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Afzal MR, Gabriels JK, Jackson GG, Chen L, Buck B, Campbell S, Sabin DF, Goldner B, Ismail H, Liu CF, Patel A, Beldner S, Daoud EG, Hummel JD, Ellis CR. Temporal Changes and Clinical Implications of Delayed Peridevice Leak Following Left Atrial Appendage Closure. JACC Clin Electrophysiol 2021; 8:15-25. [PMID: 34454881 DOI: 10.1016/j.jacep.2021.06.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to assess temporal changes and clinical implications of peridevice leak (PDL) after left atrial appendage closure. BACKGROUND Endocardial left atrial appendage closure devices are alternatives to long-term oral anticoagulation (OAC) for patients with atrial fibrillation. PDL > 5 mm may prohibit discontinuation of OAC. METHODS Patients included in the study had: 1) successful Watchman device implantation without immediate PDL; 2) new PDL identified at 45 to 90 days using transesophageal echocardiography; 3) eligibility for OAC; and 4) 1 follow-up transesophageal echocardiographic study for PDL surveillance. Relevant clinical and imaging data were collected by chart review. The combined primary outcome included failure to stop OAC after 45 to 90 days, transient ischemic attack or stroke, device-related thrombi, and need for PDL closure. RESULTS Relevant data were reviewed for 1,039 successful Watchman device implantations. One hundred eight patients (10.5%) met the inclusion criteria. The average PDL at 45 to 90 days was 3.2 ± 1.6 mm. On the basis of a median PDL of 3 mm, patients were separated into ≤3 mm (n = 73) and >3 mm (n = 35) groups. In the ≤3 mm group, PDL regressed significantly (2.2 ± 0.8 mm vs 1.6 ± 1.4 mm; P = 0.002) after 275 ± 125 days. In the >3 mm group, there was no significant change in PDL (4.9 ± 1.4 mm vs 4.0 ± 3.0 mm; P = 0.12) after 208 ± 137 days. The primary outcome occurred more frequently (69% vs 34%; P = 0.002) in the >3 mm group. The incidence of transient ischemic attack or stroke in patients with PDL was significantly higher compared with patients without PDL, irrespective of PDL size. CONCLUSIONS New PDL detected by transesophageal echocardiography at 45 to 90 days occurred in a significant percentage of patients and was associated with worse clinical outcomes. PDL ≤ 3 mm tended to regress over time.
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Affiliation(s)
- Muhammad R Afzal
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James K Gabriels
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | | | - Lu Chen
- Northwell Health, Long Island Jewish Hospital, Division of Electrophysiology, Manhasset, New York, USA
| | - Benjamin Buck
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sandra Campbell
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Dawn F Sabin
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruce Goldner
- Northwell Health, Long Island Jewish Hospital, Division of Electrophysiology, Manhasset, New York, USA
| | - Haisam Ismail
- Northwell Health, Long Island Jewish Hospital, Division of Electrophysiology, Manhasset, New York, USA
| | - Christopher F Liu
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Apoor Patel
- Division of Electrophysiology, Northwell Health, North Shore University Hospital, Manhasset, New York, USA
| | - Stuart Beldner
- Division of Electrophysiology, Northwell Health, North Shore University Hospital, Manhasset, New York, USA
| | - Emile G Daoud
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D Hummel
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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El-Said HG, Pockett CR, Moore JW. Percutaneous obliteration of left ventricular cavity to eliminate aortic regurgitation and presumed coronary steal in an infant with hypoplastic left heart syndrome. Catheter Cardiovasc Interv 2017; 90:982-985. [PMID: 28568976 DOI: 10.1002/ccd.27138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 04/29/2017] [Accepted: 05/03/2017] [Indexed: 11/07/2022]
Abstract
The phenomenon of coronary steal is well known in the setting of HLHS (Hypoplastic Left Heart Syndrome) early after the Classical Norwood Operation. We report a rare case of an infant with HLHS [Severe Aortic Stenosis (AS), Mitral Stenosis (MS) and small Left Ventricle (LV)], who developed aortic regurgitation and presumed coronary steal late after the Sano Modification of the Norwood Procedure. Coronary steal developed secondary to progressive aortic and mitral regurgitation and resulted in poor right ventricular function and severe tricuspid regurgitation. We describe a novel interventional approach for obliteration of the LV cavity by using hydrogel coils. LV obliteration eliminated the presumed steal and resulted in improvement in ventricular function, tricuspid regurgitation and clinical course.
