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Steiner K, Sjöberg G, Damlin A, Settergren M, Verouhis D. Same-day discharge after percutaneous closure of persistent foramen ovale using intracardiac echocardiography and the Gore Septal Occluder. Front Cardiovasc Med 2024; 11:1408543. [PMID: 38993520 PMCID: PMC11238211 DOI: 10.3389/fcvm.2024.1408543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
Aim Periprocedural and postinterventional care of patients undergoing closure of patent foramen ovale (PFO) varies significantly across care providers. Same-day discharge (SDD) after transcatheter interventions is an evolving concept. This study aimed to assess the same-day discharge rate and incidence of complications in patients undergoing PFO closure with intracardiac echocardiography (ICE) using the Gore®Cardioform Septal Occluder (GSO) device. The secondary aim was to analyse the efficacy of femoral vein closure with Perclose ProGlide. Methods Patients who underwent PFO closure with the GSO device at a university hospital in Stockholm, Sweden, were retrospectively included between March 1, 2017, and June 30, 2020, all with cryptogenic stroke as the indication for the procedure. All patients underwent PFO closure with conscious sedation and local anaesthesia. The indication for all patients was a cryptogenic stroke. Periprocedural imaging was performed using ICE and fluoroscopy in all patients. Patient characteristics and periprocedural data were collected from patient charts. Patients were kept on bed rest for 4-6 h post-intervention. Transthoracic echocardiography and clinical examination, including groin status, were performed before discharge. No clinical routine follow-up was performed the day following the intervention. Clinical follow-up was done by phone call two weeks after the procedure, and echocardiographic follow-up was done after 12 months. Data were analysed using linear and logistic regression models. Results In total, 262 patients were included, of which 246 (94%) had SDD. 166 patients (63%) received the ProGlide™ system for femoral vein access closure. Post-procedural arrhythmias occurred in 17 (6%) patients, and vascular complications in 9 patients (3%). The overall closure rate at follow-up was 98.5%. 25 out of 264 patients (9.5%) had to be readmitted within the first eight weeks after PFO closure, 16 due to atrial fibrillation warranting electric cardioversion, one due to an arteriovenous fistula that was operated, four due to chest pain/pain at the access site, and four patients developed fever. There was no difference in SDD among patients who received ProGlide™ vs. patients who did not receive ProGlide™. Conclusion SDD appears safe after transcatheter PFO closure with the GSO device with high procedural success rates. Low rates of complications and readmissions make the intervention suitable for this patient-friendly and cost-effective concept.
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Affiliation(s)
- Kristoffer Steiner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Cardiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Sjöberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Cardiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Damlin
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Settergren
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dinos Verouhis
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Reibel I, Hauguel-Moreau M, Guedeney P, Hage G, Hammoudi N, Duthoit G, Zeitouni M, Lattuca B, Kernéis M, Collet JP, Silvain J, Montalescot G. Comparison of three echo-guidance techniques in percutaneous patent foramen ovale closure for stroke prevention: Conventional transoesophageal, microprobe transoesophageal and intracardiac echocardiography. Arch Cardiovasc Dis 2023; 116:523-528. [PMID: 37838576 DOI: 10.1016/j.acvd.2023.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Recent randomized trials have demonstrated a consistent reduction in recurrent stroke after percutaneous transcatheter patent foramen ovale closure versus medical therapy in patients with recent cryptogenic stroke. AIM To compare the safety and efficacy of intracardiac echocardiography-guided and microprobe transoesophageal echocardiography-guided patent foramen ovale closure under local anaesthesia with transoesophageal echocardiography-guided patent foramen ovale closure under general anaesthesia. METHODS This prospective observational single-centre study included 194 consecutive patients scheduled for patent foramen ovale closure for secondary prevention of stroke from February 2018 to December 2019. Patients were asked to choose between an intracardiac echocardiography-guided, microprobe transoesophageal echocardiography-guided or transoesophageal echocardiography-guided procedure. The primary endpoint was the rate of successful closure at 6 months, defined as correct positioning of the device without severe shunt on 6-month contrast echocardiography. RESULTS Successful closure was high and did not differ between groups: 97.8% (95% confidence interval 88.5-99.9%) in the intracardiac echocardiography-guided group versus 96.9% (95% confidence interval 83.8-99.9%) in the microprobe transoesophageal echocardiography-guided group and 99.1% (95% confidence interval 95.3-99.9%) in the transoesophageal echocardiography-guided group (P=0.63). Adverse events related to patent foramen ovale closure were low and did not differ between groups. CONCLUSION Our preliminary real-world experience suggests good efficacy and safety with intracardiac echocardiography and microprobe transoesophageal echocardiography guidance compared with conventional transoesophageal echocardiography guidance for percutaneous transcatheter patent foramen ovale closure in recurrent stroke prevention.
