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Occluder
Kinds of Occluder Terms modified by Occluder Selected AbstractsPERCUTANEOUS TRANSCATHETER CLOSURE OF PATENT DUCTUS ARTERIOSUS WITH AN AMPLATZER DUCT OCCLUDER USING RETROGRADE GUIDEWIRE-ESTABLISHED FEMORAL ARTERIOVENOUS LOOPCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 5-6 2008Jian-Fa Zhang SUMMARY 1The traditional antegrade wire-guided percutaneous transcatheter approach is not ideal in closing some types of patent ductus arteriosus (PDA) with abnormal morphology. The aim of the present study was to evaluate the efficacy of a retrograde wire-guided transcatheter approach for closure of some types of PDA using the Amplatzer duct occluder (ADO). 2Nineteen patients with abnormal PDA morphology, including a smaller ostium of the side of the pulmonary artery compared with the side of the descending aorta, severe calcification or tortuosity, were included in the present study. In these patients, after the antegrade approach failed to cross a wire from the pulmonary artery via the PDA to the descending aorta, a retrograde guidewire was passed through the PDA in the opposite direction, from the descending aorta to the pulmonary artery, to establish a femoral arteriovenous loop that assisted the deployment of the ADO in all 19 patients. The size of the PDA, as determined by angiography, was 3.1 ± 1.1 mm and the diameter of the ADO selected was 6.5 ± 1.5 mm. 3In 16 cases, systolic murmur disappeared after the procedure. Systolic murmur (less than Grade II) and angiographic residual shunt remained in three cases immediately after the procedure, but disappeared 1 month later. Mean pulmonary arterial pressure decreased from 33 ± 8 to 22 ± 4 mmHg in all 19 patients (P < 0.01). There were no complications during or after the procedure. 4The retrograde wire-guided technique offers an alternative approach to facilitate closure of a PDA that cannot be achieved by traditional antegrade wire-guided methods due to morphological abnormalities in the PDA. [source] Device Closure of a Secundum Atrial Septal Defect in a 4-Month-Old Infant with a Marginal Left Ventricle Following Coarctation RepairCONGENITAL HEART DISEASE, Issue 6 2007Emilie Jean-St-Michel BSc ABSTRACT A male infant presented at birth with severe coarctation of the aorta and marginal left ventricular and mitral valve dimensions associated with a large secundum atrial septal defect. Following successful arch repair, the left ventricle remained small with preferential left-to-right atrial shunting and a dilated right ventricle. Clinically, the infant continued with tachypnea, poor feeding, and failure to thrive. At 4 months of age, the defect was closed with an Amplatzer Atrial Septal Occluder which resulted in immediate left ventricular cavity enlargement and clinical improvement. [source] Incomplete Aneurysm Coverage after Patent Foramen Ovale Closure in Patients with Huge Atrial Septal Aneurysm: Effects on Left Atrial Functional RemodelingJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2010GIANLUCA RIGATELLI M.D. Background: Large devices are often implanted to treat patent foramen ovale (PFO) and atrial septal aneurysm (ASA) with increase risk of erosion and thrombosis. Our study is aimed to assess the impact on left atrium functional remodeling and clinical outcomes of partial coverage of the approach using moderately small Amplatzer ASD Cribriform Occluder in patients with large PFO and ASA. Methods: We prospectively enrolled 30 consecutive patients with previous stroke (mean age 36 ± 9.5 years, 19 females), significant PFO, and large ASA referred to our center for catheter-based PFO closure. Left atrium (LA) passive and active emptying, LA conduit function, and LA ejection fraction were computed before and after 6 months from the procedure by echocardiography. The preclosure values were compared to values of a normal healthy population of sex and heart rate matched 30 patients. Results: Preclosure values demonstrated significantly greater reservoir function as well as passive and active emptying, with significantly reduced conduit function and LA ejection fraction, when compared normal healthy subjects. All patients underwent successful transcatheter closure (25 mm device in 15 patients, 30 mm device in 6 patients, mean ratio device/diameter of the interatrial septum = 0.74). Incomplete ASA coverage in both orthogonal views was observed in 21 patients. Compared to patients with complete coverage, there were no differences in LA functional parameters and occlusion rates. Conclusions: This study confirmed that large ASAs are associated with LA dysfunction. The use of relatively small Amplatzer ASD Cribriform Occluder devices is probably effective enough to promote functional remodeling of the left atrium. (J Interven Cardiol 2010;23:362,367) [source] Figulla ASD Occluder versus Amplatzer Septal Occluder: A Comparative Study on Validation of a Novel Device for Percutaneous Closure of Atrial Septal DefectsJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 6 2009AYSENUR PAC M.D. Objectives: Occlutech Figulla ASD Occluder (FSO) is an alternative device to Amplatzer Septal Occluder (ASO) with some structural innovations including increased flexibility, minimizing the amount of material implanted, and absence of the left atrial clamp. We aimed to report our experiences with FSO and compare the outcomes of this novel device versus ASO. Interventions: Between December 2005 and February 2009, 75 patients diagnosed with secundum atrial septal defects underwent transcatheter closure. The FSO device was used in 33 patients, and the ASO was used in 42. Results: Patient characteristics, stretch size of the defect, device left disc size, procedure, and fluoroscopy time were similar between the groups. However, the difference between device waist size and stretched diameter of the defect