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Affiliation(s)
- Howaida G El-Said
- Rady Children's Hospital, San Diego, University of California, San Diego, California
- Center at which the work was performed: Rady Children's Hospital, San Diego, California
| | - Charissa R Pockett
- Rady Children's Hospital, San Diego, University of California, San Diego, California
- Center at which the work was performed: Rady Children's Hospital, San Diego, California
| | - John W Moore
- Rady Children's Hospital, San Diego, University of California, San Diego, California
- Center at which the work was performed: Rady Children's Hospital, San Diego, California
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Ono A, Hayabuchi Y, Kagami S. Coil occlusion of aberrant arteries to pulmonary sequestration in a case with pulmonary atresia with intact ventricular septum: successful treatment of repetitive myocardial ischaemic attacks. Cardiol Young 2017; 27:193-5. [PMID: 27702416 DOI: 10.1017/S1047951116001037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this study, we describe an infant case of pulmonary atresia with intact ventricular septum associated with ventriculo-coronary arterial communication for which a modified Blalock-Taussig shunt operation was performed. He experienced repeated myocardial ischaemic attacks. Further examination revealed pulmonary sequestration in the right lower lobe. He therefore underwent a bidirectional Glenn operation and coil occlusion of the feeding arteries. His myocardial ischaemic attacks subsequently improved.
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Guan N, Mu S, Wang L, Huo X, Jiang Y, Lv X, Li Y. Endovascular Treatment of 147 Cases of Cavernous Carotid Aneurysms: A Single-Center Experience. J Stroke Cerebrovasc Dis 2016; 25:1929-35. [PMID: 27185537 DOI: 10.1016/j.jstrokecerebrovasdis.2016.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/09/2016] [Accepted: 04/14/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cavernous carotid aneurysms (CCAs) are characterized by pain and neuro-ophthalmologic deficits. The optimal treatment remains unclear, especially for asymptomatic CCAs. This study investigated the efficacy of endovascular treatment for CCAs in our center. METHODS Data obtained from patients who underwent endovascular treatment for CCAs from July 2011 to July 2014 were reviewed. A retrospective analysis was conducted regarding the general condition, clinical presentation, aneurysm characteristics, therapeutic strategy, and prognosis of CCA patients. RESULTS One hundred forty-seven patients who exhibited 155 CCAs were included, which comprised 46 asymptomatic and 101 symptomatic CCA cases. Forty-eight cases presented with headache, 5 cases presented with subarachnoid hemorrhage, 20 cases presented with diplopia, 38 cases presented with cranial nerve palsy, and 27 cases presented with ischemic stroke. The mean aneurysm sizes were 15.3 ± 12.2 and 8.1 ± 7.1 mm in the symptomatic and asymptomatic groups, respectively. Different treatments were administered: coil occlusion (n = 15), stent/balloon-assisted coil occlusion (n = 123), and parent artery occlusion (PAO) (n = 17). The PAO-treated group exhibited the highest aneurysm occlusion rate. Follow-up data were available for 131 cases, which included 86 symptomatic and 45 asymptomatic cases. There were no deaths. Among the symptomatic patients, 40.7% improved, 58.1% remained stable, and 1.2% worsened; 12 patients exhibited regrowth and 6 patients had repeated endovascular treatment. The asymptomatic patients remained stable, including 5 patients who exhibited regrowth and 2 patients who had repeated endovascular treatment. CONCLUSION Endovascular treatment is safe and effective for CCAs and should be considered in patients with minimal complications, as well as in asymptomatic patients with stable symptoms.
