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Preliminary experience with transcatheter closure of wind-sock-like perimembranous ventricular septal defects using Amplatzer Vascular Plug IV devices

Leong MC, Hoo XY, Alwi M

Cardiol Young, 2024 Jan;34(1):228-231.
PMID: 38073568 DOI: 10.1017/S1047951123004055

Amplatzer Vascular Plug IV (Abbott, USA) is usually used for the occlusion of abnormal tortuous vessels and has not been tried for the transcatheter closure of perimembranous ventricular septal defects with wind-sock morphology. Here, we report on three successful cases of perimembranous ventricular septal defect transcatheter closure using Amplatzer Vascular Plug IV. We did not observe residual shunting or new onset of complications during follow up. These preliminary positive results advocate the application and suitability of Amplatzer Vascular Plug IV for closing wind-sock-like perimembranous ventricular septal defects.

Matched MeSH terms: Cardiac Catheterization/methods
The value of transesophageal echocardiography in transcatheter closure of atrial septal defects in the oval fossa using the Amplatzer septal occluder

Latiff HA, Samion H, Kandhavel G, Aziz BA, Alwi M

Cardiol Young, 2001 Mar;11(2):201-4.
PMID: 11293739

BACKGROUND: From January, 1997, as part of an international multicentric trial, we have been closing small-to-moderate atrial septal defects within the oval fossa using the Amplatzer Septal Occluder (ASO, AGA Medical).
METHODS: All patients with defects within the oval fossa deemed potentially suitable for transcatheter closure were investigated by transesophageal echocardiography with the aim of gaining extra information that might alter the decision to use the device to close the defect. Views were obtained in transverse and longitudinal planes, permitting measurements of the diameter of the defect, and its distance from the atrioventricular valves, coronary sinus, and pulmonary veins. Additionally, we sought to identify multiple defects, and to exclude sinus venosus defects.
RESULTS: Of 56 patients with left-to-right shunts, 41 (73.2%) were deemed suitable for closure with the Amplatzer Septal Occluder. All underwent the procedure successfully, with no complications. This includes 5 patients with multiple small defects that were sufficiently close to the main defect to be closed with a single device. Only two of these had been detected on the transthoracic study. In the remaining 15 of 56 patients, transcatheter closure was deemed unsuitable. In 9 patients, this was due to the limitation of the size of the device available during the period of study, this representing a relative contraindication. In the remaining 6 (10.7%), transcatheter closure was not performed because multiple defects were too far apart to be closed with a single device in 3 patients, two patients were noted to have a sinus venosus defect, and another was noted to have anomalous connection of the right upper pulmonary vein to the right atrium. Excluding patients contraindicated due to the size of the defect alone, transesophageal echocardiography provided extra information in one-tenth of our patients, which altered the decision regarding management.
CONCLUSION: Transesophageal echocardiography is indispensable in the evaluation of patients undergoing transcatheter closure of atrial septal defect.

Matched MeSH terms: Cardiac Catheterization/methods*
Percutaneous transvenous mitral commissurotomy in patients with severe kyphoscoliosis

Ramasamy D, Zambahari R, Fu M, Yeh KH, Hung JS

Cathet Cardiovasc Diagn, 1993 Sep;30(1):40-4.
PMID: 8402863

Because transseptal catheterization is felt to be contraindicated in patients with severe kyphoscoliosis, there have been no reports of percutaneous transvenous mitral commissurotomy performed in such patients. This report describes percutaneous transvenous mitral commissurotomy in three patients with severe thoracic kyphoscoliosis, with special emphasis on the transseptal puncture technique. Biplane right atrial angiography and the contrast septal flush method are very useful in landmark selection for a safe transseptal puncture.

Matched MeSH terms: Cardiac Catheterization/methods*
Pulmonary atresia with intact septum: the use of Conquest Pro coronary guidewire for perforation of atretic valve and subsequent interventions

Alwi M, Budi RR, Mood MC, Leong MC, Samion H

Cardiol Young, 2013 Apr;23(2):197-202.
PMID: 22640635 DOI: 10.1017/S1047951112000595

Objective: To determine the feasibility and safety of the Conquest Pro wire as an alternative to radiofrequency wire for perforation of atretic pulmonary valve and subsequent balloon dilatation and patent ductus arteriosus stenting in patients with pulmonary atresia with intact ventricular septum.
Background: Radiofrequency valvotomy and balloon dilatation has become the standard of care for pulmonary atresia with intact ventricular septum in many institutions today.
Methods: We report eight consecutive patients in whom we used the Conquest Pro coronary guidewire, a stiff wire normally reserved for revascularisation of coronary lesions with chronic total occlusion, for perforation of atretic pulmonary valve and subsequent balloon dilatation, and stenting of the patent ductus arteriosus.
Results: Perforation of atretic pulmonary valve was successful in seven out of eight cases. Radiofrequency valvotomy was employed after failure of perforation by the Conquest Pro wire in one case where the right ventricular outflow tract was broad based and tapered towards the pulmonary valve, and was heavily trabeculated. Failure of the Conquest Pro wire to perforate the pulmonary valve plate was mainly attributed by the failure to engage the wire at the correct position.
Conclusion: The Conquest Pro wire for perforation and subsequent interventions in the more straightforward cases of pulmonary atresia with intact ventricular septum is effective and safe, simplifying the entire procedure. However, the radiofrequency generator and wires remain essential tools in the paediatric interventional catheter laboratory.