was significantly higher, and device delivery sheath was significantly larger in FSO group and device left disc size was significantly lower in the FSO group. In all subjects, the residual shunt was small to trivial during follow-up and the reduction in prevalence of residual shunt with time was similar in both groups (P = 0.68). We found no differences in complication rate between the two devices; however, device embolization to the pulmonary bifurcation in one patient was recorded as major complication in FSO device group. Conclusions: Both devices are clinically safe and effective in ASD closure. FSO device has similar outcomes when compared to ASO device. Difficulties in selecting the correct device size in larger defects and larger venous sheath requirement need to be evaluated in further studies. [source] Patent Ductus Arteriosus ClosureJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2006RICHARD A. KRASUSKI M.D. Patent ductus arteriosus is a common clinical lesion which increases the risk of endocarditis and may lead to heart failure and pulmonary hypertension. Devices and techniques have advanced to the point that in most patients percutaneous closure should be the procedure of choice. Devices are best selected by fully examining the anatomy of the defect. In general coils are best suited for smaller defects and the Amplatzer Duct Occluder excels in moderate to large defects. Follow-up should include echocardiography to ensure complete closure. [source] Dysfunction of an Atrial Septal Defect Occluder 8 Years after ImplantationJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2006HENRIK TEN FREYHAUS M.D. Catheter interventional treatment of atrial septal defect (ASD) is widely accepted. The ASD occluder system (ASDOS) is no longer a widely used device nowadays. However, it is implanted in a substantial number of patients. We report a case of severe left-to-right shunt 8 years after catheter interventional closure of an ASD with an ASDOS device. The shunt was due to a membrane perforation, while the arms of the device were not dislocated. Microscopy, microbiology, and histology could not establish a proper explanation for the dysfunction; so long-term follow-up investigation may be required in patients with an implanted ASDOS device. [source] Single-Center Experience with the HelexÔ Septal Occluder for Closure of Atrial Septal Defects in ChildrenJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2003ROBERT N. VINCENT M.D. Catheter closure of atrial septal defects (ASDs) is an accepted procedure among pediatric cardiologists. We report our early experience with the newest of these devices in clinical trials in the United States. Between April and October 2001, 14 patients were enrolled in an FDA phase II multicenter trial comparing the results of ASD closure using the HELEXÔ Septal Occluder to a surgical control group. Of the 14 patients, devices were placed and left in 13, one being removed for an excessive residual leak despite placing the largest device available. Of the remaining 13 patients, all patients had successful closure of their defects. An average of 1.8 devices/patient were deployed, reflecting the learning curve for this new device and new delivery style. Six devices were replaced because of excessive residual leaks, three for premature lock release, and two for improper seating of the device. There were no procedural complications, however, one patient required device removal 4 months postimplant for possible allergic reaction to nickel. The same patient had removal of stainless steel sternal wires for the same reason. At the 6-month follow-up, 11 of 13 patients had complete closure of the ASD, the other two having small, hemodynamically insignificant left to right shunts. In one of these patients, there was complete closure at the 12-month follow-up, whereas the other patient awaits the 1-year evaluation. Early experience at our institution has demonstrated the ease of use of this device, its complete retrievability, and excellent closure of small to moderate ASDs in children. (J Interven Cardiol 2003;16:79,82) [source] Occlusion of an Aberrant Artery to a Pulmonary Sequestration Using a Duct OccluderJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2002D.C.H., ELLEN CRUSHELL M.D., M.R.C.P.I. This report describes a female infant with a rare chromosome defect, del. 12 (q22-24.1), who has severe pulmonary valve stenosis, an atrial septal defect, and a small muscular ventricular septal defect. At 4 months of age a balloon pulmonary valvuloplasty was performed in the cardiac catheterization laboratory. During the procedure, a large aberrant artery from the aorta to a sequestration of the right lower lobe of lung was found. The flow-off from the sequestration was into a dilated left atrium. The single artery supplying the sequestration was successfully occluded using an Amplatzer Duct Occluder device. There were no complications and the infant remains well at 1-yearfollow-up. [source] An Unusual Encounter of a "Cobra" in the Heart: Rare Appearance of an Amplatzer Septal OccluderJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2001F.R.C.P.E., M.M.E.D., WILLIAM C. L. YIP M.B.B.S. This article presents the unusual appearance of a "cobra"due to "acute bending"of the proximal part and partial opening of the distal part of the left atrial disk of an Amplatzer Septal Occluder during the process of transcatheter closure of a secundum atrial septal defect in a 6-year-old boy. The possible reasons and method to overcome this technical problem, which resulted in successful occlusion of the atrial septal defect, are discussed. (J Interven Cardiol 2001;14:215,218) [source] Transcatheter closure of coronary artery fistulae using the Amplatzer duct occluderCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2006Sarina K. Behera MD Abstract Objective: The aim of this