C. Lanjewar

H. Shah

M. Phadke

P.G. Kerkar

S.D. Mate

Indian Heart Journal

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Electrocardiographic and Holter Study for immediate and mid-term incidence of conduction disturbances after transcatheter perimembranous ventricular septal defect device closure with Amplatz duct occluders

Mate, S.D.

Phadke, M.

Shah, H.

Lanjewar, C.

Kerkar, P.G.

Elsevier - Publisher Connector 

Electrocardiographic and Holter Study for immediate and mid-term incidence of conduction disturbances after transcatheter perimembranous ventricular septal defect device closure with Amplatz duct occluders 

wherever applicable. Our study tried to point out its implication in
intermediate stenosis and how it is more decisive than software
derived measurement (QCA) in a real world scenario.
Procedure: Total 27 patients (age 62.77  11.39 years) who received
FFR for intermediate stenosis, were included in this study. All
patients had evidence of ischemia either as stable angina
(56.26%), unstable angina (33.33%) or postMI angina (7.41%). Hyper-
tension (74.07%) and diabetes mellitus (29.63%) are most prevalent
risk factors present within patient group. In 85.19% cases, patients
have multi-vessel disease. Total patient group is subdivided into
left alone (70.37%) and stented (29.63%) as per FFR cut off value (0.8)
and both were kept under stringent medical management with
optimal antiplatelet and statin therapy. Mean follow-up period
was 18 months and primary outcome was recorded in reference to
TLR (target lesion re-stenosis) or MACE (major adverse cardiac
event).
Result: In 18months follow-up, patients of both subgroup emerged
quite well in outcome of the procedure as only 2 TLR (7.4%) have
identiﬁed one from each sub-group. In both the cases, HTN andDM
are concomitantly present as risk factors.
We observed that there is statistically highly signiﬁcant difference
in FFR score between two sub groups (0.88 vs. 0.75, p < 0.001), while
this is non-signiﬁcant in QCA score (0.66 vs. 0.71, p = 0.08) in
respective sub groups.
Both left alone sub-group and stented sub-group showed good
outcome (94.74% and 87.7%) in respect to disease free life and
Kaplan–Meier analysis for survival also corroborated the same
as it predicted excellent survival in both left alone sub groups
(0.9444; CI: 0.706–0.994) and stented sub-group (0.888; CI: 0.506–
0.994).
Inference: FFR is effective tool in deciding hemodynamically non-
signiﬁcant epicardial coronary artery stenosis with similar out-
come as compared to global PCI outcome. Moreover, this is proved
to be much superior to QCA score in judging effectiveness of
the management strategies and avoiding unnecessary coronary
stenting.
Electrocardiographic and Holter Study
for immediate and mid-term incidence
of conduction disturbances after
transcatheter perimembranous
ventricular septal defect device closure
with Amplatz duct occluders
S.D. Mate *, M. Phadke, H. Shah, C. Lanjewar,
P.G. Kerkar
King Edward Memorial Hospital and Seth GS Medical College, Mumbai,
India
Background: Trans-catheter closure of perimembranous defects
with the asymmetric device has been controversial due to a high
incidence of atrioventricular conduction disturbances. The use of
Amplatz duct occluders in carefully selected patients may reduce
this complication.
Aim: To evaluate the immediate and mid-term incidence of AV
conduction disturbances following transcatheter device closure of
perimembranous ventricular septal defect device (PMVSD) using
Amplatzer Duct Occluders.
Methods: Twenty-one patients with perimembranous VSD with
signiﬁcant left-to-right shunt (assessed by left ventricular dimen-
sion Z scores) were selected for trans-catheter closure. Patients
with weight <10 kg or with defects within 4 mm distance from the
aortic valve, or with large defects (size greater than the aortic
annulus) were excluded. The size of the device was chosen based
on the trans-esophageal dimension of the defect at the LV end
(2 mm larger device size for ADO 1 and 1 mm larger for ADO II).
Sixteen patients were available for follow-up, of which 13 had their
defects closed with the ADO I device and three with the ADO II
device. Patients were followed up clinically and with electrocar-
diography and trans-thoracic echocardiography at 1, 6, and
12 months. Holter monitoring was performed in all patients at
six months.
Results: Themean age of the patients was 10.2  9.2 years, and the
mean weight was 23.6  15.06 kg. The mean defect size (at the LV
end) was 4.02  0.98 mm. The mean follow-up period was 12.09
 1.92 months. The procedure was successful in all 21 patients,
with complete closure of the defect by 24 h as assessed on TTE. No
patient developed signiﬁcant aortic regurgitation. One patient had
device (ADO II) embolization to the left pulmonary artery within
24 h. The device was retrieved percutaneously and the defect was
closed successfully with ADO I device of a larger size. One patient
developed transient RBBB on table, which reverted spontaneously
allowing successful completion of the procedurewith noAV blocks
thereafter. No patients developed AV blocks in the peri-procedural
period. In 16 patients who were followed up, all were asympto-
matic on follow-up. None developed AV conduction disturbances
on ECG or Holter examination.
Conclusion: In carefully selected patients with small to moderate
perimembranous VSDs, transcatheter closure using the ADO I and
ADO II device can be considered to be a safe and effective alter-
native to surgery, with no AV conduction blocks observed at mid-
term follow-up. Longer follow-up with a larger study population is
desirable.
Study of short and intermediate term
clinical outcomes of patients with
protected and unprotected LMCA
stenting
T.S. Nikam *, P. Vyas, S. Sahoo, J. Prajapati, A. Patel
Department of cardiology, U.N. Mehta Institute of Cardiology and
Research Centre, Civil Hospital Campus, Asarwa, Ahmedabad 380016,
Gujarat, India
Background: Signiﬁcant unprotected left main coronary artery
disease occurs in 5–7% of patients undergoing coronary angiogra-
phy (CAG). This study has focused on safety and efﬁcacy of LMCA
stenting to determine whether it provides a true alternative to
CABG.
Materials and methods: From July 2013 to February 2015, 50
patients underwent LMCA stenting. LMCA stenting was performed
in patients with following criteria (1) Patients with LMCA stenosis
more than 50% and evidence of myocardial ischemia and who
denied CABG as revascularization procedure. (2) Patients with
signiﬁcant ostioproximal lesion of LAD or LCX, who are planned
to be treated with LMCA to LAD or LMCA to LCX stenting. (3)
Patients with bail out LMCA stenting. (4) Stenting of unprotected
LMCA stenosis in selected patients.
Results: Mean age was 53.14  9.60 years. 18 patients who under-
went LMCA stenting presentedwith STEMI, 9 (18%) had NSTEMI, 10
(20%) had unstable angina and 13 (26%) had chronic stable angina.
6 patients had protected LMCAand the rest had unprotected LMCA.
On CAG, 16 (32%) patients had ostial LMCA lesion, 12 (24%) hadmid
LMCA lesion, distal LMCA was diseased in 6 (12%). In emergency
situation, 2 bail out LMCA stenting were done for treatment of
LMCA dissection. 22 (44%) patients had LMCA stenosis less than
50%, 6 (12%) had stenosis between 50 and 70%, 19 (38%) had 71–90%
stenosis and 3 had more than 90%. 42 (84%) patients had low
syntax score, 6 (12%) had intermediate and 2 (4%) had high syntax
i n d i a n h e a r t j o u r n a l 6 7 ( 2 0 1 5 ) s 4 9 – s 7 1S68


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Electrocardiographic and Holter Study for immediate and mid-term incidence of conduction disturbances after transcatheter perimembranous ventricular septal defect device closure with Amplatz duct occluders

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