in our institution. Of these, 30 patients had TPTS and 31 patients had a right minithoracotomy (RMT). Operational data and clinical outcomes were compared between the 2 groups. RESULTS The total operation time, cardiopulmonary bypass time and aortic cross-clamp time in the TPTS group were slightly longer than those in the RMT group, but there were no differences between the 2 groups. Compared with the RMT group, the TPTS group showed a decrease in the volume of chest drainage in 24 h (98.6 ± 191.2 vs 222.6 ± 217.2 ml; P = 0.032) and a shorter postoperative hospital stay (6.5 ± 1.5 vs 8.0 ± 3.7 days; P = 0.042). The numeric rating scale on postoperative day 7 was significantly less in the TPTS group than in the RMT group (2.82 ± 1.14 vs 3.56 ± 1.42; P = 0.034). The patient satisfaction scale for the cosmetic results in the TPTS group was significantly higher than in the RMT group (4.68 ± 0.55 vs 4.22 ± 0.76; P = 0.012). No differences were found in postoperative complications. No in-hospital death or major adverse events occurred in the 2 groups. CONCLUSIONS TPTS is safe and feasible for the closure of adult atrial septal defect. Compared with RMT, it has been associated with less pain and better cosmetic outcomes.

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Trans-septal TMVIV. A: pre-implant intraoperative TEE, B: balloon septostomy, C: prosthesis advancement through the intratrial septum, D: Prosthesis deployment, E: fully deployed prosthesis and Amplatzer device (Abbott Cardiovascular, Plymouth, MN, US) to close the iatrogenic atrial septal defect, F: post-implant intraoperative TEE.

ASVIDE ◽

10.21037/asvide.2021.276 ◽

2021 ◽

Vol 8 ◽

pp. 276-276

Author(s):

Laura Besola ◽

Anson Cheung ◽

Jian Ye ◽

Myriam Akodad ◽

Andrew Chatfield ◽

...

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Amplatzer Device ◽

Iatrogenic Atrial Septal Defect

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Inappropriate shocks from a transvenous implantable defibrillator caused by atrial fibrillation and a missed atrial septal defect in a patient with a modified Bentall procedure

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab412 ◽

2021 ◽

Author(s):

Anna Kostopoulou ◽

Epameinontas Fountas ◽

Olga Karapanagiotou ◽

Stamatis Kyrzopoulos

Keyword(s):

Atrial Fibrillation ◽

Atrial Septal Defect ◽

Septal Defect ◽

Implantable Defibrillator ◽

Surgical Closure ◽

Inappropriate Shocks ◽

Bentall Procedure ◽

Complication Risk ◽

Amplatzer Device

Abstract Background Inappropriate shocks have been reported in approximately 1/3 of patients with implantable cardiac defibrillators (ICDs). We report an unusual case of inappropriate ICD shocks due to atrial fibrillation (AF) caused by a missed atrial septal defect (ASD) in a patient with a modified Bentall procedure. Case summary A 67-year-old Caucasian male, with an ICD and a history of a modified Bentall procedure 24 years ago, reported to our outpatient clinic with recurrent inappropriate ICD shocks due to episodes of fast AF. The transthoracic echocardiographic exam revealed 2 large aneurysms at the ostia of the coronary arteries. We performed further evaluation with transesophageal echocardiogram (TOE) and computed tomography (CT) angiography. The aneurysms measured on CT were 3.14*2.29 cm on the right ostium and 1.9*0.99 cm on the left. A large secundum-type atrial septal defect (ASD) of 1.5 cm was revealed that was missed in all previous echocardiographic studies. The therapeutic options of surgical closure of the ASD and repair of the aneurysms or a more conservative approach with percutaneous closure of the ASD and closer follow-up were discussed with the patient. The patient declined the surgical option due to high complication risk, and closure of the ASD with an Amplatzer device was performed 3 months later. A 3 -year Follow-up was uneventful. Conclusion It is of major importance to comprehensively and thoroughly assess patients before and after a surgical intervention to not miss other treatable conditions preoperatively and complications in the postoperative period.

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