scholarly journals Safety and Efficacy of Transcatheter Occlusion of Perimembranous Ventricular Septal Defect with Aortic Valve Prolapse: A Six-Year Follow-Up Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Wenqian Zhang ◽  
Chaojie Wang ◽  
Shenrong Liu ◽  
Lingmei Zhou ◽  
Junjie Li ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Septal Defect ◽  
Efficacy And Safety ◽  
Success Rates ◽  
Residual Shunt ◽  
Transcatheter Occlusion ◽  
Perimembranous Ventricular Septal Defect ◽  
New Onset

Background. With the rapid development of transcatheter techniques and instruments, transcatheter occlusion for patients with perimembranous ventricular septal defect (pVSD) and aortic valve prolapse (AVP) was constantly being tried, while the efficacy and safety of pVSD with AVP remain controversial. Objective. The aim of this study was to evaluate long-term efficacy and safety of transcatheter occlusion of pVSD with AVP. Methods. We retrospectively analyzed 164 children with pVSD and AVP who underwent transcatheter occlusion between January 2013 and November 2014. AVP was divided into 3 degrees according to right coronary leaflet morphology at end-diastole during aortic root angiography. Patient demographic and clinical data were collected. Results. There were 97 males and 67 females (median age, 40.0 (30.0–62.7) months; average weight, 16.94 ± 9.02 kg). Mild (n = 63), moderate (n = 89), and severe (n = 12) AVP success rates were 93.7%, 89.9%, and 58.3%, respectively. Immediately after procedure, there was no new-onset aortic regurgitation (AR) above trivial degree, residual shunt above mild degree, or complications requiring medication or operation, except for 1 patient who developed transient complete atrioventricular block. During follow-up, 1 mild AVP patient aggravated from mild to moderate AR and 1 moderate AVP patient aggravated from trivial to moderate AR. The new-onset AR in mild, moderate, and severe AVP was 2%, 1.8%, and 20%, respectively. AR disappeared in 17 patients. Residual shunt occurred in 9 patients after procedure, 4 of which disappeared during the follow-up period. No serious complications occurred in any patient during follow-up. Five-year cardiovascular event-free survival rates for mild, moderate, and severe AVP were 89.6%, 94.5%, and 80.0%, respectively. Conclusion. Transcatheter occlusion of pVSD with mild and moderate AVP has a high success rate and few complications, which is safe and effective in long-term follow-up. Transcatheter occlusion of pVSD with severe AVP has low success rates and high AR incidence. Therefore, transcatheter occlusion of pVSD with AVP is recommended for mild to moderate, but not severe, AVP.

scholarly journals Transcatheter Closure of Perimembranous Ventricular Septal Defect with Aneurysm: Radiologic Characteristic and Interventional Strategy

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Weibing Guo ◽  
Yifan Li ◽  
Jinjin Yu ◽  
Junjie Li ◽  
Ling Sun ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Type A ◽  
Left Ventricular ◽  
Type B ◽  
Residual Shunt ◽  
Perimembranous Ventricular Septal Defect ◽  
Type C

Objectives. We aimed to explore the radiologic characteristics and interventional strategies for perimembranous ventricular septal defect (pmVSD) with aneurysm. Methods. 257 patients who underwent transcatheter closure of pmVSD with aneurysm were included in our study. We retrospectively reviewed the left ventricular opening of the aneurysm (a), diameter of the midsegment of the aneurysm (b), and diameter of the right ventricular opening of the aneurysm (c). If there were multiple defects within the aneurysm, the largest defect was denoted as c1 and so forth. We developed a novel VSD classification method in which pmVSD with aneurysm was classified into three types (A, B, and C). When a >b ≥ c, it was classified as type A, when b > a ≥ c, it was type B, and when c > a ≥ b, it was type C; c/c1 described the relationship among defects. Results. All of the 257 cases of pmVSD with aneurysm were defined using left ventriculography: type A, 60, type B, 58, and type C, 139. Transcatheter closure was attempted in 244 patients and succeeded in 227 cases (success rate was 93.0%; 227/244). Forty symmetric VSD occluders and 13 asymmetric VSD occluders were used for type A aneurysm occlusion; 31 symmetric VSD occluders, 19 asymmetric VSD occluders, and one Amplatzer duct occluder II (ADOII) were used for type B; 59 VSD symmetric occluders, 59 asymmetric VSD occluders, three eccentric VSD occluders, and two ADOII were used for type C. Within 24 hours after procedure, 2.2% patients had postprocedural residual shunt, and 2.2% experienced malignant arrhythmia (including type II second-degree AVB, cAVB, and CLBBB). Two hundred and twelve patients completed follow-up (93%, 212/227). No new severe complications were reported during follow-up, except in one patient who underwent surgery (removal of the device, VSD repair, and tricuspid valvuloplasty) due to severe postprocedural tricuspid regurgitation. Conclusions. It is safe and effective to apply this method for the classification of pmVSD with aneurysm and its interventional strategy.

