Left atrial appendage closure with the Amplatzer™ Cardiac Plug: Rationale for a higher degree of device oversizing at implantation

Background: In left atrial appendage (LAA) closure, the correct sizing of the implantable devices is crucial. Data on the time-dependent changes in the shape and positioning of LAA occlusion devices are missing. We analyzed the results of 33 consecutive patients after implantation of an Amplatzer™ Cardiac Plug (ACP) LAA closure device to get more information on the optimal device sizing during implantation. Methods and results: Thirty-three consecutive patients were enrolled in this observational study. ACP implantation was guided by fluoroscopy and three dimensional transesophageal echocardiography (3-D TEE). Device sizing was based on the largest measured diameter of the intended landing zone adding 2–4 mm of device oversizing. Fluoroscopies were performed at 1 day after, and after 3 months, control 3-D TEE was performed 3 months after implantation. The stability of device positioning and shape was matched with the results of 3-D TEE. Patients’ mean age was 70.2 ± 8 years; mean CHA2DS2VASc score was 3.8 ± 1.1. According to the manufacture’s classification, the post-implant degree of compression of the device-lobe was classified in three categories 1) undercompression “square-like shape” (1 patient); 2) op­timal compression “tire-like shape” (20 patients), 3) overcompression “strawberry-like shape” (12 patients). Changes in the degree of device compression by more than one classification class occurred in 18/33 of our patients. A complete loss of device compression (“square-like shape”) was observed in 9 patients. Despite the changes in device compression, a complete closure of the LAA was achieved in 32/33 patients. Conclusions: There is a temporal change in shape and positioning of the ACP within 3 months after implantation. A late decompression of the ACP lobe was observed in 61% of our patients, leading to a complete loss in device compression in 27%. This observation may be the rationale for a higher degree of ACP oversizing during implantation

Coextrusion of Reaction‐Bonded Carbides by Robocasting

Coextrusion by robocasting is a suitable process for fabricating multimaterial ceramic structures. Herein, the robocasting process is used to fabricate core–shell structures, combined with subsequent liquid silicon infiltration (LSI). Thus, reaction‐bonded silicon carbide (RBSC), reaction‐bonded boron carbide (RBBC), and reaction‐bonded silicon–boron carbide composites are produced. The LSI process offers the possibility to circumvent high temperatures and pressures used in traditional fabrication. Pastes with high solid loading and necessary carbon content are used in order to combine the robocasting with the subsequent LSI process. The influence of the paste rheology on the sample fabrication of multimaterial core–shell structures of reaction‐bonded carbides is investigated. The key rheological data, such as the viscosities of the combined pastes, are correlated with the observations from the microstructural investigation using scanning electron microscopy. A correlation between the difference in viscosity and the core geometry can be established. Crack formation in the material combination of RBSC and RBBC is found and compared with layered multimaterial structures of reaction‐bonded carbides. Residual stresses, which can be used to explain the crack formation, are investigated using Raman spectroscopy.For the first time, the fabrication of core–shell structures from reaction‐bonded carbides is demonstrated by a combination of additive manufacturing and postinfiltration with silicon. Various structures are printed by robocasting and then successfully infiltrated. In some cases, different crack patterns are observed due to the formation of residual microstresses in each material. These stresses are investigated by Raman spectroscopy. image © 2023 WILEY‐VCH GmbH Projektträger Jülich (PtJ, Germany)Deutsche Forschungsgemeinschaf

Emergent surgical pulmonary embolectomy in a pregnant woman: case report and literature review.

Acute pulmonary embolism is a leading cause of death during pregnancy and delivery in the United States. We describe the case of a 25-year-old woman who presented in cardiogenic shock in week 38 of her first pregnancy. After the emergent cesarean delivery of a healthy male neonate, the mother underwent immediate surgical pulmonary embolectomy. We confirmed the diagnosis of pulmonary embolism intraoperatively by means of transesophageal echocardiography and removed large clots from the patient\u27s pulmonary arteries. Mother and child were doing well, 27 months later. In addition to presenting our patient\u27s case, we discuss the other relevant reports and the options for treating massive pulmonary embolism during pregnancy

Myocardial Infarction in a Young Man due to a Hypoplastic Coronary Artery

Hypoplastic coronary artery disease (HCAD) is a rare condition that may lead to myocardial infarction (MI) and sudden death. We discovered HCAD in a young man who developed chest pain after heavy drinking and who was found to have suffered an MI. His ECG showed ST-segment elevation with Q waves in the anterior leads, and echocardiography revealed apical dyskinesia with moderate left ventricular (LV) dysfunction. Coronary angiography showed hypoplasia of the left anterior descending (LAD) artery. 99mTc-tetrofosmin-gated myocardial perfusion scintigraphy showed a large, fixed perfusion defect in the anteroseptal and apical segments. Sixty-four-slice cardiac CT and cardiac MR imaging demonstrated thinning of the apical wall with calcification and delayed enhancement, supporting the diagnosis of long-standing MI. The patient was discharged symptom-free on medication for ischemic heart failure two weeks after admission. Although HCAD is very uncommon, it should be considered in children and young adults who suffer MI or sudden cardiac death

Improvements in 25 Years of Implantable Cardioverter Defibrillator Therapy

In 1980, Dr. Michel Mirowski and his team inserted the first implantable cardioverter defibrillator (ICD) in a patient. Initially, ICD therapy was not widely accepted, and many physicians actually considered this therapy unethical. Large secondary and primary prevention trials, demonstrating a beneficial effect of ICD therapy in selected patients not only on arrhythmic death but also on all-cause mortality, stimulated a rapid growth in the number of implants and increased patient’s and physician’s acceptance. Improvements in size and weight, arrhythmia discrimination capabilities, battery technology, shock waveform and output, monitoring capabilities and defibrillator electrode technology eventually resulted in the current large number of yearly implants. Today, almost 40 years after the conception of the ICD and 25 years after the first human implant, ICD therapy is the treatment of choice for patients at risk for life-threatening arrhythmias either as secondary or primary prevention. Furthermore, with the more recent addition of resynchronisation therapy to standard ICD therapy, it became possible to treat selected patients with advanced symptoms of heart failure and to lower the risk of sudden death

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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