Transcatheter Closure of Post-operative Residual Ventricular Septal Defect Using a Patent Ductus Arteriosus Closure Device in an Adult: a Case Report

Transcatheter closure of perimembranous and muscular ventricular septal defect (VSD) has been performed widely and it has more advantages compare to surgery. However, transcatheter closure of residual VSD post operation of complex congenital heart disease is still challenging because of the complexity of anatomy and concern about device stability, so the operator should meticulously choose the most appropriate technique and device. We would like to report a case of transcatheter closure of residual VSD post Rastelli operation in a patient with double outlet right ventricle (DORV), sub-aortic VSD, severe infundibulum pulmonary stenosis (PS) and single coronary artery. The patient had undergone operations for four times, but he still had intractable heart failure that did not response to medications. On the first attempt. we closed theVSD using a VSD occluder, unfortunately the device embolized into the descending aorta, but fortunately we was able to snare it out. Then we decided to close the VSD using a patent ductus arteriosus (PDA occluder). On transesophageal echocardiography (TEE) and angiography evaluation, the device position was stable. Post transcatheter VSD closure, the patient clinical condition improved significantly and he could finally be discharged after a long post-surgery hospitalization. Based on this experience we concluded that the transcatheter closure of residual VSD in complex CHD using PDA occluder could be an effective alternative treatment. Key words: residual VSD, PDA occluder, transcatheter closure, heart failure, Rastelli

Transcatheter Closure of Patent Ductus Arteriosus in Adolescents and Adults: A Case Series

During 11 years period from January 2005 to December 2015 there were 18 adolescent and adult patients  who underwent transcatheter closure of PDA using PDA Amplatzer Duct Occluder (ADO). There were 9 cases with age of 14 to 18 years and 9 cases with age of more than 18 years where the oldest case was 46 years old. Two cases were male and 16 cases were female. Prior to procedures, clinical assessment, ECG, chest x-ray and transthoracic echocardiography (TTE) were performed to confirm the diagnosis of PDA. The procedures of device implantation was performed under conscious sedation in adults and using general anesthesia in adolescents.The size of PDA ranged from 1.6 mm to 11.1 mm. Based on Kritchenko classification, the type of PDA were 15 type A1 and 3type A2. Flow ratio between pulmonary to systemic circulation was between 1.1 and 5.9. The procedure time ranged from 60-189 minutes and the fluoroscopic time 7.1-77.3 minutes. The PA pressure ranged from 22 to 63 mmHg. Immediate results after procedures as seen in angiography showed complete closure in 14 cases and smoky residual shunt or minimal residual shunts in 4 cases, which probably due to the temporary leaking through the devices. In 24 hours, complete closure was achieved in all cases (100%) and continued until 1months. At 6 month follow up, there was no residual shunts detected and also there was no significant complications, such as device embolization or recanalization. This case series suggest that transcatheter closure of PDA in adolescents and adults using Amplatzer duct occluder (ADO) is effective and has excellent resultswithout significant complication. However, long-term follow up is required to assess long term efficacy and safety

Comparison of surgical vs. non-surgical closure procedures for secundum atrial septal defect

Background Surgery has been the standard therapy for secundum atrial septal defect (ASD) closure, but it has significant associated morbidities related to sternotomy, cardiopulmonary bypass, complications, residual scars, and trauma. A less invasive non-surgical approach with transcatheter devices was developed to occlude ASD. Amplatzer® septal occluder (ASO) is a common device in transcatheter closure.\ud \ud Objective To compare two secundum ASD closure procedures, transcatheter closure by ASO and surgical closure, in terms of efficacy, complications, length of hospital stay, and total costs.\ud \ud Methods A retrospective analysis was performed on children with secundum ASD admitted to the Cardiology Center of Cipto Mangunkusumo Hospital from January 2005 to December 2011. Patients received either transcatheter closure with ASO or surgical closure procedures. Data was obtained from patients’ medical records.\ud \ud Results A total of 112 secundum ASD cases were included in this study, consisting of 42 subjects who underwent transcatheter closure procedure by ASO and 70 subjects who underwent surgical closure procedure. Procedure efficacies of surgery and ASOo were not significantly different (98.6% vs 95.2%, respectively, P=0.555). However, subjects who underwent surgical procedures had significantly more complications than subjects who underwent transcatheter closure procedure (60% vs 28.6%, respectively, OR 1.61; 95%CI 1.19 to 2.18; P=0.001). Hospital stays were also significantly longer for surgical patients than for transcatheter closure patients (6 days vs 2 days, respectively, P<0.0001). In addition, all surgical subjects required intensive care. Transcatheter closure had a mean total cost of 52.7 (SD 6.7) million Rrupiahs while the mean cost of surgery was 47 (SD 9.2) million Rupiahs (P<0.0001). Since the ASO device cost represented 58% of the total cost of transcatheter closure, the mean cost of transcatheter closure procedure without the device itself was less costly than surgery.\ud \ud Conclusion Transcatheter closure using ASO has a similar efficacy to that of surgical closure procedure. However, subjects who underwent transcatheter closure have lower complication rates and shorter length of hospital stays than subjects who had surgery, but transcatheter closure costs are higher compared to the surgical procedure. [Paediatr Indones. 2013;53:108-16.]