scholarly journals Short, Intermediate and Long Term Follow up of Device Closure of Atrial Septal Defect (Secundum) Cases: Thirteen Years Experience with Special Reference to Complications

2015 ◽  
Vol 7 (2) ◽  
pp. 85-92
Author(s):  
Nurun Nahar Fatema
Keyword(s):  
Atrial Septal Defect ◽  
Special Reference ◽  
Aortic Regurgitation ◽  
Septal Defect ◽  
Study Patient ◽  
Device Closure ◽  
Residual Shunt ◽  
Long Term Follow Up

Background: Device closure of Atrial Septal Defect (ASD) Secundum type is gaining popularity because of short learning curve, cosmetic benefits, reduced hospital stay, reduced working hour loss, reduced pain, less or no need for general anesthesia etc. In most centers this is the first choice of therapy comparing to surgical closure. The major concern recently is related to development of erosion and aortic regurgitation. Objective of our study is to review the outcome of our cases over last 13 years with special reference to complication in our series and review from literatures. Methods: One thousand and twenty patients with secundum ASD with indication for closure, age 8 months to (median 11 years) 68 years from December 2000 to December 2013 were included in the study. Patient were followed up after device closure at 1, 3, 6, 9, 12, and 18 months and yearly thereafter with ECG, CXR, and Echocardiography. One hundred and seventy two cases were lost from follow up after first year. Results: Device was implanted on 1020 patient but tried on 1075 patient. Forty one cases postponed after balloon sizing and 12 for unstable position of device or mashrooming deformity of device. Immediate complications were ST changes (n=12), transient arrhythmia (n=4), residual shunt (n=7) etc. Immediate major complication was embolization of device (n=2). There was no late embolization, thromboembolic events, erosion, pericardial effusion, aortic regurgitation in follow up. Mean follow up time was 6.9 years (8 month to 13 years). Residual shunt was abolished in all patients other than those having another uncovered ASD (2 cases). Conclusion: Device closure of ASD is safe and effective in short, intermediate and long term follow up without any major late complication. DOI: http://dx.doi.org/10.3329/cardio.v7i2.22248 Cardiovasc. j. 2015; 7(2): 85-92

New onset atrial fibrillation after percutaneous Patent Foramen Ovale closure: how serious is this problem?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Ferreira ◽  
L Almeida Morais ◽  
L Sousa ◽  
A Fiarresga ◽  
J.D Martins ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Patent Foramen Ovale ◽  
Clinical Impact ◽  
Foramen Ovale ◽  
Residual Shunt ◽  
Onset Atrial Fibrillation ◽  
Ischemic Events ◽  
New Onset

Abstract Background Percutaneous Patent Foramen Ovale (pPFO) closure benefits for secondary prevention after cardio-embolic stroke have recently been proved. With the increasing number of cases and procedures, a concern with new onset atrial fibrillation (NOAF) has been raised. Purpose To evaluate long-term outcome regarding NOAF rate and to identify its predictors and clinical impact, in a real population submitted to pPFO closure. Methods From 2000 to 2017, consecutive patients (P) submitted to pPFO closure in a tertiary centre were prospectively enrolled. The primary endpoint was NOAF rate and secondary endpoints were all-cause, neurologic and cardiac mortality rates and recurrent ischemic events. Previous and follow-up electrocardiographic, echocardiographic and 24-hour heart rhythm monitoring data were analysed. Follow-up was performed through medical visits, medical charts consultation and a phone call based system, in order to assess clinical status, on-going treatment and events. Results 496 patients were submitted to pPFO. Immediate success was achieved in 98.8% and 9.1% presented a residual shunt on the 1st year TEE. Mean age was 45.0±11.2 years-old with 50.2% of males. The prevalence of hypertension, hypercholesterolemia and atrial septum aneurysm (ASA) was 25.7%, 45.0% and 46.3%, respectively. Pre-procedural mean left atrial (LA) diameter was 36.0±5.3 mm. FU data was available for 490 (98.6%), for a mean FU time of 7.41±3.51 years. 34 P (6.9%) presented ischemic events recurrence (26 strokes and 8 TIA). The primary endpoint was observed in 21 P (4.3%) during the FU period. Median time to 1st AF episode since PFO closure was 5.90±5.53 years. 11 P (52.3%) initiated oral anticoagulation. In univariate analysis, age (44.6±11.3 vs 51.8±6.0 years, p=0.005) and hypertension (24.7% vs 47.6%, p=0.019) were predictors of NOAF in this population. In multivariated analysis, only age remained a predictor of NOAF (OR 1.05 (1.007–1.101), p=0.025). LA pre pPFO closure dimensions, ASA, device type or size and the presence of residual shunt in TEE were not determinants of AF occurrence. The incidence of NOAF was associated with the need for hospitalization due to cardiac causes (19% vs 3.2%, p=0.001) and a trend towards higher rate of recurrent stroke (4.9% vs 14.3%, p=0.06). Conclusion Despite being a highly successful and safe procedure in most patients, pPFO closure was associated with a non-negligenciable rate of NOAF during long-term follow-up. NOAF predictors were related with classical cardiovascular risk factors, such as age and hypertension. None of the procedure or device features were associated with NOAF. Yet, a clinical impact was attributed to NOAF, with more hospitalizations and a trend towards ischemic events recurrence. As young patients submitted to pPFO closure grow older, prevention strategies to diagnose and treat NOAF should be endeavoured. Funding Acknowledgement Type of funding source: None