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Affiliation(s)
- Iphigénie Reibel
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Marie Hauguel-Moreau
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Paul Guedeney
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Georges Hage
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Nadjib Hammoudi
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Guillaume Duthoit
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Michel Zeitouni
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Benoit Lattuca
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Mathieu Kernéis
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Jean-Philippe Collet
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Johanne Silvain
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Gilles Montalescot
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Krishnaswamy A, Isogai T, Brilakis ES, Nanjundappa A, Ziada KM, Parikh SA, Rodés-Cabau J, Windecker S, Kapadia SR. Same-Day Discharge After Elective Percutaneous Transcatheter Cardiovascular Interventions. JACC Cardiovasc Interv 2023; 16:1561-1578. [PMID: 37438024 DOI: 10.1016/j.jcin.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/23/2023] [Accepted: 05/08/2023] [Indexed: 07/14/2023]
Abstract
Percutaneous transcatheter interventions have evolved as standard therapies for a variety of cardiovascular diseases, from revascularization for atherosclerotic vascular lesions to the treatment of structural cardiac diseases. Concomitant technological innovations, procedural advancements, and operator experience have contributed to effective therapies with low complication rates, making early hospital discharge safe and common. Same-day discharge presents numerous potential benefits for patients, providers, and health care systems. There are several key elements that are shared across the spectrum of interventional cardiology procedures to create a successful same-day discharge pathway. These include appropriate patient and procedure selection, close postprocedural observation, predischarge assessments specific for each type of procedure, and the existence of a patient support system beyond hospital discharge. This review provides the rationale, available data, and a framework for same-day discharge across the spectrum of coronary, peripheral, and structural cardiovascular interventions.
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Affiliation(s)
- Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Aravinda Nanjundappa
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaled M Ziada
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sahil A Parikh
- Division of Cardiology and Center for Interventional Vascular Therapy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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Lan Q, Wu F, Ye X, Wang S, Zhong J. Intracardiac vs. transesophageal echocardiography for guiding transcatheter closure of interatrial communications: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1082663. [PMID: 37215547 PMCID: PMC10198467 DOI: 10.3389/fcvm.2023.1082663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
Background Transcatheter closure of atrial septal defect (ASD) and patent foramen ovale (PFO) is an established practice, and it requires monitoring and guidance. Both transoesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) can be used as guidance tools. However, the use of ICE and TEE in structural heart disease is controversial and the advantages and disadvantages of both for ASD and PFO closure need to be investigated. We did a systematic review and meta-analysis to compare the efficacy and safety of TEE and ICE for guiding transcatheter closure of ASD and PFO. Methods A systematic search of Embase, PubMed, Cochrane library, Web of Science was conducted from inception to May 2022. The outcomes of this study included average time for both fluoroscopy and the procedure, complete closure, length of stay at hospital and adverse events. This study was performed using mean difference (MD), relative risk (RR) and 95% confidence interval (CI). Results The meta-analysis was conducted with a total of 11 studies, involving 4,748 patients were included in meta-analysis, including 2,386 patients in the ICE group and 2,362 patients in the TEE group. The results of the meta-analysis showed that compared with TEE, ICE was shorter in time both fluoroscopy [MD: -3.72 (95%CI: -4.09 to -3.34) minutes, P < 0.00001] and the procedure [MD: -6.43 (95%CI: -7.65 to -5.21) minutes, P < 0.00001], shorter length of stay at hospital [MD = -0.95 (95% CI = -1.21 to -0.69) days, P < 0.00001], lower incidence of adverse events (RR = 0.72, 95%CI: 0.62 to 0.84, P < 0.0001), and the arrhythmia (RR = 0.50, 95% CI = 0.27 to 0.94, P = 0.03) and vascular complications (RR = 0.52, 95%CI = 0.29 to 0.92, P = 0.02) in ICE group were lower than those in TEE group. No significant difference in complete closure was found between ICE and TEE (RR = 1.00, 95% CI = 0.98 to 1.03, P = 0.74). Conclusion Under the premise of ensuring successful rate of complete closure, ICE can shorten time between fluoroscopy and procedure and length of stay at hospital, and there was no increase in adverse events. However, more high-quality studies are needed to confirm the benefits of using ICE in ASD and PFO closure.