study is to report our experience using the Amplatzer Duct Occluder (ADO) for occlusion of significant coronary artery fistulae (CAF). Background: Transcatheter closure of CAF with coils is well described. Use of newer devices may offer advantages such as improved control of device placement, use of a single instead of multiple devices, and high rates of occlusion. Methods: A retrospective review of all patients catheterized for CAF from July 2002 through August 2005 was performed. Results: Thirteen patients with CAF underwent cardiac catheterization, of which a total of 6 patients had ADO placement in CAF (age, 21 days to 56 years; median age, 4.3 years and weight, 3.8 kg to 74.6 kg; median weight, 13.3 kg). An arteriovenous wire loop was used to advance a long sheath antegrade to deploy the ADO in the CAF. Immediate and short-term outcomes (follow-up, 3 months to 14 months; median follow-up, 8.5 months) demonstrated complete CAF occlusion in 5 patients and minimal residual shunt in 1 patient (who had resolution of right atrial and right ventricular enlargement). On follow-up clinical evaluation, all 6 patients had absence of fistula-related murmurs, and 2 previously symptomatic patients had resolution of congestive heart failure symptoms. Early complications included transient palpitations and atrial arrhythmia in the 2 oldest patients (52 and 56 years old). Conclusions: Use of the ADO is applicable for transcatheter closure of significant CAF. Advantages of using the ADO include the antegrade approach, use of a single device, and effective CAF occlusion. © 2006 Wiley-Liss, Inc. [source] Percutaneous Closure of a Large PDA in a 35-Year-Old Man with Elevated Pulmonary Vascular ResistanceCONGENITAL HEART DISEASE, Issue 2 2008John S. Hokanson MD ABSTRACT The presence of a large patent ductus arteriosus (PDA) may result in significant pulmonary hypertension, which may not be reversible. We present the case of a 35-year-old man with pulmonary hypertension who had successful percutaneous closure of a large PDA with an Amplatzer muscular ventricular septal defect occluder and resolution of his pulmonary hypertension. The use of prior balloon test occlusion of the PDA suggested that the procedure would be successful, despite the lack of an immediate fall in the pulmonary artery pressure. [source] Transcatheter versus Surgical Closure of Secundum Atrial Septal Defect in Adults: Impact of Age at Intervention.CONGENITAL HEART DISEASE, Issue 3 2007A Concurrent Matched Comparative Study Abstract Objectives., To compare the short- and mid-term outcomes of surgical (SUR) vs. transcatheter closure of secundum atrial septal defect (ASD) using Amplatzer septal occluder (ASO) in adults with a very similar spectrum of the disease; and to identify predictors for the primary end point. Design., Single-center, concurrent comparative study. Surgically treated patients were randomly matched (2:1) by age, sex, date of procedure, ASD size, and hemodynamic profile. Setting., Tertiary referral center. Patients., One hundred sixty-two concurrent patients with ASD submitted to ASO (n = 54) or SUR closure (n = 108) according with their preferences. Main Outcome Measures., Primary end point was a composite index of major events including failure of the procedure, important bleeding, critical arrhythmias, serious infections, embolism, or any major cardiovascular intervention-related complication. Predictors of these major events were investigated. Results., Atrial septal defects were successfully closed in all patients, and there was no mortality. The primary event rate was 13.2% in ASO vs. 25.0% in SUR (P = .001). Multivariate analysis showed that higher rate of events was significantly associated with age >40 years; systemic/pulmonary output ratio <2.1; and systolic pulmonary arterial pressure >50 mm Hg; while in the ASO group the event rate was only associated with the ASD size (>15 cm2/m2; relative risk = 1.75, 95% confidence interval 1.01,8.8). There were no differences in the event-free survival curves in adults with ages <40 years. Conclusions., The efficacy for closure ASD was similar in both groups. The higher morbidity observed in SUR group was observed only in the patients submitted to the procedure with age >40 years. The length of hospital stay was shorter in the ASO group. Surgical closure is a safe and effective treatment, especially in young adults. There is certainly nothing wrong with continuing to do surgery in countries where the resources are limited. [source] Representational momentum and children's sensori-motor representations of objectsDEVELOPMENTAL SCIENCE, Issue 3 2008Lynn K. Perry Recent research has shown that 2-year-olds fail at a task that ostensibly only requires the ability to understand that solid objects cannot pass through other solid objects. Two experiments were conducted in which 2- and 3-year-olds judged the stopping point of an object as it moved at varying speeds along a path and behind an occluder, stopping at a barrier visible above the occluder. Three-year-olds were able to take into account the barrier when searching for the object, while 2-year-olds were not. However, both groups judged faster moving objects to travel farther as indicated by their incorrect reaches. Thus, the results show that young children's sensori-motor representations exhibit a form of representational momentum. This unifies the perceptually based representations of early childhood with adults' dynamic representations that incorporate physical regularities but that are also available to conscious reasoning. [source] Predictive tracking over occlusions by 4-month-old infantsDEVELOPMENTAL SCIENCE, Issue 5 2007Claes Von Hofsten Two experiments investigated how 16,20-week-old infants visually tracked an object that oscillated on a horizontal trajectory with a centrally placed occluder. To determine the principles