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Affiliation(s)
- Ning Guan
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiqing Mu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linyuan Wang
- Department of Periodontics, The Second Affiliated Hospital of Liaoning Medical College, Jinzhou, Liaoning, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Devanagondi R, Latson L, Bradley-Skelton S, Prieto L. Results of coil closure of patent ductus arteriosus using a tapered tip catheter for enhanced control. Catheter Cardiovasc Interv 2016; 88:233-8. [PMID: 26800854 DOI: 10.1002/ccd.26415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/01/2015] [Accepted: 12/26/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This article describes the efficacy and embolization rates of coil delivery via modified vertebral catheter (MVC) for patent ductus arteriosus (PDA) closure. BACKGROUND Various techniques have been devised to enhance coil control and prevent embolization during PDA closure. Since 1995, they have delivered coils via tapered vertebral catheters for improved coil control. METHODS Catheterization reports, angiograms, and echocardiograms were reviewed for patients with PDA occlusion via MVC from 2001 to 2014. Residual shunting was determined by angiography and echocardiogram within 24 hr post-procedure. Procedural success was defined as ≤ trivial angiographic and echocardiographic shunt, and no aortic nor LPA obstruction, after final coil delivery. RESULTS About 125 coil occlusions were attempted in 103 patients. Minimal PDA diameter was 2 (0.6-6) mm. Four coils were removed with a snare/bioptome due to aortic/LPA obstruction following release. Seven were malpositioned while still held by the MVC of which three embolized while attempting withdrawal. Five embolized after full release from the MVC. The embolization rate was 6.4%. Embolizations were more likely in PDAs ≥ 2.5 mm (P < 0.05). Ultimately, 98/103 PDAs were occluded using the MVC. No patient had greater trivial residual shunt or aortic/LPA obstruction for an overall success rate of 95%. For PDAs < 2.5 mm the success rate was 97%. CONCLUSIONS Coil delivery via MVC was safe and effective for small PDAs. While fully controlled release and retrieval devices are now available for PDA closure with lower embolization rates, coil occlusion by MVC should still be considered for small PDAs, especially in resource limited regions. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Rajiv Devanagondi
- Division of Pediatric Cardiology, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York
| | - Larry Latson
- Heart Center, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Sharon Bradley-Skelton
- Center for Pediatric and Congenital Heart Disease, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lourdes Prieto
- Center for Pediatric and Congenital Heart Disease, Cleveland Clinic Foundation, Cleveland, Ohio
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Pabaney AH, Mazaris PA, Kole MK, Reinard KA. Endovascular management of fusiform aneurysm of anterior temporal artery: Technical report. Surg Neurol Int 2015; 6:119. [PMID: 26290771 PMCID: PMC4521225 DOI: 10.4103/2152-7806.161239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/27/2015] [Indexed: 11/09/2022] Open
Abstract
Background: The treatment of a rare, nontraumatic, fusiform aneurysm of the anterior temporal artery (ATA) via endovascular techniques is presented, and procedural nuances are highlighted. Methods: We performed a retrospective chart review and collected demographic and clinical data on the patient presented here; procedural details were extracted from operative notes. Results: Following successful balloon test occlusion (BTO) of the ATA, complete coil embolization of the ATA, and its associated fusiform aneurysm was performed. Postprocedurally, the patient did not suffer any adverse neurological sequelae. Conclusion: Selective BTO of intracranial branch vessels is safe, technically feasible, and could serve as a useful technical tool in the treatment of complex, fusiform intracranial aneurysms.
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Affiliation(s)
| | - Paul A Mazaris
- Department of Neurosurgery, Hartford Hospital, Hartford, CT, USA
| | - Max K Kole
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| | - Kevin A Reinard
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
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Abstract
OBJECTIVE To assess the frequency of systemic venous collaterals to the atria, which may cause desaturation, after stage II reconstructive surgery for hypoplastic left heart syndrome (HLHS) and to determine whether coil occlusion prevents the need for surgical ligation. DESIGN Prospective interventional study. SETTING Tertiary referral centre. PATIENTS 27 children with HLHS undergoing cardiac catheterisation between October 1996 and February 2001. INTERVENTIONS 19 children were catheterised prestage II, 1 poststage II, and 17 prestage III. Aortic oxygen saturation (SaAo) and pulmonary artery pressure (pPA) were recorded. Angiography was performed into the left internal jugular vein to look for venous collaterals. If present, they were occluded with Cook MReye coils. Angiography was repeated to confirm occlusion, and SaAo and pPA were remeasured. RESULTS Collaterals were found in 7 of 27 children: 1 poststage II and 6 prestage III. These were occluded with 1-3 coils without complication. Mean (SE) SaAo before occlusion was 80.2 (2.1)% in those with collaterals compared with 88.7 (1.0)% in those without (p = 0.007). There was no difference in mean pPA between the two groups. After coil occlusion mean SaAo rose to 83.8 (1.8)% (p = 0.007) and mean pPA rose from 12.5 (1.5) to 14.5 (1.8) mm Hg (p = 0.02). None required surgical ligation. CONCLUSION Angiography should be performed at catheterisation before stage II and III surgery for HLHS to exclude systemic venous collaterals. If present, they may be safely and effectively occluded with coils to improve saturation and prevent the need for subsequent surgical ligation.
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Affiliation(s)
- R E Andrews
- Department of Congenital Heart Disease, Guy's and St Thomas' Hospital, London, UK
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