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Affiliation(s)
- Qingsu Lan
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Fengchao Wu
- Cardiology Department, Shanxi Provincial People's Hospital, Xi'an, China
| | - Xudong Ye
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Shaohua Wang
- Clinical Medical College, Dali University, Dali, China
| | - Jingquan Zhong
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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Asbeutah AA, Junaid M, Hassan F, Avila Vega J, Efeovbokhan N, Khouzam RN, Ibebuogu UN. Same day discharge after structural heart disease interventions in the era of the coronavirus-19 pandemic and beyond. World J Cardiol 2022; 14:271-281. [PMID: 35702323 PMCID: PMC9157608 DOI: 10.4330/wjc.v14.i5.271] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/14/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
With recent advancements in imaging modalities and techniques and increased recognition of the long-term impact of several structural heart disease interventions, the number of procedures has significantly increased. With the increase in procedures, also comes an increase in cost. In view of this, efficient and cost-effective methods to facilitate and manage structural heart disease interventions are a necessity. Same-day discharge (SDD) after invasive cardiac procedures improves resource utilization and patient satisfaction. SDD in appropriately selected patients has become the standard of care for some invasive cardiac procedures such as percutaneous coronary interventions. This is not the case for the majority of structural heart procedures. With the coronavirus disease 2019 pandemic, safely reducing the duration of time spent within the hospital to prevent unnecessary exposure to pathogens has become a priority. In light of this, it is prudent to assess the feasibility of SDD in several structural heart procedures. In this review we highlight the feasibility of SDD in a carefully selected population, by reviewing and summarizing studies on SDD among patients undergoing left atrial appendage occlusion, patent foramen ovale/atrial septal defect closure, Mitra-clip, and trans-catheter aortic valve replacement procedures.
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Affiliation(s)
- Abdulaziz A Asbeutah
- Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38013, United States
| | - Muhammad Junaid
- Internal Medicine, Forrest City Medical Center, Forrest City, AR 72335, United States
| | - Fatima Hassan
- Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38013, United States
| | - Jesus Avila Vega
- Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38013, United States
| | | | - Rami N Khouzam
- Department of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38104, United States
| | - Uzoma N Ibebuogu
- Department of Cardiology, University of Tennessee Health Science Center, Memphis, TN 38103, United States
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Hagemeyer D, Ali FM, Ong G, Fam NP. The Role of Intracardiac Echocardiography in Percutaneous Tricuspid Intervention: A New ICE Age. Interv Cardiol Clin 2021; 11:103-112. [PMID: 34838293 DOI: 10.1016/j.iccl.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The prevalence of severe tricuspid regurgitation in older patients is high, and the clinical relevance is perceived more and more in recent years. Many of these patients are not suitable for surgery because of their age and comorbidities. Therefore, a variety of percutaneous interventions have been developed to address this unmet need. Procedural success strongly depends on adequate imaging during the intervention. Although transesophageal echocardiography is the standard of care, imaging may be limited due to anatomic factors and adverse acoustic shadowing. In this review, we discuss the current and future role of intracardiac echocardiography in tricuspid valve interventions.
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Affiliation(s)
- Daniel Hagemeyer
- Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. https://twitter.com/DanielHagemeyer
| | - Faeez M Ali
- Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; Waikato Hospital, 183 Pembroke Street, Hamilton 3204, New Zealand
| | - Geraldine Ong
- Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Neil P Fam
- Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
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Safety and Cost Implications of Same-Day Discharge Following Elective Percutaneous Closure of Patent Foramen Ovale and Atrial Septal Defects in Australia. HEARTS 2021. [DOI: 10.3390/hearts2040041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Percutaneous closure of patent foramen ovale (PFO) and atrial septal defects (ASD) is being more commonly performed due to changes in international guidelines supporting its use. This study was performed to determine the clinical outcomes, safety and cost implications of same-day discharge (SDD) following such procedures and place this in an Australian context. Methods: This was a retrospective, observational study of patients undergoing elective percutaneous PFO or ASD closure at St. George Hospital, Australia between January 2011 and January 2020. Primary outcomes included 30-day major adverse cardiovascular endpoints (MACE) and readmission to hospital within 30 days. Results: Twenty-four patients were included in the primary analysis. Ten (41.7%) patients underwent elective ASD closure while 14 (58.3%) underwent PFO closure. Among the 24 patients who underwent elective percutaneous closure of structural heart disease, 23 patients (95.8%) were managed with SDD. There were no MACE outcomes at 30 days. No patients were re-admitted to hospital at 30 days following these procedures. When compared to overnight admission to hospital post-elective percutaneous structural heart condition closure, SDD yielded a cost saving of AUD 5999 per case. Conclusion: SDD following elective percutaneous closure of ASD and PFO was demonstrated to be a safe and effective strategy for managing patients. With more widespread use, it can lead to significant cost savings for hospitals without compromising patient care.