underlying infants' tendency to shift gaze to the exiting side before the object arrives, occluder width, oscillation frequency, and motion amplitude were manipulated resulting in occlusion durations between 0.20 and 1.66 s. Through these manipulations, we were able to distinguish between several possible modes of behavior underlying ,predictive' actions at occluders. Four such modes were tested. First, if passage-of-time determines when saccades are made, the tendency to shift gaze over the occluder is expected to be a function of time since disappearance. Second, if visual salience of the exiting occluder edge determines when saccades are made, occluder width would determine the pre-reappearance gaze shifts but not oscillation frequency, amplitude, or velocity. Third, if memory of the duration of the previous occlusion determines when the subjects shift gaze over the occluder, it is expected that the gaze will shift after the same latency at the next occlusion irrespective of whether occlusion duration is changed or not. Finally, if infants base their pre-reapperance gaze shifts on their ability to represent object motion (cognitive mode), it is expected that the latency of the gaze shifts over the occluder is scaled to occlusion duration. Eye and head movements as well as object motion were measured at 240 Hz. In 49% of the passages, the infants shifted gaze to the opposite side of the occluder before the object arrived there. The tendency to make such gaze shifts could not be explained by the passage of time since disappearance. Neither could it be fully explained in terms of visual information present during occlusion, i.e. occluder width. On the contrary, it was found that the latency of the pre-reappearance gaze shifts was determined by the time of object reappearance and that it was a function of all three factors manipulated. The results suggest that object velocity is represented during occlusion and that infants track the object behind the occluder in their ,mind's eye'. [source] Searching for food in the wild: a nonhuman rimate's expectations about invisible displacementDEVELOPMENTAL SCIENCE, Issue 1 2001Marc D. Hauser Five experiments involving invisible displacements were run on a population of semi-free-ranging rhesus monkeys (Macaca mulatta). The goal of these experiments was to assess, without training, the kinds of expectations individuals spontaneously set up when an object has moved out of sight. The first experiment, modeled after studies of human infants and children, involved a table with one box on the top surface and a second box lined up below on the ground. An occluder was placed in front of the table, blocking the subject's view. A piece of food was then dropped behind the occluder, above the top box. The presenter then removed the occluder, walked away, and allowed the subject to approach. Consistently, subjects searched in the incorrect bottom box. This error can be interpreted as a failure to understand solidity, containment, or some other factor. It can also be interpreted as an error guided by a gravity bias, i.e. an expectation that all falling objects fall straight down or to the lowest point. Experiments 2,5 tested these alternative hypotheses. Results show that rhesus monkeys do not have an inherent bottom box bias, are not avoiding the top box, and do recognize that in some contexts boxes can contain or hold food. Thus, for example, when the two boxes are placed on the ground, one in front of the other, and occluded, subjects search in the near box after a piece of food has been rolled behind the occluder (horizontal trajectory). This shows that rhesus can solve an invisible displacement problem that involves solid containers, where one container blocks travel to the other container. We conclude that the rhesus monkey's error in Experiment 1 is guided by an expectation that all falling objects fall straight down or, at least, to the lowest point. This expectation represents a limitation of their knowledge of physical objects and events. [source] Role of Echocardiography in Percutaneous Occlusion of the Left Atrial AppendageECHOCARDIOGRAPHY, Issue 4 2007Mráz M.D. Percutaneous occlusion of the left atrial appendage (LAA) is a modern alternative for the treatment of patients with atrial fibrillation (AF) and with a high risk of stroke who are not eligible for long-term anticoagulation therapy. Echocardiography plays a significant role in selecting patients, guiding the procedure, and in the postprocedural follow-up. Objectives and methods: To test the role of transesophagoeal echocardiography (TEE) and intracardiac echocardiography (ICE) in facilitating and shortening the procedure. Results: ICE represents a more convenient approach in patients who are not under generally anesthesia and helps to facilitate transseptal puncture. On the other hand, TEE, having the ability to rotate the image plane, helps to better determine the position of the occluder. Conclusions: Echocardiographic guidance of this procedure is essential. Which approach will be preferred will depend on the development of these two methods. [source] Where Infants Look Determines How They See: Eye Movements and Object Perception Performance in 3-Month-OldsINFANCY, Issue 2 2004Scott P. Johnson A fundamental question of perceptual development concerns how infants come to perceive partly hidden objects as unified across a spatial gap imposed by an occluder. Much is known about the time course of development of perceptual completion during the first several months after birth, as well as some of the visual information that supports unity perception in infants. The goal of this investigation was to examine the inputs to this process. We recorded eye movements in 3-month-old infants as they participated in a standard object unity task and found systematic differences in scanning patterns between