A novel method for closing the percutaneous transapical access tract using coils and gelatin matrix. (33/221)

A patient with a symptomatic mitral paravalvular leak was successfully treated by implantation of an Amplatzer (16 mm) occluder device (AGA Medical, Plymouth, Minnesota) at the defect via percutaneous direct transapical puncture of the left ventricle. We describe a novel technique for closure and immediate hemostasis of the transapical access tract, comprising two stainless steel coils deployed across the myocardial wound and a hemostatic matrix injected at the epicardium and within the subcutaneous tract.  (+info)

Transcatheter closure of atrial septal defects--is balloon sizing still necessary? (34/221)

INTRODUCTION: The device closure of atrial septal defects has evolved over the years. In the early days of transcatheter occlusion, balloon sizing was used to choose an appropriate sized device. We postulate that balloon sizing does not value-add to the procedure and is unnecessary. MATERIALS AND METHODS: Patients who had balloon sizing, with (Group 1, n = 38) or without (Group 2, n = 21) atrial septal defect closure, were compared to another group (Group 3, n = 64) who had atrial septal defect closure without balloon sizing. Although the atrial septal defect size (mm) in those without balloon sizing (Group 3) compared to patients who had balloon sizing (Group 1) (18.3 +/- 5.4 vs 14.8 +/- 5.8; P = 0.021) was larger, the Amplatzer septal occluder size chosen (mm) (21.6 +/- 6.3 vs 21.2 +/- 8.1; P = 0.693) was similar. RESULTS: We analysed the degree of absolute sizing, defined as [(Balloon or Amplatzer occluder size) - (transoesophageal echocardiography size)], versus relative sizing, which is defined as [(Balloon or Amplatzer occluder size)--(transoesophageal echocardiography size) / (Balloon or Amplatzer occluder size)]. It was evident that there was greater absolute and relative over-sizing (6.3 +/- 4.4 mm vs 4.2 +/- 2.1 mm; P = 0.009 and 28.3 +/- 15.4% vs 20.0 +/- 7.0%; P = 0.001, respectively) in patients with balloon sizing (Group 1) compared to those who did not (Group 3). Even a greater degree of absolute (5.1 +/- 3.9 mm vs 9.5 +/- 4.7 mm; P <0.001) and relative over-sizing (24.8 +/- 15.6% vs 33.0 +/- 13.6%; P = 0.001) was observed in patients who had balloon sizing but there was no closure (Group 2) compared to those who had balloon sizing and closure of their defects (Group 1). CONCLUSION: Our results showed that balloon sizing tended to over-size the atrial septal defect. This may have an important bearing in selecting a larger device than necessary, or even precluding transcatheter closure of the larger atrial septal defects. It is also associated with increased procedural, fluoroscopy time and cost. We suggest that balloon sizing may no longer be necessary in the protocol of device closure of an atrial septal defect.  (+info)

Percutaneous closure of recurrent noncoronary Sinus of Valsalva aneurysm rupture: utility of computed tomography in procedural planning. (35/221)

This case demonstrates the benefit of CT angiography in procedure planning and device selection for percutaneous closure of Sinus of Valsalva aneurysm rupture. As there is no dedicated equipment for closure, appropriate device selection is paramount. Amplatzer Muscular VSD Occluder device was chosen based on the anatomy of the defect that was readily appreciable by CT angiography, but was not well visualized with transesophageal echocardiography and thoracic aortography. CT angiography can provide anatomic information vital to percutaneous procedure planning and device selection. It is complementary to other imaging modalities.  (+info)

Retrograde approach for closure of ruptured sinus of Valsalva. (36/221)

Though ruptured sinuses of Valsalva have been traditionally managed surgically, they are amenable to transcatheter closure. Various devices have been used for closure of these defects. We describe a novel technique of closure of a ruptured right sinus of Valsalva into the right ventricular outflow tract. A muscular ventricular septal defect occluder was deployed retrogradely, without resorting to the usual antegrade technique involving formation of an arteriovenous loop.  (+info)

Transcatheter perimembranous ventricular septal defect closure with atrial septal occluder. (37/221)

We report a patient with hemodynamically significant perimembranous ventricular septal defect who underwent successful closure with the Amplatzer Atrial Septal Occluder (AGA Medical Corporation, Golden Valley, Minnesota) without complications in short-term follow up.  (+info)

Transcatheter closures of a postinfarction ventricular septal defect and late ventricular pseudoaneurysm. (38/221)

An 83-year-old woman with a history of coronary artery disease presented with anterior ST-elevation myocardial infarction. During coronary intervention, she was found to have a ventricular septal rupture, but was felt not to be a surgical candidate due to advanced shock. She was offered transcatheter repair using an Amplatzer post-infarction muscular ventricular septal defect occluder and recovered completely. She was discharged, but returned four months later with chest pain. A cardiac CT and contrast-enhanced echocardiogram revealed a left ventricular pseudoaneurysm. She underwent transcatheter repair using an Amplatzer Vascular Plug II and recovered without further sequelae.  (+info)

Which patients might be suitable for a septal occluder device closure of postinfarction ventricular septal rupture rather than immediate surgery? (39/221)

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Echocardiographic evaluation of patent foramen ovale prior to device closure. (40/221)

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