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Tan BEX, Boppana LKT, Abdullah AS, Chuprun D, Shah A, Rao M, Bhatt DL, Depta JP. Safety and Feasibility of Same-Day Discharge After Left Atrial Appendage Closure With the WATCHMAN Device. Circ Cardiovasc Interv 2021; 14:e009669. [PMID: 33423538 PMCID: PMC7813443 DOI: 10.1161/circinterventions.120.009669] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: As the use of left atrial appendage closure (LAAC) becomes more widespread, improvements in resource utilization and cost-effectiveness are necessary. Currently, there are limited data on same-day discharge (SDD) after LAAC. We aimed to evaluate the safety and feasibility of SDD versus non-SDD in patients with nonvalvular atrial fibrillation who underwent LAAC. Methods: We retrospectively studied 211 patients who underwent the WATCHMAN procedure in a tertiary hospital (June 2016 to June 2019). The primary safety outcome was the composite of stroke, systemic embolism, major bleeding requiring transfusion, vascular complications requiring endovascular intervention, or death through 7 days (periprocedural) and 45 days post-procedure. The secondary outcomes were the individual components of the primary outcome and all-cause readmission. We compared the clinical outcomes of patients who had SDD and non-SDD post-procedure. Results: Patients with procedure-related complications on the day of LAAC and patients who were admitted for acute clinical events before LAAC were excluded. One hundred ninety patients were included in the final analysis. Seventy-two of 190 (38%) patients had SDD, and 118 of 190 (62%) had non-SDD. There were no statistically significant differences in the primary safety outcome through 7 days (1.4% versus 5.9%; P=0.26) and 45 days post-procedure (2.8% versus 9.3%; P=0.14) between the two groups. The secondary outcomes were similar in both groups. No patients had device-related thrombus on transesophageal echocardiography at 45 days. Only 1 patient from the non-SDD group had clinically significant peri-device flow (>5 mm) at 45 days. Conclusions: In a selected cohort of patients who underwent successful elective LAAC with WATCHMAN without same-day procedure-related complications, the primary safety outcome and secondary outcomes through 7 and 45 days post-procedure were similar in the SDD and non-SDD groups. Our findings are hypothesis generating and warrant further investigation in prospective trials.
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Affiliation(s)
- Bryan E-Xin Tan
- Department of Internal Medicine, Rochester General Hospital, NY (B.E.-X.T., L.K.T.B.)
| | | | - Abdullah S Abdullah
- Sands Constellation Heart Institute, Rochester Regional Health, NY (A.S.A., D.C., A.S., M.R., J.P.D.)
| | - Dmitry Chuprun
- Sands Constellation Heart Institute, Rochester Regional Health, NY (A.S.A., D.C., A.S., M.R., J.P.D.)
| | - Abrar Shah
- Sands Constellation Heart Institute, Rochester Regional Health, NY (A.S.A., D.C., A.S., M.R., J.P.D.)
| | - Mohan Rao
- Sands Constellation Heart Institute, Rochester Regional Health, NY (A.S.A., D.C., A.S., M.R., J.P.D.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Jeremiah P Depta
- Sands Constellation Heart Institute, Rochester Regional Health, NY (A.S.A., D.C., A.S., M.R., J.P.D.)
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Hemam ME, Kuroki K, Schurmann PA, Dave AS, Rodríguez DA, Sáenz LC, Reddy VY, Valderrábano M. Left atrial appendage closure with the Watchman device using intracardiac vs transesophageal echocardiography: Procedural and cost considerations. Heart Rhythm 2020; 16:334-342. [PMID: 30827462 DOI: 10.1016/j.hrthm.2018.12.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Imaging guidance for left atrial appendage (LAA) closure (LAAC) conventionally consists of transesophageal echocardiography (TEE) and fluoroscopy under general anesthesia (GA). Intracardiac echocardiography (ICE) can eliminate the need for GA, expedite procedural logistics, and reduce the patient experience to a simple venous puncture. OBJECTIVE The purpose of this study was to define optimal ICE views and compare procedural parameters and cost of ICE vs TEE during LAAC with the Watchman device. METHODS Optimal ICE views of the LAA for Watchman implant were delineated using Carto-Sound and 3-dimensional rendition of the LAA in 6 patients. Procedural and financial parameters of 104 consecutive patients with standard indications for LAAC undergoing Watchman implant using ICE guidance through a single transseptal puncture (n = 53 [51%]) were compared with those of TEE-guided implants (n = 51 [49%]) in 3 centers. RESULTS Clinical characteristics were similar between the 2 groups. Total in-room, turnaround, and fluoroscopy times all were shorter using ICE (P <.05) under local anesthesia compared to the TEE group. Implant success was 100% in both groups without peri-device leaks or procedural complications. Follow-up TEE showed no significant peri-device leak in both groups. Total hospital charges for ICE with local anesthesia vs TEE were similar, as were total hospital direct and indirect costs. Professional fees were significantly lower with ICE and local anesthesia than with TEE because the charge of anesthesia staff was avoided. CONCLUSION ICE-guided Watchman implant is safe, feasible, and comparable in cost to TEE during LAAC with a Watchman device but avoids GA and expedites procedure turnaround.