those infants whose post-habituation preferences were indicative of unity perception versus those infants who did not perceive unity. Perceivers, relative to nonperceivers, scanned more reliably in the vicinity of the visible rod parts and scanned more frequently across the range of rod motion. These results suggest that emerging object concepts are tied closely to available visual information in the environment, and the process of information pickup. [source] 10-month-old infants' inference of invisible agent: Distinction in causality between object motion and human action1JAPANESE PSYCHOLOGICAL RESEARCH, Issue 1 2003Daisuke Kosugi Abstract: Two habituation experiments investigated 10-month-old infants' interpretation of events where a stationary object began to move without any visible causes. During habituation, infants saw that an object partly hidden by an occluder began to move away from the occluder. Then, they were tested with three test events without the occluder: the ,rst event showed a hand pushing the object, the second event showed a hand failing to touch the object, and the last event had no agent. The objects were a ball in Experiment 1, and a person in Experiment 2. The test event that the infants looked at for the shortest duration in Experiment 1 was where the hand pushed the ball, whereas they looked at the three test events almost equal amounts of time in Experiment 2. These results indicate that 10-month-old infants responded to the events in terms of causality and could infer the presence of the agent behind the occluder only when they saw the habituation event featuring the ball. [source] Mechanical Prosthetic Valve Dysfunction Causing Pulsus Alternans Leading to Intermittent Electromechanical Dissociation: A Case Report and Literature ReviewJOURNAL OF CARDIAC SURGERY, Issue 6 2007Vasha Kaur M.B.Ch.B. (Hons) She initially developed pulsus alternans which led, over a few hours, to intermittent electromechanical dissociation. Clinical and echocardiographic findings are described. Emergency surgical intervention revealed a piece of chorda wedged between the disc occluder and the valve ring. This case illustrates clinical and Doppler echocardiographic features associated with a rare presentation of an unusual perioperative complication of prosthetic mitral valve dysfunction. We have also included a brief review of related literature. [source] Transcatheter Closure of Patent Foramen Ovale in Patients with Paradoxical Embolism.JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2008Follow-up Results after Implantation of the Starflex® Occluder Device with Conjunctive Intensified Anticoagulation Regimen, Procedural Background:Prevalence of patent foramen ovale (PFO) is higher in patients with paradoxical embolism and associated with increased risk for recurrent thromboembolic events. By percutaneous closure of PFO, surgical closure or permanent oral anticoagulation can be avoided. So far, published series included different occluder systems and various indications and regimens of postprocedural anticoagulation. The aim of the present study was to evaluate the short- and long-term results after implantation of the Starflex® occluder in patients with PFO using an intensified anticoagulation regimen. Methods and Results:154 patients with PFO (94 men; age: 44 ± 13 years) and >1 thromboembolic event were included. Other causes for embolism were excluded. PFO closure was successful in 147 patients (95.5%). All patients were treated with phenprocoumon (INR 2.5) and aspirin (100 mg/die) for 6 months. Transesophageal echocardiography (TEE) was repeated at 6 months. Mean clinical follow-up period was 26 ± 18 months. After 6 months, five patients had a significant residual shunt, and five patients had suspected thrombus formation on the occluder. In three of these five patients, the occluder was surgically removed and foreign body reaction was noted. During follow-up, nine patients suffered from neurological events (two strokes, seven transient ischemic attacks [TIA]), though complete closure of the PFO was documented by TEE. Two patients died during follow-up; three patients had bleeding complications. Conclusion:Percutaneous closure of PFO in symptomatic patients by Starflex® occluder represents an effective therapy with a low incidence of periinterventional complications and recurrent thromboembolism. However, thrombus formation at the occluder system may occur in some patients despite an aggressive anticoagulation regimen. [source] Transcatheter Closure of Congenital Ventricular Septal Defects: Experience with Various DevicesJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2003RAMESH ARORA D.M. Transcatheter closure of congenital ventricular septal defect (VSD) using various devices is gaining acceptance in selected cases of perimembranous and muscular defects, avoiding the inherent risks of cardiopulmonary bypass. The procedure was attempted in 137 patients having congenital defects using Rashkind Umbrella Device (RUD) in 29 patients, Amplatzer ventricular septal occluder (AVSO) in 107 patients, and Detachable Coil in one. All patients were selected using stringent criteria by detailed transthoracic echocardiography and/or transesophageal echocardiography. The location of VSD was perimembranous in 91 patients and was muscular trabecular in 46 patients. Seven patients had left ventricle (LV) to right atrium (RA) communication. Thirty-five patients with perimembranous and two with muscular VSD had aneurysm formation. The patients were 3 to 33 years old, and the diameter of VSD ranged from 3 to 12 mm. The pulmonary to systemic flow ratio was ,2:1 in 47 (34.3%) patients. The procedure was successful in 130 (94.8%) patients, with a success rate of 86.2% with RUD and 97.1% with AVSO. Residual shunt at 24 hours was seen in eight (32%) patients with RUD and in one patient (0.9%) with