A new coated nitinol occluder for transcatheter closure of ventricular septal defects in a canine model

An observational study of symmetrical VSD occluder for transcatheter closure of ruptured sinus of Valsalva aneurysm

This study evaluated the immediate and 1-year postoperative outcomes of 14 patients with ruptured Valsalva aneurysmal sinus (RSVA) using symmetric ventricular septal defect (VSD) occluder for transcatheter closure (TCC). The sites of rupture were from the non-coronary sinus to the right atrium (RA) in 10 cases (71.4%), the right coronary sinus (RCS) to the RA in 3 cases (21.4%) and the RCS to the right ventricle in 1 case (7.2%). The defects (5-11 mm) were closed with a symmetrical VSD device. During the follow-up (12 months), the enlarged heart of the patients had significantly shrunk and the NYHA improved after closure. In 1 case, a moderate residual shunt was present and the patient suffered from hemolysis at 2 h after the operation, and 1 patient was transferred to surgery for aortic regurgitation 1 year after the initial treatment of RSVA. In conclusion, the TCC of RSVA with the China made symmetrical VSD occluder is safe and effective.

Preparation and in vitro biocompatibility of PBAT and chitosan composites for novel biodegradable cardiac occluders

The biodegradable composites were prepared by melt blending of chitosan (CS) and poly(butyleneadipate-co-terephthalate) (PBAT). By utilizing Fourier transformed infrared spectroscopy, scanning electron microscopy-energy dispersive spectroscopy, mechanical properties analysis, water contact angle measuring, differential scanning calorimetry, and thermogravimetric analysis, it was demonstrated that the CS of the PBAT-CS10 composite was relatively evenly dispersed in the PBAT matrix, the mechanical properties were significantly improved, the hydrophilicity was increased, the cold crystallization temperature was increased, and a good range of melt working temperature was obtained. The PBAT-CS10 composite was used to fabricate a cardiac occluder by fused deposition modeling of three-dimensional printing, and finite element analysis, and in vitro implantation testing proved the occluder’s mechanical support and sealing function under extreme boundary conditions. In vitro degradation experiments, neutral red uptake cytotoxicity assay, CCK-8 cell proliferation detection, immunofluorescence staining of the cytoskeleton, cell apoptosis detection, and reactive oxygen species assay were all performed on the composite, confirming that it and the occluder made of it could be hydrolyzed under physiological conditions and had no adverse effects on the cell membrane, lysosome membrane, cell proliferation, cell morphology, cell apoptosis, or ROS level, and had good biocompatibility.

Unconventional combination of left atrial appendage device occlusion in patients with atrial fibrillation who needed concomitant catheter interventions for underlying structural heart disease

Objectives

Left atrial appendage occlusion (LAAO) in non-valvar atrial fibrillation (AF) reduces cardioembolic strokes. Despite increased risk, trials exclude valvar AF in structural heart diseases where clots extend beyond appendage.

Methods

Patients with AF and relative risks for oral anticoagulation (OAC) needing structural interventions underwent concomitant LAAO. After six months of OAC, aspirin was continued. Transesophageal echocardiogram was done three monthly till one year and yearly thereafter. The patient demographics, procedural details, post-procedural follow-up were analyzed.

Results

Nine patients aged 51.5 ± 6.3 years with AF underwent LAAO concomitantly with balloon mitral valvotomy in four patients, atrial septal defect device closure in four and periprosthetic mitral leak closure in one patient. Six patients had heart failure, four had prior embolic events, and two had documented LAA thrombus. The mean CHADS₂VASc score was 2.44 ± 0.8 and mean HASBLED score was 3.0 ± 0.8. Devices included Amplatzer Cardiac Plug™ in six patients, LAmbre™ Lifetech device in two and Watchman™ device in one. All procedures were successful without acute complications. A patient developed pericardial effusion at six months requiring pericardiocentesis. Early device-associated thrombus in one patient resolved after OAC for six months. No embolic events occurred on follow-up.

Conclusion

On a detailed literature search, this largest LAAO experience in structural heart diseases indicates its utility. OAC for six months followed by aspirin seems to prevent thrombus formation in these patients. The only incidence of early thrombus formation indicates immunity from clot formation after device endothelialisation. Larger multicenter trials combining LAAO with structural interventions in valvular AF are warranted in developing nations.

Post-Bentall Ascending Aortic Pseudoaneurysm Due to Coronary Button Dehiscence

Ascending aortic pseudoaneurysms after the Bentall procedure caused by proximal or distal anastomotic or coronary dehiscence could carry high operative risks. One report in literature has described transcatheter management for distal anastomotic dehiscence using a vascular plug. A similar management of proximal anastomotic or coronary dehiscence may affect valve function and coronary flows. A successful nonsurgical closure of a left coronary dehiscence aided by multimodal imaging and its short-term follow-up is described.