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Affiliation(s)
- Majd E Hemam
- Division of Cardiac Electrophysiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Kenji Kuroki
- Mount Sinai Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, New York
| | - Paul A Schurmann
- Division of Cardiac Electrophysiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Amish S Dave
- Division of Cardiac Electrophysiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | | | | | - Vivek Y Reddy
- Mount Sinai Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, New York
| | - Miguel Valderrábano
- Division of Cardiac Electrophysiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.
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10
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Barker M, Muthuppalaniappan AM, Abrahamyan L, Osten MD, Benson LN, Bach Y, Ma J, Abraha N, Horlick E. Periprocedural Outcomes of Fluoroscopy-Guided Patent Foramen Ovale Closure With Selective Use of Intracardiac Echocardiography. Can J Cardiol 2020; 36:1608-1615. [PMID: 32610094 DOI: 10.1016/j.cjca.2019.12.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/05/2019] [Accepted: 12/26/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Recent randomized trials have confirmed the role of patent foramen ovale (PFO) closure in the secondary prevention of cryptogenic stroke. Guidelines have suggested a central role for intraprocedural imaging using intracardiac echocardiography (ICE). However, this modality may not be required to achieve safe and effective closure. We aimed to examine the periprocedural outcomes of PFO closure retrospectively, using fluoroscopic guidance in patients with cryptogenic stroke, with provisional ICE guidance driven by anatomic and procedural factors. METHODS A retrospective chart review of consecutive patients who underwent PFO closure in a single centre using the Amplatzer PFO occluder (AGA Medical Corporation, Plymouth, Minnesota) for cryptogenic stroke was conducted. Outcomes analyzed included procedural data, periprocedural complications, length of stay, and factors contributing to the use of intraprocedural imaging. RESULTS Between 2006 and 2017, 467 patients underwent PFO closure for cryptogenic stroke with the Amplatzer PFO occluder; 381 patients underwent closure with fluoroscopy alone, and 86 with ICE and fluoroscopic guidance. Periprocedural arrhythmic complications occurred in 1.3% in the fluoroscopy group and 1.2% in the ICE group (P = 1.000). Vascular complications occurred in 0.5% in the fluoroscopy group and 2.3% (P = 0.323) in the ICE group. One device embolized requiring surgical intervention. There was no in-hospital mortality or stroke. Same-day discharge occurred in 97.6% of patients. CONCLUSION Our single-centre experience suggests that PFO closure can be safely conducted under fluoroscopic guidance alone with provisional adjunctive ICE use limited to specific anatomic situations.
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Affiliation(s)
- Madeleine Barker
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Annamalar M Muthuppalaniappan
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Mark D Osten
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Lee N Benson
- The Labatt Family Heart Centre, The Hospital for Sick Children, Division of Cardiology, The University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Yvonne Bach
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jin Ma
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Natalie Abraha
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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11
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Das BB. Patent Foramen Ovale in Fetal Life, Infancy and Childhood. Med Sci (Basel) 2020; 8:medsci8030025. [PMID: 32630193 PMCID: PMC7565039 DOI: 10.3390/medsci8030025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/25/2020] [Accepted: 06/28/2020] [Indexed: 01/16/2023] Open
Abstract
A patent foramen ovale (PFO) is a common, incidental echocardiographic finding in otherwise healthy and asymptomatic infants and children. However, a variety of clinical conditions have been ascribed to the presence of a PFO in childhood, such as cryptogenic stroke, platypnea-orthodeoxia syndrome, decompression sickness and migraine, although the data on these are controversial and sometimes contradictory. This review discusses embryology and correlation with post-natal anatomy, anatomical variations of the atrial septum, diagnostic modalities in special circumstances of PFO associated clinical syndromes, and the role of PFO in congenital heart disease, pulmonary hypertension, dilated cardiomyopathy and heart failure in children who require an extracorporeal membrane oxygenator or ventricular assist device as life support.
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Affiliation(s)
- Bibhuti B Das
- Department of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital Specialty Care Austin, Austin, TX 78759, USA
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12
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Martínez-Sande JL, García-Seara J, González-Melchor L, Rodriguez-Mañero M, Fernández-López XA, González-Juanatey JR. Use of an angioplasty wire in transseptal puncture: A new application of an old technique. Rev Port Cardiol 2020; 39:199-202. [PMID: 32402561 DOI: 10.1016/j.repc.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 06/16/2019] [Accepted: 07/21/2019] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE We wondered if a modification of the conventional transseptal puncture technique performed with an angioplasty wire could be useful in patients with contrast hypersensitivity or allergy-like reactions. METHODS This study comprised our initial experience in 22 patients with atrial fibrillation who were scheduled for an electrophysiology study (EPS) and pulmonary vein ablation and who had a contraindication for iodinated contrast administration. RESULTS Of the 22 patients, 16 were men and ages ranged from 27 to 74 years (mean 56 years). Overall successful transseptal access was achieved in all 22. A control echocardiogram was performed in all patients. There were no complications in any case and no significant differences were found from the conventional transseptal puncture technique regarding procedure or fluoroscopy time. CONCLUSIONS A modification of the conventional transseptal puncture technique performed with fluoroscopy and EPS catheters for anatomical reference and an angioplasty wire is an option in cases with severe contrast hypersensitivity.