AVSO. Three (2.8%) developed transient bundle branch block, and two (1.9%) patients had complete heart block. New tricuspid stenosis and tricuspid regurgitation was observed in one patient each with AVSO. After immediate balloon dilatation, the mean pressure gradient across tricuspid valve decreased from 11 to 3 mmHg in the patient with tricuspid stenosis. On a follow-up of 1 to 66(mean 35.2 ± 10.7)months, the device was in position in all. None developed late conduction defect, aortic regurgitation, infective endocarditis, or hemolysis. At 9-month follow-up, the mean pressure gradient across the tricuspid valve was 3 mmHg in the patient with tricuspid stenosis. Complete occlusion of the shunt was achieved in 129 (99.2%) patients. One patient with RUD having persistent residual shunt underwent a second procedure with AVSO. Three out of 107 patients with AVSO had an unsuccessful procedure where the defect was perimembranous with a superior margin of defect less than 3 mm away from the aortic valve, and the specially designed perimembranous AVSO had to be retrieved because of hemodynamic compromise due to significant acute aortic regurgitation, whereas in all others, the defect was either ,3 mm away from the aortic valve or had aneurysm formation. All seven patients with LV to RA communication showed complete abolition of the shunt. Thus, in properly selected cases of perimembranous and muscular ventricular septal defects, the transcatheter closure is safe and efficacious using appropriate devices. The success rate is higher with AVSO compared with the previously used devices, as well as more successful for the muscular defects than those that are perimembranous in location. (J Interven Cardiol 2003;16:83,91) [source] Splanchnic vasoconstriction by angiotensin II is arterial pressure dependentACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2002M. Broomé Background: Our hypothesis was that splanchnic vasoconstriction by exogenous angiotensin II (Ang II) is significantly potentiated by local mechanisms increasing vasomotor tone and that splanchnic tissue oxygenation during administration of Ang II is perfusion pressure dependent. The aim was to study local splanchnic circulatory effects and tissue oxygenation during intravenous infusion of Ang II at different levels of regional arterial driving pressure in a whole-body large animal model. Methods: Ang II was infused in incremental doses (0,200 ,g,·,h,1) in anaesthetised instrumented pigs (n=8). Mean superior mesenteric arterial pressure (PSMA) was adjusted by a local variable perivascular occluder. Perivascular ultrasound and laser-Doppler flowmetry were used for measurements of mesenteric venous blood flow and superficial intestinal blood flow, respectively. Intestinal oxygenation was evaluated by oxygen tissue tension (PtiO2) and lactate fluxes. Results: Ang II produced prominent and dose-dependent increases in mesenteric vascular resistance (RSMA) when the intestine was exposed to systemic arterial pressure, but Ang II increased RSMA only minimally when PSMA was artificially kept constant at a lower level (50 mmHg) by the occluder. Although Ang II decreased PtiO2 at a PSMA of 50 mmHg, splanchnic lactate production was not observed. Conclusion: We demonstrate that splanchnic vasoconstriction by exogenous Ang II is dependent on arterial driving pressure, suggesting significant potentiation through autoregulatory increases in vasomotor tone. Intestinal hypoxaemia does not seem to occur during short-term infusion of Ang II in doses that significantly increases systemic arterial pressure. [source] The prevalence of suppression in amblyopic individualsOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 1 2008Brendan Barrett Purpose:, A popular view of visual functioning in individuals with amblyopia is that the weaker eye is suppressed in key regions of the binocular visual field. Indeed, some have argued that chronic interocular suppression may represent the cause of amblyopia. Here we evaluate the prevalence of amblyopic-eye suppression in a simple light detection task when the eyes are open, minimally dissociated and in their habitual motor position. Methods:, A custom program on the Humphrey Field Analyzer (Carl Zeiss Meditec Inc., Dublin, CA, USA) was used to measure detection thresholds for a blue light on a yellow background along the horizontal meridian at two-degree intervals to an eccentricity of 25 degrees on either side of the fixation mark. The fellow eye was prevented from seeing the target using three different methods: (1) full-occlusion (i.e. no light entered the fellow eye), (2) a translucent occluder (3) a yellow filter in front of the fellow eye. In (3), the yellow filter only prevented the fellow eye from seeing the blue stimulus; the fixation mark and the background remained visible (minimal-dissociation condition). Fourteen amblyopes participated in the study, of whom 11 had strabismus. Results:, Three basic patterns of results were observed. (1) Only three of the fourteen participants (,21%) showed evidence of suppression, where amblyopic-eye sensitivity was lower with the fellow eye open. In these cases, the retinal locations that showed greatest suppression corresponded to the direction and angle of the strabismus. (2) Three participants (,21%) showed the opposite effect to the result in (1); i.e. amblyopic-eye sensitivity was greatest when the fellow was open with minimal dissociation between the eyes. One possible explanation is that the dominance of the fellow eye caused this reduction. (3) Seven participants (50%) exhibited patterns of amblyopic sensitivity that did not depend upon the occlusion status of the fellow eye. The results for one participant did not fit into any of the above patterns. Conclusions:, Suppression appears not to be a universal feature of central amblyopic vision. Our results for this simple