Matched MeSH terms: Cardiac Catheterization/methods
Fulltext "Fishing for lines": removal of endovascular catheters from the cardiovascular system

Wong AR, Suhaimi H, Ridzuan MA, Rizal MM, Saedah A

Singapore Med J, 2009 Oct;50(10):e358-61.
PMID: 19907875

We present two infants whose endovascular lines were accidentally cut or fractured, and had to be retrieved via transcatheter means in the cardiac catheterisation laboratory. The first case was a two-month-old infant with transposition of the great arteries, requiring an emergency balloon atrial septostomy. An indwelling vascular catheter that was placed in the right femoral vein was accidentally cut and had migrated into the inferior vena cava, before being retrieved. The second case was a one-week-old neonate who presented with pneumonia at birth, and had a long intravenous catheter placed in the left saphenous vein, which became fractured, and subsequently migrated into the heart. This case presented as a pulmonary embolus with haemodynamic instability, as the catheter had partially obstructed the right ventricular outflow tract. This was later retrieved via transcatheter means.

Matched MeSH terms: Cardiac Catheterization/methods*
Fulltext Invasive and antiplatelet treatment of patients with non-ST-segment elevation myocardial infarction: Understanding and addressing the global risk-treatment paradox

Ahrens I, Averkov O, Zúñiga EC, Fong AYY, Alhabib KF, Halvorsen S, et al.

Clin Cardiol, 2019 Oct;42(10):1028-1040.
PMID: 31317575 DOI: 10.1002/clc.23232

Clinical guidelines for the treatment of patients with non-ST-segment elevation myocardial infarction (NSTEMI) recommend an invasive strategy with cardiac catheterization, revascularization when clinically appropriate, and initiation of dual antiplatelet therapy regardless of whether the patient receives revascularization. However, although patients with NSTEMI have a higher long-term mortality risk than patients with ST-segment elevation myocardial infarction (STEMI), they are often treated less aggressively; with those who have the highest ischemic risk often receiving the least aggressive treatment (the "treatment-risk paradox"). Here, using evidence gathered from across the world, we examine some reasons behind the suboptimal treatment of patients with NSTEMI, and recommend approaches to address this issue in order to improve the standard of healthcare for this group of patients. The challenges for the treatment of patients with NSTEMI can be categorized into four "P" factors that contribute to poor clinical outcomes: patient characteristics being heterogeneous; physicians underestimating the high ischemic risk compared with bleeding risk; procedure availability; and policy within the healthcare system. To address these challenges, potential approaches include: developing guidelines and protocols that incorporate rigorous definitions of NSTEMI; risk assessment and integrated quality assessment measures; providing education to physicians on the management of long-term cardiovascular risk in patients with NSTEMI; and making stents and antiplatelet therapies more accessible to patients.

Matched MeSH terms: Cardiac Catheterization/methods*
Massive coronary air embolism successfully treated with intracoronary catheter aspiration and intracoronary adenosine

Yew KL, Razali F

Int J Cardiol, 2015 Jun 1;188:56-7.
PMID: 25885752 DOI: 10.1016/j.ijcard.2015.04.040
Matched MeSH terms: Cardiac Catheterization/methods
Impact of ductal stenting on pulmonary artery reconstruction in patients with duct-dependent congenital heart diseases-an institutional experience

Haranal M, Mood MC, Leong MC, Febrianti Z, Abdul Latiff H, Samion H, et al.

Interact Cardiovasc Thorac Surg, 2020 08 01;31(2):221-227.
PMID: 32437520 DOI: 10.1093/icvts/ivaa069

OBJECTIVES: This study aims to review our institutional experience of ductal stenting (DS) on the growth of pulmonary arteries (PAs) and surgical outcomes of PA reconstruction in this subset of patients.
METHODS: This is a retrospective study done in neonates and infants up to 3 months of age with duct-dependent pulmonary circulation who underwent DS from January 2014 to December 2015. Post-stenting PA growth, surgical outcomes of PA reconstruction, post-surgical re-interventions, morbidity and mortality were analysed.
RESULTS: During the study period, 46 patients underwent successful DS, of whom 38 underwent presurgery catheterization and definite surgery. There was significant growth of PAs in these patients. Biventricular repair was done in 31 patients while 7 had univentricular palliation. Left PA augmentation was required in 13 patients, and 10 required central PA augmentation during surgery. The mean follow-up period post-surgery was 4.5 ± 1.5 years. No significant postoperative complications were seen. No early or follow-up post-surgery mortality was seen. Four patients required re-interventions in the form of left PA stenting based on the echocardiography or computed tomography evidence of significant stenosis.
CONCLUSIONS: DS provides good short-term palliation and the growth of PAs. However, a significant number of stented patients require reparative procedure on PAs at the time of surgical intervention. Acquired changes in the PAs following DS may be the reason for reintervention following PA reconstruction.

Matched MeSH terms: Cardiac Catheterization/methods*
Infolding of the Venus P-Valve After Transcatheter Pulmonary Valve Implantation

Riahi M, Ang HL, Jones M, Prachasilchai P, Baruteau AE, Promphan W, et al.

Circ Cardiovasc Interv, 2018 04;11(4):e005923.
PMID: 29618579 DOI: 10.1161/CIRCINTERVENTIONS.117.005923
Matched MeSH terms: Cardiac Catheterization/methods