Refractory hypertension and the lower limbs ischaemia as an aortic coarctation symptom

Coarctation of the aorta (CoA) is a very rare cause of secondary hypertension, accounting for 0.1% of cases. Thecoarctation can present at any age. Hypertension is the most common presenting symptom. All patients with newlydiagnosed hypertension must have a physical examination with assessment of the brachial and femoral pulses andmeasurement of brachial and popliteal blood pressures. A thorough physical examination is a crucial first step indiagnosing aortic coarctation

Application of Cardio-O-Fix occluders for transcatheter closure of patent ductus arteriosus and interatrial communications: Preliminary experience

Background: Transcatheter treatment has become the method of choice for treating many heart defects. Recently, Cardio-O-Fix occluder (COF) - a new, self-expandable nitinol wire-mesh device very similar to the Amplatzer device - has been introduced into clinical practice. To the best of our knowledge, this is the first publication related to its application. Methods: Five patients aged from six months to 69 years were included in the study: two with atrial septal defect (ASD), one with patent foramen ovale (PFO) after cryptogenic stroke, and two with patent ductus arteriosus (PDA). These latter two comprised one six month old infant with co-existent hypertrophied cardiomyopathy, and a 53 year-old woman with recanalized PDA after previous ligation. All were treated percutaneously with COF. There was no preliminary patient selection. The only limitation was the size of the devices in our possession (16 and 22 mm ASD COF, 25 PFO COF, 4/6 and 6/8 PDA COF). The implantation technique was the same as previously described for Amplatzer occluders. Results: All procedures were finished successfully with complete closure of the shunt. No complications were observed during a six month follow-up. In the child with PDA, we observed decrease of gradient from 80 to 60 mm Hg in hypertrophied left ventricular outflow tract, although a small protrusion of PDA-COF device was noted in the descending aorta (8 mm Hg gradient in ECHO). In the patient with recanalized PDA, the procedure was performed after arterio-venous loop creation. Mean fluoroscopy time was 4.4 (range from 1.6 to 11) minutes. Conclusions: Our preliminary experience indicates that the application of Cardio-O-Fix devices is safe and effective. (Cardiol J 2010; 17, 6: 607-611

Transcatheter closure of atrial septal defect in children up to 10 kg of body weight with Amplatzer device

Background: Transcatheter closure of atrial septal defect (ASD) in older children and adults is currently considered the first-choice therapeutic option. This approach remains challenging in younger children. The aim of the study was to evaluate feasibility, safety and midterm efficacy of percutaneous ASD closure in symptomatic infants ≤ 10 kg body weight in our institution.Methods: There were 28 children up to 10 kg of body weight, who were qualified for transcatheter closure of ASD. All patients but one showed overload of right atrium and right ventricle. Mean weight of patients who underwent transcatheter closure was 9.2 ± 0.88 kg and age 1.59 ± 0.58 years, respectively. Transcatheter closure of ASD was conducted using Amplatzer occluders (ASO).Results: The devices were implanted successfully in 26/28 patients (93%). In 2 (7%) children the device repeatedly straddled the septum in relatively big ASD and the procedure was abandoned. Mean ASD diameter in patients, who underwent transcatheter closure, was 9.08 ± 2.9 mm (transthoracic echocardiography) and mean implant size/weight ratio was 1.07 ± 0.31. In the child with right-left shunt through ASD normalization of saturation occurred. Mean fluoroscopy time was 4.16 min. In 3 children minor complications occurred: transient arrhythmias (n = 1), fever after procedure (n = 2). The follow-up time was 6.1 (range 1.2–11) years. At follow-up, clinical condition and/or growth improved in all patients except 4 children with coexisting comorbidity. No arrhythmia nor conduction disturbances were observed during follow-up.Conclusions: In selected patients weighing less or equal to 10 kg, percutaneous closure of ASD is a safe and effective procedure.