detection task suggest that suppression may exist in as few as 20% of amblyopes. These results present a challenge to the view that suppression represents a root cause of amblyopia but they are consistent with the view that the amblyopic eye makes a useful contribution under habitual viewing conditions. [source] Ganzfeld changes in short wavelength automated perimetryOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 6 2002S. Sukumar Purpose:, The change in perception of background illumination known as Ganzfeld changes occurs while performing perimetry test. It occurs under higher background illumination and whilst covering the non-tested eye with a black patch. We investigated the occurrence of Ganzfeld changes in Short Wavelength Automated Perimetry (SWAP) and assessed the performance while covering the non-tested eye with a standard black patch and with a translucent occluder. Methods:, Twenty-eight volunteers of age 22 ± 3 years participated in the study. A custom made 16-point test was used to analyse the sensitivity with a standard black patch and with the translucent occluder. The number and duration of Ganzfeld changes in each condition were detected by subjective responses. The visual comfort of the subjects under each patching condition was assessed using a comfort scale (0,5) and subject's preference. Results:, Ganzfeld changes occurred when a standard black patch was used and appears to influence the ability to see the test targets. With a standard black patch 5 Ganzfeld changes were observed per minute and it varied between 2 and 8 s. The duration and occurrence increased towards the end of the test. Using a translucent occluder almost eliminates the occurrence of Ganzfeld changes and improved the sensitivity (p = 0.001). Of the 28 subjects, 22 preferred translucent occluder to black patch. Conclusion:, Use of a translucent spectacle occluder over the non-tested eye significantly reduces the Ganzfeld changes and improves the performance in SWAP. [source] Lung perfusion studies after transcatheter closure of persistent ductus arteriosus with the Amplatzer duct occluder,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2010Tugcin Bora Polat MD Abstract Background: Reduced left lung perfusion has been described after transcatheter closure of the patent ductus arteriosus (PDA) with several prostheses. Although the Amplatzer ductal occluder (ADO) device is currently the most widely used occluder for closure of large-sized PDAs, the potential consequences of flow distribution to the lungs of this device have not been completely clarified. We evaluated lung perfusion following occlusion of PDA with the ADO device. Methods: Forty-seven patients underwent successful transcatheter PDA occlusion using the ADO device were included in this study. Lung perfusion scans were performed 6 months after the procedure. Results: Decreased perfusion to the left lung (defined as < 40% of total lung flow) was observed in 17 patients (36%), 5 of whom were low-weight symptomatic infants. Ductal ampulla length was significantly shorter and minimal ductal diameter to ampulla diameter ratio was significantly higher in patients with decreased left lung perfusion and correlated well with left lung perfusion values (r = 0.516 and r = ,0.501, respectively). A cut-off value of ,5.8 mm for the ductal ampulla length and ,1.9 for ampulla diameter to ampulla length ratio showed high sensitivity and specificity for reduced lung perfusion. Conclusions: The incidence of abnormal left lung perfusion is high 6 months after transcatheter closure of PDA with the ADO, more likely in the low weight symptomatic infants and in patients with a short duct or a relatively shallow duct having abrupt narrowing of a large ampulla. © 2010 Wiley-Liss, Inc. [source] Closure of ostium secundum atrial septum defect with the Atriasept occluder: Early European experience,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2010Valérie Steiger Stolt MD Abstract Objectives: This multicentre study sought to report the safety and efficacy of the ATRIASEPT septal occluder to repair atrial septal defect (ASD). Background: The ATRIASEPT is a low profile, flexible, double disk occluder with centering system specifically designed for closure of ostium secundum ASD. Method: Patients were enrolled from four participating European sites and followed up for 12 months post procedure. Outcomes were evaluated, including closure success and incidence of adverse events. Results: Seventy-six patients received the ATRIASEPT device. Mean size of the defect was 15 ± 4 mm. Closure success was observed in 69 patients (89%) at the end of the procedure. Sixty-four patients had a six-month follow up with a complete closure by 58 patients (90%). Minor adverse events occurred in two patients. Significant functional improvement was reported by all symptomatic patients. Conclusion: Percutaneous closure of ASD ostium secundum type defects with the ATRIASEPT is safe and effective with high success rate and excellent mid-term outcome. © 2010 Wiley-Liss, Inc. [source] Early clinical experience with the new amplatzer ductal occluder II for closure of the persistent arterial duct,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2009Jonathan Forsey MB, MRCPCH Abstract Objectives: To describe the early single-center clinical experience with the Amplatzer Ductal Occluder II (ADO II). Methods: All patients undergoing attempted transcatheter closure of persistent arterial duct (PDA) with the ADO II were included. Data collected included demographic, clinical, and echocardiographic parameters. Results: From March until September 2008, 29 procedures were undertaken in 27 patients (21 female). Median age was 1.4 years (range 0.4,76 years) with median weight 9.4 kg (range 4.7,108 kg). A transarterial approach was used in 2 patients. The median minimum ductal diameter was 2.7 