Long-term analysis of pulmonary hypertension and tricuspid regurgitation after transcatheter aortic valve replacement

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Bignoto ◽  
D Le Bihan ◽  
A.C Souza ◽  
N Oliveira ◽  
B.M.O Nascimento ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Diastolic Dysfunction ◽  
Tricuspid Regurgitation ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
New Onset

Abstract Introduction Transcatheter aortic valve replacement (TAVR) is increasingly utilized in treatment of aortic stenosis (AS). AS is commonly associated to pulmonary hypertension (PH) and tricuspid regurgitation (TR). We aimed to evaluate the long-term post-TAVR course of PH and TR. Methods Patients undergoing TAVR were screened for 24-month echocardiographic data on PH and TR. All echocardiograms were performed by a single team. Patients were divided in groups according to TR and PH (pulmonary systolic pressure ≥ or <45 mmHg) grading at 24 months with follow-up of up to 96 months. Standardized clinical outcomes and survival were compared. Results 156 and 151 patients were selected for PH and TR follow-up, respectively. Mean follow-up was 42.23±17.53 months and 42.60±17.67 months for PH and TR groups. Maximum follow-up was 96 months. PH was reduced post-TAVR (32.7% pre-TAVR vs. 20.5% post-TAVR, p<0.001), but no significant difference in TR was found (11.9% pre-TAVR vs. 10.6% post-TAVR). Increased left atrial (LA) diameter (p=0.002) was associated to maintenance PH. Moreover, increased LA diameter (p=0.015) and increased EuroSCORE II (p=0.041) were correlated to new onset PH. On a multivariable Cox regression model, new onset PH (HR 6.17, 95% CI 1.71–22.29, p=0.005), diastolic dysfunction type II or III (HR 1.06, 95% CI 1.06–1.11, p=0.036) and LA diameter (HR 1.11, 95% CI 1.02–1.21, p=0.02) were independent predictors of long-term mortality. Conclusions TAVR was able to reduce the severity of PH, but not TR, in this cohort. Additionally, long-term survival was affected by PH, diastolic dysfunction and LA sizing. Kaplan-Meier survival curve Funding Acknowledgement Type of funding source: None

scholarly journals Transcatheter Closure of Perimembranous and Intracristal Ventricular Septal Defects Using Amplatzer Duct Occluder II in Children

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Shenrong Liu ◽  
Wenqian Zhang ◽  
Junjie Li ◽  
Shushui Wang ◽  
Mingyang Qian ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Tricuspid Regurgitation ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Amplatzer Duct Occluder ◽  
Ventricular Septal Defects ◽  
Septal Defects ◽  
Total Range ◽  
New Onset

Background. Transcatheter closure of aneurysmal perimembranous ventricular septal defect (pmVSD), pmVSD near the aortic valve, and intracristal VSD (icVSD) with symmetrical or asymmetrical ventricular septal defect occluders still presents significant challenges. We report our experience with transcatheter closure of pmVSD and icVSD using Amplatzer duct occluder II (ADO II) in children. Method. We retrospectively analyzed all children, who presented to our hospital consecutively between March 2014 and June 2020 for attempted transcatheter closure of pmVSD or icVSD with the ADO II device. Standard safety and last-follow-up outcomes were assessed and compared. Results. In total, 41 patients underwent transcatheter closure of VSD with the ADO II (28 in pmVSD and 13 in icVSD groups) with a median age of 3.5 years (total range: 0.9 to 12 years) and median weight of 15.0 kg (total range: 10.0 to 43.0 kg). Implantation was successful in 40/41 patients (97.5%, 27/28 in pmVSD group, 13/13 in icVSD group). One patient with mild aortic valve prolapse in pmVSD group developed new-onset moderate aortic regurgitation after a 4/4 mm ADO II was deployed; however, this resolved after the device was retrieved and successfully replaced with a 5 mm zero eccentric VSD occluder. There was no procedure-related mortality. After a median follow-up of six months (total range: 6 to 72 months), complete closure rates were 85.1% and 76.9% among pmVSD and icVSD groups, respectively. In the pmVSD group, one case of new-onset moderate tricuspid regurgitation was observed at six months, and there was one case of severe tricuspid regurgitation that had progressed from mild tricuspid regurgitation at 12 months. No serious complications were noted in the icVSD group. Conclusion. ADO II provides a safe and reproducible alternative for the closure of perimembranous and intracristal ventricular septal defects with a diameter less than 5 mm in young children.