Penanganan Penyakit Jantung Bawaan Tanpa Operasi (Kardiologi Intervensi) Petunjuk Praktis Menangani Pasien dan Mengedukasi Keluarga

xxvi, 174 hlm. : ilus. ; 24 cm

Penanganan penyakit jantung bawaan tanpa operasi (kardiologi intervensi). petunjuk praktis menangani dan mengedukasi keluarga

xxvi, 174 hlm. : ilus. ; 24 cm

Penanganan penyakit jantung bawaan tanpa operasi (kardiologi intervensi): petunjuk praktis menangani pasien dan mengedukasi keluarga

Buku ini membahas topik penanganan penyakit jantung bawaan serta petunjuk dalam mengedukasi keluarg

Tatalaksana Penyakit Jantung Bawaan

Penyakit jantung bawaan (PJB) merupakan kelainan jantung yang sudah didapat sejak lahir. Manifestasinya klinis bergantung dari berat ringan penyakit, mulai dari asimtomatis sampai dengan adanya gejala gagal jantung pada neonatus. Dengan berkembangnya teknologi, terutama dengan ditemukannya ekokardiografi, banyak kelainan jantung bawaan asimtomatis yang dapat dideteksi. Tata laksana meliputi non-bedah dan bedah. Tata laksana non-bedah meliputi pengobatan medikamentosa dan kardiologi intervensi, sedangkan tata laksana bedah meliputi bedah paliatif dan operasi definitif. Tujuan tata laksana medikamentosa dan bedah paliatif adalah untuk mengatasi gejala klinis akibat komplikasi PJB sambil menunggu waktu yang tepat untuk dilakukan operasi definitif. Akhir-akhir ini telah dikembangkan kardiologi intervensi, suatu tindakan yang memberi harapan baru bagi pasien PJB tanpa operasi, namun saat ini biayanya masih cukup tingg

Inhaled iloprost as part of combination therapy for persistent pulmonary hypertension of the newborn

Persistent pulmonary hypertension of the newborn (PPHN) is rare, but life-threatening. If not treated, PPHN may cause respiratory failure and death in neonates. l,2,3 PPHN often occurs in term or post-term infants with a history of difficult labor, infection or asphyxia during birth. These infants do not have adequate oxygen during labor.3 Based on etiology, PPHN can be categorized into primary PPHN, which occurs by itself without apparent cause; or secondary PPHN, which is caused by meconium aspiration, hyaline membrane disease, neonatal sepsis with pneumonia, congenital heart abnormality, or maternal drug use (non-steroidal anti-inflammatories, methamphetamine, or selective serotonin re uptake inhibitors) during the third trimester of pregnancy

Blood nickel level and its toxic effect after transcatheter closure of persistent duct arteriosus using Amplatzer duct occluder

Background  Transcatheter closure using amplatzer  duct  occluder (ADO)  is  currently the  treatment  of  choice for  patent  ductus arteriosus (PDA).  The  ADO  device  is  constructed from a Nitinol wire mesh containing 55% nickel. Up  to  now, there  is  still a controversy about the effects  of  nickel contained in ADO. Objectives  To  determine blood nickel level  at  six months after transcatheter closure  of  PDA  using  ADO,  toxic effects  of  nickel at six months after  PDA  closure using  ADO,  and the effects  of nickel  on  complete blood  count  (CBC), blood glucose and renal function. Methods  Subjects  were  patients  with  PDA  at  Integrated Cardiovascular Services,  Dr.  Cipto Mangunkusumo Hospital, Jakarta. Routine blood test and blood nickel levels were measured at  the time  of  the procedure,  and  at  the  end  of  the first, third,  and sixth months after intervention. Results  There  were  29  patients who underwent heart catheteri- zation  and  PDA closure using  ADO.  A time series analysis was conducted  on  23  patients who completed six-month follow-up after the intervention. Median blood nickel level before procedure was 58 ng/mL while  at  one, three  and  six months afterwards were 60, 63 and 64 ng/mL respectively.  The  blood nickel levels did not  differ significantly between pre- and  post-ADO. After  PDA closure,  no  toxic effects  of  nickel were found,  both  clinically and laboratorically. Conclusions  PDA  closure using  ADO  has no effects  on  the nickel levels, CBC, blood glucose and renal function

Valvuloplasti Balon Transkateter Perkutan pada Neonatus dengan Stenosis Pulmonal Kritis

Valvuloplasti balon transkateter perkutan/percutaneous transcatheter balloon valvuloplasty (PTBV) pada stenosis pulmonal adalah tindakan non bedah untuk mengatasi obstruksi jalan keluar dan mengurangi beban sistolik ventrikel kanan akibat stenosis katup pulmonal dengan menggunakan balon. Metode ini merupakan kardiologi intervensi yang telah berkembang pesat menggantikan peran bedah dalam penanganan penyakit jantung bawaan dengan menawarkan beberapa keuntungan, antara lain: berkurangnya waktu perawatan dan biaya perawatan, alasan kosmetik (tidak menimbulkan jaringan parut di dada) serta kurang invasif. Dilaporkan seorang bayi laki-laki berumur 2 hari, dirawat di Pelayanan Jantung Terpadu Rumah Sakit Dr. Cipto Mangunkusumo (RSCM) dengan stenosis pulmonal kritis (SPK), defek septum atrium (DSA) sekundum sedang dengan pirau kanan ke kiri dan duktus arteriosus persisten (DAP) sedang yang panjang. Tindakan percutaneus transcatheter balloon valvuloplasty (PTBV) harus dilakukan secepatnya untuk menyelamatkan jiwa pasie