Przezcewnikowe zamknięcie szerokiej przetoki wieńcowej za pomocą korka PDA

A large fistula from the left coronary artery to the right ventricle was successfully closed percutaneously in a 40 year-old patient using a patent ductus arteriosus occluder. The device was positioned and deployed via the venous system using a guidewire that had been advanced via the aorta, coronary artery and fistula to the venous circulation (arterio-venous loop creation). No complications were reported at follow-up. Kardiol Pol 2011; 69, 12: 1318–131

Percutaneous dilatation of coarctation of the aorta, stenotic pulmonary arteries or homografts, and stenotic superior vena cava using Andrastents XL and XXL

Background: Major vessel stenoses are currently successfully treated with stent implantation. Recently, new cobalt-chromium stents (Andrastents XL and XXL, Andramed, Germany) have been introduced into clinical practice. This alloy combines high biocompatibility with radial strength and flexibility. Aim: To present our experience with the use of Andrastents XL and XXL for the dilatation of stenosed pulmonary arteries, coarctation of the aorta (CoA), and a stenosed superior vena cava (SVC). Methods: The study group included 24 patients treated with 26 Andrastents. In 7 patients aged 23.3 (range 18–27) years, with the mean body weight of 64.7 (range 50–77) kg, prestenting of a calcified pulmonary homograft was performed using 9 Andrastents XL or XXL (length of 30, 39, or 48 mm) before the Melody valve implantation. In one patient with a long and stiff stenosis, 3 stents were necessary. In 12 patients with native CoA aged 30.1 (range 9–55) years, with the mean body weight of 60 (range 25–105) kg, twelve Andrastents XL or XXL (length of 30, 39, or 48 mm) were implanted. In 4 patients with the right or left pulmonary artery stenosis close to the bifurcation (age 8.5 [range 6–10] years, body weight 27.3 [range 17–33] kg), 4 Andrastents 30 XL were implanted. In one child (age 7.5 years, body weight 21.7 kg) with a iatrogenic SVC stenosis (after 2 venous cannulations necessary for 2 surgical corrections of his double-outlet right ventricle), the stenosed site was dilated using Andrastent 21 XL. Results: All procedures were performed successfully. No stent fractures were observed during the follow-up. The mean pressure gradient was reduced from 42.4 to 18 mm Hg (RVOT) in patients who underwent Andrastent and Melody valve implantation, from 54.1 to 13.2 mm Hg in patients with CoA, and from 49 to 21.7 mm Hg in patients with pulmonary artery stenosis. No aneurysm formation, stent migration, or rupture of the treated vessel during stent implantation were observed in any patient. The mean fluoroscopy time during stent implanatation was 6.6 min in CoA, 8.8 min in pulmonary artery stenosis, 24.8 min during implantation of Melody valve (with prestenting of RVOT with Andrastents) and 17.6 min during SVC dilation. Procedural outcomes (evaluated using noninvasive methods) remained favourable during the follow-up (0.5–21 months), with no complications observed. Conclusions: Implantation of Andrastents XL or XXL is a very good therapeutic option in the treatment of major vessel stenoses. Kardiol Pol 2011; 69, 12: 1213–1219Wstęp: Zwężenia dużych naczyń aktualnie skutecznie leczy się za pomocą implantacji stentów. Ostatnio do praktyki klinicznej wprowadzono nowe stenty kobaltowo-chromowe (Andrastent XL i XXL). Powyższy stop zapewnia wysoką biokompatybilność oraz połączenie wysokiej siły odśrodkowej stentu z jego giętkością. Cel: Celem pracy było przedstawienie własnych doświadczeń w zastosowaniu Andrastentów XL i XXL w poszerzaniu koarkatcji aorty (CoA), zwężeń gałęzi tętnicy płucnej (TP), zwapniałych homograftów w pozycji płucnej i żyły głównej górnej (SVC). Metody: Leczeniem objęto 24 pacjentów, u których wszczepiono 26 Andrastentów. U 7 z nich w wieku 23,3 roku (18–27 lat), o masie ciała 64,7 (50–77) kg przed implantacją zastawki płucnej na stencie Melody dokonano prestentowania zwapniałego homgraftu za pomocą 9 Andrastentów XL lub XXL o długości 30, 39 lub 48 mm. U 1 pacjenta z długim niepodatnym zwężeniem wszczepiono 3 stenty. U kolejnych 12 osób w wieku 30,1 roku (9–55 lat), o masie ciała 60 (25–105) kg z wrodzoną CoA dokonano implantacji Andrastentów XL lub XXL o długości 30, 39 lub 48 mm. U kolejnych 4 pacjentów w wieku 8,5 roku (6–10 lat) i o masie ciała 27,3 (17–33) kg zastosowano stenty XL 30 do prawej bądź lewej gałęzi płucnej blisko jej odejścia od pnia płucnego. U 1 dziecka w wieku 7,5 roku, o masie ciała 21 kg zwężoną jatrogennie SVC (po dwóch kaniulacjach związanych z operacją przeprowadzoną w krążeniu pozaustrojowym) poszerzono tę zmianę za pomocą Andrastentu XL 21. Wyniki: Wszystkie zabiegi ukończono pomyślnie, uzyskując spadek gradientu ciśnień w przypadku CoA z 54,1 do 13,2 mm Hg; poszerzania RVOT (homograftu) z 42,4 do 18 mm Hg, gałęzi TP z 49 do 21,7 mm Hg i zwężenia SVC z 9 do 1 mm Hg. Podczas implantacji nie stwierdzono ani jednego przypadku migracji stentu, jego pęknięcia czy powstania tętniaka. Średni czas fluoroskopii wynosił w przypadku: implantacji Andrastentu do CoA — 6,6 min; implantacji zastawki Melody (z prestentowaniem Andrastentem RVOT) — 24,8 min, poszerzania gałęzi TP — 8,8 min i poszerzania SVC — 17,6 min. W dalszej obserwacji (od 0,5 do 21 miesięcy) stan pacjentów pozostawał dobry, w badaniach nieinwazyjnych utrzymywał się dobry wynik zabiegu i nie zanotowano powikłań. Wnioski: Przezskórne poszerzanie zwężonych dużych naczyń za pomocą Andrastentów stanowi bardzo dobrą opcję terapeutyczną. Kardiol Pol 2011; 69, 12: 1213–121