mm (range 1.7,5). ADO II was released in 25 patients (92.5%). Two patients had significant residual shunting following deployment of ADO II and underwent closure with Amplatzer ductal occluder (ADO I). Postprocedural echocardiography identified one occluder had changed position with development of a significant leak and one occluder had embolized to the left pulmonary artery. Both occluders were retrieved successfully at a second catheter procedure. Complete occlusion was noted predischarge in 22 of the remaining 23 occluders (96%). One patient had mild flow acceleration in the left pulmonary artery which has resolved. Conclusions: The ADO II is highly effective at providing rapid occlusion of morphologically varied PDAs. Occluder design allows closure with arterial or venous approach and delivery with 4 or 5 F delivery catheters. Stable occluder position is dependent on correct positioning of both aortic and pulmonary discs. A larger range of sizes and configurations of this occluder may be required to successfully occlude all ductal sizes and morphologies. © 2009 Wiley-Liss, Inc. [source] Perforation of the aortic sinus after closure of atrial septal defects with the Atriasept occluder,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2009Stephen Brown Abstract Percutaneous atrial septal defect closure is routinely performed nowadays because of the ease of implantation as well as the low complication rate. The Atriasept ASD occluder is a low profile, double disc device; over the years several modifications have been made. We report two cases of aortic sinus perforation by the Atriasept ASD occluder (model 2007). Two asymptomatic patients, in whom the device was implanted, were noticed to have metal projecting into the aorta. Real-time fluoroscopy showed fractures of the outer metal ring with abnormal movement of one of the struts of the device. One patient is being conservatively managed and in the other the device was surgically removed due to the presence of a second ASD, which needed closure. Transesophageal echocardiography and fluoroscopy may be necessary to identify this potentially life-threatening complication of this device. © 2009 Wiley-Liss, Inc. [source] Catheter closure of atrial septal defects with deficient inferior vena cava rim under transesophageal echo guidance,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2009K.S. Remadevi MD Abstract Objectives: To describe the case selection, imaging considerations, technique, and results of catheter closure of atrial septal defects (ASD) with deficient inferior vena cava (IVC) rim. Background: Transcatheter closure with Amplatzer septal occluder (ASO) has become standard treatment for most secundum ASDs. Defects with deficient IVC rim continue to be challenging to image and close in the catheterization laboratory. Methods: Records of 12 patients with deficient IVC rim (<5 mm), who underwent catheter closure (April 2007 to June 2008) were reviewed. General anesthesia and transesophageal echo (TEE) guidance was used in all. The IVC rim was imaged at 70°,90° with retroflexion of the TEE probe, in addition to the conventional views. Devices 1,4 mm > maximal ASD size were selected. Deployment was accomplished either from the left atrium, left upper or from the right pulmonary veins. Results: The median age was 5.5 (2.5,27) years and median weight was 19.5 (9-65) kg. The defects measured 16,32 mm and 18,36 mm septal occluders were used. The median fluoroscopic time was 13.1 (4.2,32.7) min. Initial device selection was revised in four patients. Two patients had residual flows at IVC margin. The device embolized to right ventricular outflow tract in one patient. This was retrieved, and a larger device was deployed. No other complications were observed immediately or on follow-up (median 6; range 1,14 months). Conclusions: Transcatheter closure of ASDs with deficient IVC rim is feasible under TEE guidance. The modified retroflexed view allows adequate imaging of IVC rim through TEE. © 2008 Wiley-Liss, Inc. [source] Transcatheter closure of high-risk muscular ventricular septal defects with the CardioSEAL occluder: Initial report from the CardioSEAL VSD RegistryCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 5 2007D. Scott Lim MD Abstract Objectives: The CardioSEAL VSD registry was created to track safety of the device to close high-risk Ventricular Septal Defect (VSD). Background: This is the first report from the multi-centered CardioSEAL VSD registry reviewing demographics and initial results. Methods: Centers recruited patients with VSD who were high-risk for surgery due to medical condition or anatomic features. Results: 18 centers contributed data on 55 high-risk patients who had 61 VSD-occlusion procedures, with age of range of 5 days to 65 years and using one to six devices. Implantation approach was transvenous in 48, perventricular in five, and by combined approach in two patients. Ninety-two percent of intended VSD device implants were judged successful. Twenty-two patients had single VSD closed by single device in 18 and by two devices in four patients. All patients <8 kg underwent perventricular device implantation. Thirty-three patients had multiple VSDs which were closed by a single device in 23, and multiple devices in 10. At discharge echocardiography showed total residual flow through all VSDs in which devices were used was classified as "Small" or less in 74%, "More than small" in 11%, and "Uncertain" in 15%. Eight major adverse events occurred in 5/61 cases (8% event rate), with 3/81 devices embolized (4% embolization rate), 5/81 devices surgically explanted (6% explant rate), and no deaths judged to be procedure-related. Conclusion: This initial report from the multi-centered CardioSEAL VSD registry demonstrates the safety of the device to close high-risk VSDs. © 2007 Wiley-Liss, Inc. [source] | |||||||||||||