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Affiliation(s)
- Jose Luis Martínez-Sande
- University Clinical Hospital of Santiago de Compostela, Cardiology Department, Santiago de Compostela, Spain
| | - Javier García-Seara
- University Clinical Hospital of Santiago de Compostela, Cardiology Department, Santiago de Compostela, Spain
| | - Laila González-Melchor
- University Clinical Hospital of Santiago de Compostela, Cardiology Department, Santiago de Compostela, Spain.
| | - Moises Rodriguez-Mañero
- University Clinical Hospital of Santiago de Compostela, Cardiology Department, Santiago de Compostela, Spain
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13
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Martínez-Sande JL, García-Seara J, González-Melchor L, Rodriguez-Mañero M, Fernández-López XA, González-Juanatey JR. Use of an angioplasty wire in transseptal puncture: A new application of an old technique. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Intracardiac Echocardiography in Structural Heart Disease Interventions. JACC Cardiovasc Interv 2018; 11:2133-2147. [DOI: 10.1016/j.jcin.2018.06.056] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/17/2018] [Accepted: 06/05/2018] [Indexed: 01/17/2023]
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15
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Bechis MZ, Rubenson DS, Price MJ. Imaging Assessment of the Interatrial Septum for Transcatheter Atrial Septal Defect and Patent Foramen Ovale Closure. Interv Cardiol Clin 2017; 6:505-524. [PMID: 28886842 DOI: 10.1016/j.iccl.2017.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Transcatheter closure of atrial septal defects and patent foramen ovale has become increasingly common with advances in device and imaging technology. The percutaneous approach is now the preferred method of closure when anatomically suitable. Two-dimensional and 3-dimensional echocardiography determines anatomic suitability by characterizing the interatrial defect and its surrounding structures, and is critical for intraprocedural guidance and postprocedure follow-up. This article provides an overview of interatrial anatomy as it pertains to interventional considerations and discusses the transthoracic, transesophageal, and intracardiac echocardiographic modalities used for periprocedural and intraprocedural imaging of the interatrial septum.
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Affiliation(s)
- Mary Z Bechis
- Division of Cardiovascular Diseases, Scripps Clinic, 9898 Genesee Avenue, La Jolla, CA 92037, USA
| | - David S Rubenson
- Division of Cardiovascular Diseases, Scripps Clinic, 9898 Genesee Avenue, La Jolla, CA 92037, USA
| | - Matthew J Price
- Division of Cardiovascular Diseases, Scripps Clinic, 9898 Genesee Avenue, La Jolla, CA 92037, USA.
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Frangieh AH, Alibegovic J, Templin C, Gaemperli O, Obeid S, Manka R, Holy EW, Maier W, Lüscher TF, Binder RK. Intracardiac versus transesophageal echocardiography for left atrial appendage occlusion with watchman. Catheter Cardiovasc Interv 2016; 90:331-338. [DOI: 10.1002/ccd.26805] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/02/2016] [Accepted: 09/05/2016] [Indexed: 01/17/2023]
Affiliation(s)
- Antonio H. Frangieh
- Department of Cardiology; University Heart Center, University Hospital, Zürich; Switzerland
| | - Jasmina Alibegovic
- Department of Cardiology; University Heart Center, University Hospital, Zürich; Switzerland
| | - Christian Templin
- Department of Cardiology; University Heart Center, University Hospital, Zürich; Switzerland
| | - Oliver Gaemperli
- Department of Cardiology; University Heart Center, University Hospital, Zürich; Switzerland
| | - Slayman Obeid
- Department of Cardiology; University Heart Center, University Hospital, Zürich; Switzerland
| | - Robert Manka
- Department of Cardiology; University Heart Center, University Hospital, Zürich; Switzerland
| | - Erik W. Holy
- Department of Cardiology; University Heart Center, University Hospital, Zürich; Switzerland
| | - Willibald Maier
- Department of Cardiology; University Heart Center, University Hospital, Zürich; Switzerland
| | - Thomas F. Lüscher
- Department of Cardiology; University Heart Center, University Hospital, Zürich; Switzerland
| | - Ronald K. Binder
- Department of Cardiology; University Heart Center, University Hospital, Zürich; Switzerland
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17
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Cooper RM, Shahzad A, Newton J, Vejlstrup N, Axelsson A, Sharma V, Ormerod OI, Stables RH. Intra-cardiac echocardiography in alcohol septal ablation: a prospective comparative study against trans-thoracic echocardiography. Echo Res Pract 2015; 2:9-17. [PMID: 26693311 PMCID: PMC4676484 DOI: 10.1530/erp-15-0002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 01/17/2023] Open
Abstract
Alcohol septal ablation (ASA) in hypertrophic obstructive cardiomyopathy reduces left ventricular outflow tract gradients. A third of patients do not respond; inaccurate localisation of the iatrogenic infarct can be responsible. Transthoracic echocardiography (TTE) using myocardial contrast can be difficult in the laboratory environment. Intra-cardiac echocardiography (ICE) provides high-quality images. We aimed to assess ICE against TTE in ASA. The ability of ICE and TTE to assess three key domains (mitral valve (MV) anatomy and systolic anterior motion, visualisation of target septum, adjacent structures) was evaluated in 20 consecutive patients undergoing ASA. Two independent experts scored paired TTE and ICE images off line for each domain in both groups. The ability to see myocardial contrast following septal arterial injection was also assessed by the cardiologist performing ASA. In patients undergoing ASA, ICE was superior in viewing MV anatomy (P=0.02). TTE was superior in assessing adjacent structures (P=0.002). There was no difference in assessing target septum. Myocardial contrast: ICE did not clearly identify the area of contrast in 17/19 patients due to dense acoustic shadowing (8/19) and inadequate opacification of the myocardium (6/19). ICE only clearly localised contrast in 2/19 cases. ICE does not visualise myocardial contrast well and therefore cannot be used to guide ASA. TTE was substantially better at viewing myocardial contrast. There was no significant difference between ICE and TTE in the overall ability to comment on cardiac anatomy relevant to ASA.
