Headache after transcatheter closure of atrial septal defect: An attempt to explain its origin in pediatric population

BACKGROUND

Transcatheter closure of atrial septal defect (ASD) has become the treatment of choice for most patients. About 5% of them after the procedure suffer from the transient headache episodes (THE), the etiology of which is unclear.

AIMS

To evaluate risk factors for THE occurrence after transcatheter closure of ASD in the pediatric population.

METHODS

840 patients, after transcatheter ASD closure, with nitinol devices, from a single center, were included in retrospective analysis. THE was defined as occurring up to 24 hours after procedure. A logistic regression model including age, weight, ASD diameter, device size, presence of nitinol coating on device, fluoroscopy time, application of balloon calibration, device oversizing and residual shunt after 24 hours was created to evaluate risk factors for THE occurrence.

RESULTS

There were 40 patients (females 70%) with THE (4.8%). Median age was 13 (7.35-16) years. 40 patients (4.8%) with THE. Female 70%, male 30%. Median age 13 (7.35-16) years. Among patients with headache BC was performed more frequently (82.5% vs. 43.3%; P <0.001), the balloon waist median (interquartile range [IQR]), 19 (16-22) mm vs. 15 mm (12-18) mm; P P P = 0.03) and a year (7.5 vs. 1.0%; P <0.001) was more frequent. ASD size and prevalence of double/multiple ASD were similar in both groups. Age, application of BC, no nickel release protection, duration of fluoroscopy and device oversizing were predictors of THE (P <0.001).

CONCLUSIONS

Balloon calibration during percutaneous ASD closure and absent nickel release protection layer on the device are risk factors of headache occurrence in the early postprocedural period.

Transcatheter patent ductus arteriosus closure: what have we learned after over 25 years? A single--center experience with 1036 patients

BACKGROUND

Transcatheter patent ductus arteriosus (PDA) closure has become the first‑choice method of treatment in the majority of patients. However, device selection poses a challenge.

AIMS

This study aimed to analyze periprocedural and 1‑year outcomes of PDA transcatheter closure performed with different devices throughout a 25‑year time period in a single center.

METHODS

All 1036 patients who underwent transcatheter PDA closure between 1993 and 2020 were included in retrospective analysis. Various devices were used: the Rashkind device (RD; n = 25), coils (n = 469), nitinol duct occluders type I (DO I; n = 300), type II (n = 32), type II additional sizes (ADO II AS; n = 209), as well as off‑label devices: vascular plugs and atrial septal and muscular ventricular septal defect occluders (n = 17). Data on 24‑hour and 1‑year follow‑up were available for 100% and 78.9% of the study patients, respectively.

RESULTS

The procedure was successful in 98.6% of the study patients, with a major complication rate of 0.2%. Complete PDA closure after a year was observed in 81.8% of the patients treated with RD, 93.7% of those with coils, and 100% of those with duct occluders. There were no differences between Amplatzer DO I (n = 159) and its DO I copies manufactured in China (n = 141) with regard to success, efficacy, and complication rates. Recently, ADO II AS has replaced coils and become the preferred device to close small‑to‑moderate PDA.

CONCLUSIONS

Transcatheter PDA closure with all types of nitinol duct occluders is safe and effective, with no residual shunting at 1‑year follow‑up. Due to higher efficacy, ADO II AS has replaced coils in the treatment of smaller PDA.

Efficiency of transcatheter patent foramen ovale closure in children after paradoxical embolism events

BACKGROUND AND AIM

Patent foramen ovale (PFO) may result in a cerebrovascular event - a presumed paradoxical embolism (PE). However, the presence of this phenomenon among paediatric patients was rarely evaluated. Transcatheter PFO closure was considered to be a method of treatment in such patients.

METHODS

For evaluation clinical data and long-term outcome, we reviewed records of patients below 18 years of age, with history of cerebrovascular event related to PE, who underwent procedure of percutaneous PFO closure in years 1999-2014 in our department.

RESULTS

Among 230 patients with cerebrovascular events who had PFO closed percutaneously, seven children (aged 12-16 years, five male) were selected. Indications for closure were cryptogenic stroke in two patients and transient ischaemic attack (TIA) in five patients. Diagnosis of PFO was established by transthoracic echocardiography, with right-to-left shunt (RLS) through PFO confirmed by transoesophageal echocardiography. Contrast transcranial Doppler (c-TCD) was performed preprocedurally in four patients, revealing significant RLS. For percutaneous closure of PFO different occluders (Starflex, Amplatzer PFO devices, Cardio-O-Fix) were used. Closure was successfully completed in all patients and no procedure-related complications were observed. Postprocedural c-TCD six months after closure revealed no significant RLS. During follow-up (3 to 10 years) one patient had an episode of recurrent TIA; however, in this patient paroxysmal atrial fibrillation was found during the follow-up period.

CONCLUSIONS

Cerebral embolism due to PFO is uncommon in children. Transcatheter PFO closure in this group of patients is a safe and effective procedure. C-TCD is plausible technique for detection RLS and monitoring PFO closure efficacy in this group of patients.

Professional and social activity of patients after heart transplant

OBJECTIVES

The aim of the study is to describe both professional and social activities of patients after heart transplant.

MATERIAL AND METHODS

Ninety-five heart transplant patients treated at the Silesian Center for Heart Diseases in Zabrze were surveyed, comprising 29 women (30.5%) and 66 men (69.5%). The average age of respondents was 54.3 years old (standard deviation (SD) = 15 years); the average period that had elapsed since the heart transplant was 7.1 years (SD = 4 years). We designed a questionnaire as a tool for collecting information from patients.

RESULTS

Twenty-five percent of patients worked at the time of completion of the questionnaire. Eighty percent of those patients were working before and after the transplant, 20%--only after transplantation (p < 0.05). A different job position at a new workplace had 47.8% of patients, 34.8% of them had the same job position at the same work place as they had had before, 63.4% of the heart transplant respondents were pensioners. Eighty-two percent of patients had a certificate with a designated degree of disability--among them: 69% had a certificate for a significant degree of disability, 22%--for a moderate degree of disability. Among those surveyed, 52.5% said that their financial situation had not changed whereas 34.5% of those surveyed reported a change for the worse. Thirty-seven percent of respondents reported changes in family relationships. Seventy-seven percent reported that they received help from family members, as compared with 19% who did not.

CONCLUSIONS

Only 25.3% of the patients treated at the Silesian Centre for Heart Diseases after heart transplant are employed and it is one of the lowest employment rates in this category of patients in Europe. One third of working patients have the same work place as they had before their operation. Heart transplant is a cause of changes in family relationships. Most often family bonds are strengthened but sometimes family members become nervous, impatient and unwilling to talk about the transplant.