Uzasadnienie zamknięcia jatrogennego ubytku przegrody międzyprzedsionkowej podczas zabiegu MitraClip

Introduction. The formation of an iatrogenic septal defect (iASD) during the MitraClip procedure may be associated with adverse consequences, including right ventricular (RV) volume overload resulting in worsening heart failure, hospitalizations, and increased mortality. The aim of the study is to evaluate the effects of closing the iASD simultaneously during MitraClip on the RV function. Material and methods. Four patients who underwent the MitraClip procedure were analysed. The resulting iASD was closed using an Amplatzer occluder during the indexed procedure. The patients were followed up for 12 months. Results. The complete iASD closure was achieved in all patients. There were no deaths during 12 months of observation. In all cases, the RV dimensions decreased, on average, from 38 ± 5.35 mm to 34.35 ± 5.06 mm. No patient had progression of tricuspid regurgitation to significant regurgitation (TR ≥ 3+). Right ventricular systolic pressure (RVSP) decreased from an average of 47.50 ± 7.82 mm Hg to 38.00 ± 8.57 mm Hg. Conclusions. The results indicate a beneficial effect of concomitant closure of iASD during the MitraClip procedure by reducing RV exposure to volume overload and the associated severity of tricuspid valve regurgitation and pulmonary hypertension.Wstęp. Powstawanie jatrogennego ubytku przegrody (iASD) podczas zabiegu MitraClip może wiązać się z niekorzystnymi konsekwencjami, między innymi z przeciążeniem objętościowym prawej komory serca skutkującym nasileniem objawów niewydolności serca, hospitalizacjami i zwiększoną śmiertelnością. Celem tej pracy jest ocena wpływu jednoczesnego zamykania iASD podczas zabiegów MitraClip na funkcję prawej komory serca (RV). Materiał i metody. Przeanalizowano przypadki 4 pacjentów, którzy przeszli zabieg MitraClip, u których zamknięto powstały iASD za pomocą okludera Amplatzer podczas indeksowanej procedury. Pacjenci byli obserwowani przez 12 miesięcy. Wyniki. Całkowite zamknięcie iASD osiągnięto u wszystkich pacjentów. Nie było zgonów podczas 12 miesięcy obserwacji. We wszystkich przypadkach wymiary RV zmniejszyły się średnio z 38 ± 5,35 mm do 34,35 ± 5,06 mm. U żadnego pacjenta nie wystąpiła progresja niedomykalności trójdzielnej do niedomykalności istotnej (TR ≥ 3+). Ciśnienie skurczowe prawej komory (RVSP) zmniejszyło się ze średnio 47,50 ± 7,82 mm Hg do 38 ± 8,57 mm Hg. Wnioski. Wyniki wskazują na korzystny wpływ równoczesnego zamknięcia iASD podczas procedury MitraClip poprzez zmniejszanie ekspozycji RV na przeciążenie objętościowe i związane z tym nasilenie niedomykalności trójdzielnej i nadciśnienia płucnego

Treatment of elevated pulmonary artery pressure in a child after Glenn procedure: transcatheter closure of pulmonary artery banding with subsequent sildenafil therapy

