New PFO device for closure of patent foramen ovale in patients who had a history of cryptogenic stroke; a report of 14 cases.

OBJECTIVE: The Cocoon PFO Occluder is a device for percutaneous closure of inter-atrial communications. Its self-centering characteristics make it attractive for closure of patent foramen ovales (PFOs) with or without atrial septal aneurysms. The goal of this study is to report the immediate and follow-up results of the first 14 patients in implanted with the Cocoon PFO Occluder. MATERIAL AND METHOD: This is a retrospective report of immediate and short-term clinical and echocardiographic outcome of patients who underwent transcatheter closure of PFO because of paradoxical embolism. Procedural success was defined as successful deployment of the device and effective occlusion (no, or trivial, shunt after device placement). All patients had a transesophageal echocardiography (TEE) with saline contrast injection at baseline and clinical follow-up at 6 months. RESULTS: Between September 2012 and March 2014, 14 patients had successfully undergone transcatheter closure of PFO using Cocoon device. During follow-up none of the patients had a recurrence of stroke after device closure. No residual shunt was observed in any patients at follow-up. CONCLUSION: Transcatheter closure of PFO with the Cocoon PFO device is safe and effective and can be used for preventing recurrent strokes in patients who present with cryptogenic stroke and PFO.

Reevaluation of the indications for permanent pacemaker implantation after transcatheter aortic valve implantation.

AIMS: Conduction abnormalities (CA) requiring permanent pacemaker (PPM) are a well-known complication after transcatheter aortic valve implantation (TAVI). This study aimed to determine the incidence of TAVI-related PPM and reevaluate the indications for PPM after the periprocedural period. METHODS AND RESULTS: A total of 258 consecutive patients underwent TAVI with the Medtronic CoreValve (MCV), whereas 24 patients were excluded from the study. TAVI-related PPM was defined as PPM implantation ≤30 days after the procedure and due to atrioventricular block (AVB). Third-degree AVB, second-degree type-II, or advanced second-degree AVB were considered as absolute indications for PPM. The incidence of TAVI-related PPM implantation was 27.4%. Forty-six patients (19.7%) had an absolute indication for PPM, but CA had resolved in 50% beyond the periprocedural period. Electrocardiographic analysis of the patients who did not have a TAVI-related PPM implantation showed that the PR and QRS intervals increased following TAVI, reaching a peak on days 4-6 and 7-9, respectively, before decreasing to near baseline levels. CONCLUSION: Although the incidence of periprocedural PPM implantation following TAVI was high, most CAs following TAVI tend to resolve after the periprocedural period. This suggests that delaying the decision for PPM implantation after TAVI may reduce the PPM rate.

In-hospital outcomes of primary percutaneous coronary intervention in King Chulalongkorn Memorial Hospital: 11 years of experience.

BACKGROUND: Primary percutaneous coronary intervention (PCI) appears to be the preferred reperf usion methodfor patients with ST-segment elevation myocardial infarction (STEMI). This method was introduced in our hospital before the year 2000. In Thailand, data showing long experience results in patients with STEMI who underwent primary percutaneous coronary intervention remain limited. OBJECTIVE: To demonstrate 11-yr experience of primary percutaneous coronary intervention at King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: This retrospective descriptive single-center study analyses clinical characteristics, angiographic features and in-hospital outcomes of 772 patients with STEMI who underwent primary percutaneous coronary intervention between 2000 and 2010. RESULTS: Seven hundred seventy two consecutive patients with STEMI were enrolled in the study. Three-fourth of the patients were male. Mean age was 60.13 years (range 28 to 96 years) and 12.6% were older than 75 years old. Forty-eight percent of patients were referred from hospital without cardiac catheterization facilities. Of these patients 94.4% underwent primary PCI and rescue PCI was done in 5.6% of patients. There were 27% ofpatients with left ventricular ejection fraction less than 40%, 21% of patients with Killip's class IV and 12% suffered cardiac arrest prior to angiography. Median door-to-balloon time in referred and non-referred patients was 28 and 104.5 minutes, respectively. Ninety-two percent of referred patients and 36% of non-referred patients, door to balloon time were within 90 minutes. About half ofthe patients had multi-vessels disease at that time of diagnosis. The overall angiographic success rate was 96%. Platelet glycoprotein llb/lla inhibitors were used in two-third ofpatients and stent placement in 82%. Post procedural thrombolysis in myocardial infarction (TII) 3 flow was documented in 87%. Intra-aortic balloon pump was used in 15% and thrombus aspiration device in 47%. During hospital stay, in-hospital mortality was 8.5% and 80% of those cases died from cardiac cause. One-third of patients died if they had Killip's class IV at presentation compared with 1.6% in patients with Killip's class I-III. In-hospital major adverse cardiovascular event was 10.4%. CONCLUSION: During 11 years of primary PCI experience in King Chulalongkorn Memorial Hospital, the angiographic success rate was high with acceptable in-hospital mortality and major adverse cardiac event. This strategy of treatment should be the treatment of choice for patients with STEMI in experienced PCI capable center with 24 hours/7 days availability.

In-hospital and mid-term outcomes of stent implantation in patients with protected and unprotected left main coronary artery disease; King Chulalongkorn Memorial Hospital experiences.

BACKGROUND: Left Main Coronary Artery (LMCA) disease is now uniformly treated with coronary artery by pass grafting (CABG). However some patients with LMCA disease did not receive CABG because of high operative risks as well as those who refused CABG Recent studies demonstrated the feasibility of stenting for LM stenosis, although data remain limited. OBJECTIVE: To evaluate in-hospital and mid-term outcomes of using bare metal stent (BMS) and drug eluting stent (DES) in protected and unprotected left main coronary artery disease at King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: Retrospective, single-center study. The authors reviewed the outcomes of patients who underwent percutaneous coronary intervention on left main coronary artery lesions in our hospital from July 2000 to August 2007. In-hospital data and clinical follow-up outcomes were analyzed and determined as in-hospital and mid-term mortality, major adverse cardiac event (MACE). RESULTS: In eight years the authors reviewed 64 consecutive protected and unprotected LMCA patients who underwent PCI with stent placement. Altogether left main coronary artery stents were successfully deployed in all patients. DES usage was 64%. Bifurcation technique for distal left main coronary artery was executed in 32 patients (50%), included single stent in 62 (97%), two stents in 2(3%). Final kissing ballon inflation was done in 14 (21.9%). In-hospital mortality was 4.7% (three patients), two patients died from cardiac origin. The total in-hospital major adverse cardiac event (MACE) was 4.7%. Clinical follow-up of 6 months was completed in 100% of patients. Fifty percent of patients had angiographic follow-up and in-stent restenosis rate was 9.7%. No further death was noted and MACE at 6 months was 9.4%. Moreover, overall mean and median follow-up period were 31 +/- 25 months (range, 6-93 months) and 26 months respectively. CONCLUSION: Stent Implantation was technically feasible and safely applied for the treatment ofprotected and unprotected left main coronary artery lesions in patients, with acceptable in-hospital and mid-term outcomes. More randomized and controlled clinical trials are needed to confirm the long-term effects of stents for LMCA disease.