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Affiliation(s)
- Robert M Cooper
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
| | - Adeel Shahzad
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
| | | | | | | | | | | | - Rodney H Stables
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
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18
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Cruz-González I, Solis J, Kiernan TJ, Yan BP, Lam YY, Palacios IF. Clinical manifestation and current management of patent foramen ovale. Expert Rev Cardiovasc Ther 2014; 7:1011-22. [DOI: 10.1586/erc.09.62] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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19
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Kutty S, Delaney JW, Latson LA, Danford DA. Can we talk? Reflections on effective communication between imager and interventionalist in congenital heart disease. J Am Soc Echocardiogr 2013; 26:813-27. [PMID: 23768692 DOI: 10.1016/j.echo.2013.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Indexed: 02/06/2023]
Abstract
The rapid proliferation of catheter-mediated treatments for congenital heart defects has brought with it a critical need for cooperation and communication among the numerous physicians supporting these new and complex procedures. New interdependencies between physicians in specialties including cardiac imaging, interventional cardiology, pediatric cardiology, anesthesia, cardiothoracic surgery, and radiology have become apparent, as centers have strived to develop the best systems to foster success. Best practices for congenital heart disease interventions mandate confident and timely input from an individual with excellent adjunctive imaging skills and a thorough understanding of the devices and procedures being used. The imager and interventionalist must share an understanding of what each offers for the procedure, use a common terminology and spatial orientation system, and convey concise and accurate information about what is needed, what is seen, and what cannot be seen. The goal of this article is to review how the cardiovascular imaging specialists and interventionalists can work together effectively to plan and execute catheter interventions for congenital heart disease.
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Affiliation(s)
- Shelby Kutty
- Division of Pediatric Cardiology, University of Nebraska Medical Center College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska, USA.
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20
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Intracardiac echocardiography in structural heart disease: Current prospects. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.repce.2012.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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21
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de Sousa L. [Intracardiac echocardiography in structural heart disease: current prospects]. Rev Port Cardiol 2012; 31:413-4. [PMID: 22578265 DOI: 10.1016/j.repc.2012.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 04/02/2012] [Indexed: 11/18/2022] Open
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22
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Hayman M, Forrest P, Kam P. Anesthesia for Interventional Cardiology. J Cardiothorac Vasc Anesth 2012; 26:134-47. [DOI: 10.1053/j.jvca.2011.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Indexed: 01/17/2023]
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23
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Bayrak F, Chierchia GB, Namdar M, Yazaki Y, Sarkozy A, de Asmundis C, Muller-Burri SA, Rao J, Ricciardi D, Sorgente A, Brugada P. Added value of transoesophageal echocardiography during transseptal puncture performed by inexperienced operators. Europace 2011; 14:661-5. [PMID: 22117031 DOI: 10.1093/europace/eur366] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AIMS Transseptal puncture (TP) appears to be safe in experienced hands; however, it can be associated with life-threatening complications. The aim of our study was to demonstrate the added value of routine use of transoesophageal echocardiography (TEE) for the correct positioning of the transseptal system in the fossa ovalis, thus potentially preventing complications during fluoroscopy-guided TP performed by inexperienced operators. METHODS AND RESULTS Two hundred and five patients undergoing pulmonary vein isolation procedure (PVI) for drug-resistant paroxysmal or persistent atrial fibrillation were prospectively included. When the operator (initially blinded to TEE) assumed that the transseptal system was in a correct position according to fluoroscopical landmarks, the latter was then checked with TEE unblinding the physician. If necessary, further refinement of the catheter position was performed. Refinement >10 mm, or in case of catheter pointing directly at the aortic root or posterior wall were considered as major repositioning. Thirty-four patients required major repositioning. Regression analysis revealed age (P: 0.0001, Wald: 12.9, 95% confidence interval: 1.04-1.16), left atrial diameter (P: 0.01, Wald: 6.6, 95% confidence interval: 1.04-1.34), previous PVI (P: 0.01, Wald: 6.3, 95% confidence interval: 1.31-8.76), and atrial septal thickness (P: 0.03, Wald: 4.5, 95% confidence interval: 1.05-3.4) as independent predictors of major revision with TEE. CONCLUSION Routine 2D TEE in addition to traditional fluoroscopic TP appears to be very useful to guide the TP assembly in a correct puncture position and thus, to avoid TP-related complications. However, further randomized prospective comparative studies are necessary to support these suggestions.