An additional source of pulmonary blood flow in a patient with bidirectional Glenn procedure (BGD) may cause elevation of mean pulmonary artery pressure (MPAP), precluding safe completion of the Fontan operation. We present a case of single ventricle physiology after pulmonary artery banding (PAB) and Glenn procedure. At the age of six years, cardiac catheterisation revealed in the patient elevated MPAP (22 mm Hg). The PAB was closed through the right internal jugular vein with an Amplatzer Atrial Septal Occluder. After the procedure, MPAP remained at a similar level. Sildenafil oral therapy was applied for six months. Subsequent heart catheterisation confirmed complete closure of PAB and decrease of MPAP to 10 mm Hg. The abovementioned complex treatment of elevated MPAP pressure in a child after Glenn therapy allowed safe completion of the Fontan operation.An additional source of pulmonary blood flow in a patient with bidirectional Glenn procedure (BGD) may cause elevation of mean pulmonary artery pressure (MPAP), precluding safe completion of the Fontan operation. We present a case of single ventricle physiology after pulmonary artery banding (PAB) and Glenn procedure. At the age of six years, cardiac catheterisation revealed in the patient elevated MPAP (22 mm Hg). The PAB was closed through the right internal jugular vein with an Amplatzer Atrial Septal Occluder. After the procedure, MPAP remained at a similar level. Sildenafil oral therapy was applied for six months. Subsequent heart catheterisation confirmed complete closure of PAB and decrease of MPAP to 10 mm Hg. The abovementioned complex treatment of elevated MPAP pressure in a child after Glenn therapy allowed safe completion of the Fontan operation

Immediate and long-term outcomes of percutaneous transcatheter pulmonary valve implantation

Background: Transcutaneous pulmonary valve replacement (TPVR) has become an alternative to heart surgery for patients after previous right ventricular outflow tract (RVOT) or pulmonary artery (PA) surgical interventions. The objective was to present immediate and long-term outcomes of trans¬cutaneous pulmonary valve replacement. Methods: Between 06/2009 and 06/2016, 46 patients underwent TPVR. Initial diagnoses included tetralogy of Fallot, common arterial trunk, transposition of great arteries post Rastelli correction, left ventricle outflow obstruction after Ross operation, pulmonary atresia, and isolated dysplastic pulmonary valve stenosis. Thirty eight (78%) patients had previously implanted conduits in the pulmonary position, the rest had either RVOT patch reconstruction (n = 6; 13%) or biological valve implantation (n = 2; 4%). They presented primarily with pulmonary stenosis (n = 18; 39%) or regurgitation (n = 28; 60%). Results: All procedures were successful — 44 Melody and 2 Edwards-Sapien valves were implanted. Before each procedure exclusion of potential coronary compression and RVOT prestenting was performed. Significant RVOT systolic gradient reduction (from 35.3 ± 19.5 to 13.5 ± 7.1 mm Hg; p < 0.001) and decrease of right to left ventricle systolic pressure ratio from 0.58 ± 0.18 to mean 0.37 ± 0.1 (p < 0.001) was achieved. Also, in every patient PA-RVOT competence was restored, with minor in¬competence in only a few patients. Post procedure follow-up ranged from 2 to 86 (mean 35.2) months. Follow-up fluoroscopy or chest X-ray revealed 6 stent fractures (2 stent defragmentation — with only 1 significant valve stenosis). Conclusions: Transcutaneous pulmonary valve replacement is a safe procedure with encouraging results, it also enables deferring surgical reintervention in the majority of patients

Embolizacja prawej komory zestawem Amplatza implantowanym w ubytek przegrody międzyprzedsionkowej

Pacjentkę w wieku 40 lat z rozpoznaniem ubytku przegrody mi&#234;dzyprzedsionkowej typu ostium secundum (ASD II) zakwalifikowano do przezskórnego leczenia zestawem Amplatza. W badaniu echokardiograficznym stwierdzono duży, 28-milimetrowy ubytek z wiotką przegrodą międzyprzedsionkową. Podczas zabiegu przezskórnego zamknięcia ASD II zaraz po uwolnieniu zestaw wypadł z ubytku i migrował do prawej komory. W opisywanym przypadku implant usunięto przezskórnie, a ubytek zamknięto większym zestawem o rozmiarze 32 mm. W niniejszej pracy omówiono przyczyny występowania embolizacji oraz metodę jej rozwiązania