scholarly journals PROCEDURAL TECHNICALITIES AND OUTCOME OF TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT USING OCCLUTECH DEVICE IN TERTIARY CARE CENTRE

2021 ◽  
Vol 71 (6) ◽  
pp. 2170-74
Author(s):  
Asma Kanwal ◽  
Abdul Malik Shiekh ◽  
Kiran Azim ◽  
Khushal Khan Khattak
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Tertiary Care ◽  
Minimum Size ◽  
Long Term Results ◽  
Safe Procedure ◽  
Transcatheter Occlusion

Objective: To determine the safety and efficacy of transcatheter closure of atrial septal defects and to evaluate the initial, midterm and long-term results of the treatment. Study Design: Cross sectional study. Place and Duration of Study: Department of Paediatric Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, from Jul 2017 to Jun 2018. Methodology: Sixty-four patients underwent transcatheter closure of atrial septal defect. Size of the defect was measured by Transoesophageal/Transthoracic. Follow up was carried out at twenty-four hours, one month, six months and at twelve months. Early, Midterm and late complications after device occlusion were analysed using SPSS-22 statistical software. Results: Minimum size of atrial septal defect on echocardiography was 7 mm and maximum size was 31 mm with mean of 18.3 ± 5.7 mm. The procedure was successful in 96.8% cases. There was only one device embolization (1.56%). Cobrahead” configuration malformation of the device occurred in one case (1.56%). Mitral valve regurgitation did not occur in any of the case. There was no residual shunt across the device in the present study. ECG abnormalities associated with transcatheter closure did not occur in any of the patient. In intermediate and long-term follow up, no complication like cardiac erosion was seen in all cases under study. Conclusion: Transcatheter occlusion of ASD with device was found effective and safe procedure with minimal complication rate, short hospital stay, good short, intermediate and long-term results.

Complete atrio-ventricular heart block, a not to be forgotten complication in transcatheter closure of perimembranous ventricular septal defect – a case report and review of literature

2021 ◽  
pp. 1-4
Author(s):  
Ming Chern Leong ◽  
Mazeni Alwi
Keyword(s):  
Ventricular Septal Defect ◽  
Heart Block ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Review Of Literature ◽  
Device Closure ◽  
Bundle Branch Block ◽  
Know How ◽  
Perimembranous Ventricular Septal Defect ◽  
New Onset

Abstract Device occlusion of perimembranous ventricular septal defect is gaining popularity with the emergence of newer, softer occluders and improved technical know-how. We report a 26-year-old lady with a moderate size perimembranous ventricular septal defect who had a new onset of bundle branch block shortly after device closure. The patient subsequently developed a complete atrio-ventricular heart block.

scholarly journals The Role of Hydraulic Silicate Cements on Long-Term Properties and Biocompatibility of Partial Pulpotomy in Permanent Teeth

Materials ◽  
2021 ◽  
Vol 14 (2) ◽  
pp. 305
Author(s):  
Chung-Min Kang ◽  
Saemi Seong ◽  
Je Seon Song ◽  
Yooseok Shin
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Antimicrobial Properties ◽  
Permanent Teeth ◽  
Success Rates ◽  
Pulp Tissue ◽  
Cox Regression Analysis ◽  
Clinical Variables

The use of hydraulic silicate cements (HSCs) for vital pulp therapy has been found to release calcium and hydroxyl ions promoting pulp tissue healing and mineralized tissue formation. The present study investigated whether HSCs such as mineral trioxide aggregate (MTA) affect their biological and antimicrobial properties when used as long-term pulp protection materials. The effect of variables on treatment outcomes of three HSCs (ProRoot MTA, OrthoMTA, and RetroMTA) was evaluated clinically and radiographically over a 48–78 month follow-up period. Survival analysis was performed using Kaplan–Meier survival curves. Fisher’s exact test and Cox regression analysis were used to determine hazard ratios of clinical variables. The overall success rate of MTA partial pulpotomy was 89.3%; Cumulative success rates of the three HSCs were not statistically different when analyzed by Cox proportional hazard regression analysis. None of the investigated clinical variables affected success rates significantly. These HSCs showed favorable biocompatibility and antimicrobial properties in partial pulpotomy of permanent teeth in long-term follow-up, with no statistical differences between clinical factors.

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