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Affiliation(s)
- Fatih Bayrak
- Heart Rhythm Management Center, UZ Brussels-VUB, Laarbeeklaan 101, Brussel 1090, Belgium.
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Abstract
PURPOSE OF REVIEW To provide an overview of the various modalities that have emerged in the last years as adjunctive tools to provide detailed imaging of the cardiovascular system in the catheterization laboratory. RECENT FINDINGS Completion angiography after cardiac surgery for congenital heart disease using a dedicated hybrid operating cardiac suite may aid in early diagnosis and therapy of postsurgical abnormalities. The application of three-dimensional rotational digital angiography results in a more precise delineation of the three-dimensional anatomy of vascular structures outside the heart with rapid image processing and reduction of the amount of contrast used and ionizing radiation dose. Combined catheterization/magnetic resonance (MR) hybrid laboratories have the potential to accurately assess changes in the anatomy and physiology pretranscatheter and posttranscatheter interventions. Fully MR-guided transcatheter procedures have become possible in animal models. Real-time three-dimensional transesophageal echocardiography (TEE) has helped to guide transcatheter procedures in septal and valvar structures. Miniaturization of probes has expanded the applications of TEE for smaller neonates. The use of intravascular ultrasound has helped to better understand the mechanisms of vascular diseases and transcatheter treatments. SUMMARY Knowledge and proper application of new imaging modalities during interventions in the catheterization laboratory may improve the outcomes of patients with congenital and acquired structural heart disease.
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Current world literature. Curr Opin Cardiol 2011; 26:165-73. [PMID: 21307667 DOI: 10.1097/hco.0b013e328344b569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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MacDonald ST, Newton JD, Ormerod OJ. Intracardiac echocardiography off piste? Closure of the left atrial appendage using ICE and local anesthesia. Catheter Cardiovasc Interv 2010; 77:124-7. [DOI: 10.1002/ccd.22652] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Almpanis GC, Tsigkas GG, Koutsojannis C, Mazarakis A, Kounis GN, Kounis NG. Nickel allergy, Kounis syndrome and intracardiac metal devices. Int J Cardiol 2010; 145:364-365. [DOI: 10.1016/j.ijcard.2010.02.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Accepted: 02/14/2010] [Indexed: 01/17/2023]
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28
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Transseptal puncture using minimally invasive echocardiography during atrial fibrillation ablation. Europace 2010; 12:1435-8. [DOI: 10.1093/europace/euq297] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Blood pressure treatment in acute ischemic stroke: a review of studies and recommendations. Curr Opin Neurol 2010; 23:46-52. [PMID: 20038827 DOI: 10.1097/wco.0b013e3283355694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Elevated blood pressure (BP) is frequent in patients with acute ischemic stroke. Pathophysiological data support its usefulness to maintain adequate perfusion of the ischemic penumba. This review article aims to summarize the available evidence from clinical studies that examined the prognostic role of BP during the acute phase of ischemic stroke and intervention studies that assessed the efficacy of active BP alteration. RECENT FINDINGS We found 34 observational studies (33,470 patients), with results being inconsistent among the studies; most studies reported a negative association between increased levels of BP and clinical outcome, whereas a few studies showed clinical improvement with higher BP levels, clinical deterioration with decreased BP, or no association at all. Similarly, the conclusions drawn by the 18 intervention studies included in this review (1637 patients) were also heterogeneous. Very recent clinical data suggest a possible beneficial effect of early treatment with some antihypertensives on late clinical outcome. SUMMARY Observational and interventional studies of management of acute poststroke hypertension yield conflicting results. We discuss different explanations that may account for this and discuss the current guidelines and pathophysiological considerations for the management of acute poststroke hypertension.
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