Perkutaner Verschluss des Vorhofseptumdefekts mit dem Device Nit-Occlud® ASD-R

Einleitung: Der Vorhofseptumdefekt (ASD) macht 6 – 10% aller ange-borenen Herzfehler (AHF) aus, im Erwachsenenalter bis zu 40%. 80% aller ASDs sind von Secundum-Typ (II). Sicherheit und Wirksamkeit des Amplatzer-Devices ASO® wurden bereits bewiesen; nichtsdestotrotz traten zum Teil schwere Komplikationen auf, und der Preis ist für Entwicklungsländer zu hoch. Ein neues Device, der Nit-Occlud ASD-R®, gefertigt aus einem Nitinoldraht ohne Lötstellen, mit Polyesthermembranen und Reverse-Konfiguration, entwickelt und hergestellt in Bolivien, soll auch diese Nachteile noch überwinden. Zielsetzung: Vorstellung der kurz- und mittelfristigen Ergebnisse des perkutanen Verschlusses des ASD II mit dem ASD-R® in Bolivien. Methodik: Retrospektive Studie an 55 Patienten, interveniert im größten kardiologischen Zentrum in Bolivien, mit Analyse der Variablen bzgl. Sicherheit und Wirksamkeit des Devices. Ergebnisse: Alter 20,9 ± 16,6 Jahre (3 bis 67); w:m = 40:15. Defektmaß 17 ± 5,7 mm (5,4 bis 28), Device-Stent 18,5 ± 5,5 mm (6 bis 30). Geringere unerwünschte Ereignisse im Zusammenhang mit dem Device traten bei 5 Patienten auf (4 Arrhythmien), nur ein schweres: Embolisierung des trotz Protrusion freigesetzten Devices nach 12h mit chirurgischer Bergung und ASD-Verschluss. Nur in 2 Patienten traten Probleme bei der Liberation auf. Die Verschlussrate am Folgetag war 85,2%, nach 6 Monaten 100%. Schlussfolgerungen: 1. Für die Patienten dieser Studie ist der perkutane ASD-Verschluss mit Nit-Occlud ASD-R® eine wirksame und sichere Methode. 2. Es ereigneten sich weder Erosion noch Perforierung, das Device zeigte sich als atraumatisch. 3. Extrem große Defekte oder ungeeignete Defektränder können andere Methoden (Chirurgie) erfordern

Chronic hypobaric hypoxia, patent arterial duct and a new interventional technique to close it

Abstract Background: Interventional closure of patent arterial duct has become an accepted alternative to surgical closure. Clinical trial with ''Nit-Occlud s PDA-R''. Methods and results: To assess the safety and efficacy of the device, we performed a prospective clinical study between June, 2009 and December, 2010 in La Paz, Bolivia. In all, 29 -22 female patients and 7 male patients -out of 59 patients were selected on the basis of inclusion criteria. The procedures were performed under sedation at an age and weight of 5.7 years and 22.7 kilograms, respectively, with 4-6 French arterial sheaths and 5-7 French venous sheaths. The minimal diameter of the duct was 3.5 millimetres. The procedure, fluoroscopy, and hospitalisation times were 96.4 minutes (55 to 145), 13.1 minutes (3 to 25.2), and 24 hours, respectively. The ''Nit-Occlud s PDA-R'' was successfully deployed in all patients. Immediate, 24-hour, 1-, 3-, and 6-month closure rates were 65.5%, 79.3%, 96.5%, and 100%, respectively. The systolic pulmonary pressure diminished from 37 millimetres of mercury (21 to 57) before the intervention to 31 millimetres of mercury (21 to 45) after the intervention. No early or late embolisation, haemolysis, left pulmonary artery, or descending aorta obstruction occurred. Conclusions: We conclude that the ''Nit-Occlud s PDA-R'' device is safe and effective in closing patent arterial duct up to a diameter of 8 millimetres

Vascular Disorders of Pregnancy Increase Susceptibility to Neonatal Pulmonary Hypertension in High-Altitude Populations.

BACKGROUND: Preeclampsia and fetal growth restriction increase cardiopulmonary disease risk for affected offspring and occur more frequently at high-altitude (≥2500 m). Retrospective studies indicate that birth to a preeclampsia woman at high altitude increases the risk of pulmonary hypertension (PH) in later life. This prospective study asked whether preeclampsia with or without fetal growth restriction exaggerated fetal hypoxia and impaired angiogenesis in the fetal lung, leading to neonatal cardiopulmonary circulation abnormalities and neonatal or infantile PH. METHODS AND RESULTS: We studied 79 maternal-infant pairs (39 preeclampsia, 40 controls) in Bolivia (3600-4100 m). Cord blood erythropoietin, hemoglobin, and umbilical artery and venous blood gases were measured as indices of fetal hypoxia. Maternal and cord plasma levels of angiogenic (VEGF [vascular endothelial growth factor]) and antiangiogenic (sFlt1 [soluble fms-like tyrosine kinase]) factors were determined. Postnatal echocardiography (1 week and 6-9 months) assessed pulmonary hemodynamics and PH. Preeclampsia augmented fetal hypoxia and increased the risk of PH in the neonate but not later in infancy. Pulmonary abnormalities were confined to preeclampsia cases with fetal growth restriction. Maternal and fetal plasma sFlt1 levels were higher in preeclampsia than controls and positively associated with PH. CONCLUSIONS: The effect of preeclampsia with fetal growth restriction to increase fetal hypoxia and sFlt1 levels may impede normal development of the pulmonary circulation at high altitude, leading to adverse neonatal pulmonary vascular outcomes. Our observations highlight important temporal windows for the prevention of pulmonary vascular disease among babies born to highland residents or those with exaggerated hypoxia in utero or newborn life