Transcatheter Closure of Large-Sized Coronary Artery Fistula

We report our experience with the use of AMPLATZER?? Vascular Plug for the closure of coronary artery fistulas. Three patients (age: 3, 12, 14 years) were diagnosed with coronary fistulas (pulmonary-to-systemic blood flow ratio: 1.5 to 3). Two of the fistulas originated each, from the proximal right and left coronary artery and had maximal diameter 9 and 10 mm respectively; their narrowest diameter (6 mm) was proximal to their entrance into the right atrium creating a form of a saccular aneurysm.The third fistula (maximal diameter: 16 mm) originated from the circumflex artery and entered the right atrium with unobstructed flow (narrowest diameter: 8 mm). Interventional closure was considered optimal and the decision was made to use devices sized twice the size of the narrowest diameter of the fistulas (12, 12 and 16 mm respectively). An arterio-venous loop was established through the fistula by snaring an exchange guide-wire. All plugs were implanted from the femoral vein with the use of a seven or eight French guide catheter, reaching the narrowest segment of the fistula and leading to complete closure of the two fistulas, immediately after the procedure. The fistula arising from the circumflex artery that received the largest plug continued to have residual flow up to 12 months after the procedure, when follow-up echocardiography revealed its complete occlusion. We present and consider the use of the AMPLATZER?? Vascular Plug as a safe and effective method for the transcatheter closure of large-sized coronary fistulas. The plug potentially offers an alternative method to coil occlusion techniques as well as open heart surgery

Transcatheter Closure of Secundum Atrial Septal Defect Using the Amplatzer Device: Single Center Experience in 140 Patients

BACKGROUND: Transcatheter closure of secundum atrial septal defect (ASD) is nowadays widely practiced and has replaced surgical ASD closure in many centers. Improvements in design have made the closure devices retrievable, and reduction in the size of the introduction systems allows interventional treatment even in young patients. In this paper we present our experience with the Amplatzer septal occluder device in patients with ASD. PATIENTS AND METHODS: Between October 2002 and February 2006, 206 consecutive patients with a significant ASD, demonstrated by initial transthoracic echocardiography (TTE), were considered for transcatheter closure with the Amplatzer septal occluder. A total of 156 patients underwent cardiac catheterization, and 140 patients had successful transcatheter ASD closure. Routine examination before catheterization included a standard ECG, a chest x ray, blood tests and TTE. The initial TTE showed the location of the ASD, its septal rim, and its diameter and also helped to measure the length of the interatrial septum in the four-chamber view. These measurements were used to assess the feasibility of transcatheter closure with the Amplatzer device. The “stretched” diameter of the ASD, determined by a balloon sizing catheter, was used to select the diameter of the waist of the device. The size of the selected device was 1 to 2 mm larger than the stretched diameter of the defect. Transesophageal echocardiography was used to monitor the implantation procedure. RESULTS: The Amplatzer device was finally employed in 140 patients for percutaneous closure of ASD. The age of patients ranged between 5.3 and 70 years, median 21.9 years. Procedure time ranged between 25 and 240 minutes, median 60 minutes; fluoroscopy time ranged between 3.5 and 45 minutes, median 12 minutes. The size of the selected device ranged between 6-40 mm. Two devices were implanted in two patients. Serious procedure related complications (embolization and perforation of the left atrial wall) occurred in two cases. At follow up (10 days to 3.4 years, median 2.3 years) complete closure was documented in 97% of this patient group. Unrecognized during implantation, but detected after release, small additional defect with trivial residual shunt was documented in 4 patients. A young critically ill patient, cyanotic due to right-to-left shunt, with complex congenital heart disease developed a brain abscess three months after implantation. CONCLUSION: Percutaneous ASD closure with use of the Amplatzer device in this cohort of 140 patients was highly successful with a low complication rate

Transcatheter Closure of Secundum Atrial Septal Defect Using the Amplatzer Device: Single Center Experience in 140 Patients

In this paper we present our experience with the Amplatzer septal occluder device, employed in 140 patients for percutaneous closure of atrial secundum defect (ASD), from October 2002 to February 2006. The age of patients ranged between 5.3 and 70 years, median 21.9 years. Procedure time ranged between 25 and 240 minutes, median 60 minutes; fluoroscopy time ranged between 3.5 and 45 minutes, median 12 minutes. Transoesophageal echocardiography was used to monitor the implantation procedure. The size of the selected device was 1 to 2 mm larger than the stretched diameter of the defect and ranged between 6-40 mm. Two devices have been implanted in two patients. Serious procedure related complications (embolization and perforation of the left atrial wall) occurred in two cases. At follow up (10 days to 3.4 years, median 2.3 years) complete closure was documented in 97% of this patient group. Unrecognized during implantation, but detected after release, small additional defect with trivial residual shunt was documented in 4 patients. A young critically ill patient, cyanotic due to right-to-left shunt, with complex congenital heart disease developed a brain abscess three months after implantation. In conclusion, percutaneous ASD closure with use of the Amplatzer device in this patient cohort was highly successful with a low complication rate

A Population-Based Cohort Study Examining the Incidence and Impact of Psychotic Experiences From Childhood to Adulthood, and Prediction of Psychotic Disorder.

OBJECTIVE: The authors investigated the incidence, course, and outcome of psychotic experiences from childhood through early adulthood in the general population and examined prediction of psychotic disorder. METHODS: This was a population-based cohort study using the semistructured Psychosis-Like Symptoms Interview at ages 12, 18, and 24 (N=7,900 with any data). Incidence rates were estimated using flexible parametric modeling, and positive predictive values (PPVs), sensitivity, specificity, and area under the curve were estimated for prediction. RESULTS: The incidence rate of psychotic experiences increased between ages 13 and 24, peaking during late adolescence. Of 3,866 participants interviewed at age 24, 313 (8.1%, 95% CI=7.2, 9.0) had a definite psychotic experience since age 12. A total of 109 individuals (2.8%) met criteria for a psychotic disorder up to age 24, of whom 70% had sought professional help. Prediction of current psychotic disorder at age 24 (N=47, 1.2%), by both self-report and interviewer-rated measures of psychotic experiences at age 18 (PPVs, 2.9% and 10.0%, respectively), was improved by incorporating information on frequency and distress (PPVs, 13.3% and 20.0%, respectively), although sensitivities were low. The PPV of an at-risk mental state at age 18 predicting incident disorder at ages 18-24 was 21.1% (95% CI=6.1, 45.6) (sensitivity, 14.3%, 95% CI=4.0, 32.7). CONCLUSIONS: The study results show a peak in incidence of psychotic experiences during late adolescence as well as an unmet need for care in young people with psychotic disorders. Because of the low sensitivity, targeting individuals in non-help-seeking samples based only on more severe symptom cutoff thresholds will likely have little impact on population levels of first-episode psychosis.The UK Medical Research Council and Wellcome (Grant ref: 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. This study was funded by the Medical Research Council (MRC) Grant MR/M006727/1. The following authors acknowledge support: S.Z by the NIHR Biomedical Research Centre (BRC) at University Hospitals Bristol NHS Foundation Trust and the University of Bristol; A.S.D and G.H by the NIHR BRC at University College London Hospital; P.B.J. by the NIHR CLAHRC East of England, NIHR PGfAR RP-PG-0616-20003 (TYPPEX) and the Wellcome Trust Neuroscience in Psychiatry Network (095844/Z/11/Z); PCF by the Wellcome Trust (206368/Z/17/Z) and the Bernard Wolfe health Neuroscience Fund; M.C. by a European Research Council Consolidator Award (iHEAR 724809). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Car