Long-term follow-up of percutaneous secundum-type atrial septal defect closure using Amplatzer Septal Occluder since 1995: a single-centre study.

INTRODUCTION: The goal of this single-centre study was to evaluate long-term results of percutaneous closure of secundum-type atrial septal defect using Amplatzer Septal Occluder with the follow-up to 25 years. METHODS: A retrospective analysis of patients who underwent percutaneous closure of secundum-type atrial septal defect between September 1995 and October 2012 in our institution was performed. All procedures were performed after fulfilling strict indication criteria. More than 5 years follow-up was reached in 651/803 patients (81%) with median follow-up time of 12 (5-25) years. RESULTS: The mean stretched defect diameter was 14,0 ± 5,2 mm. Early reintervention due to moderate or severe residual atrial septal defect had to be performed in 3/803 patients (0,03%). The incidence of long-term moderate or severe residual atrial septal defect was 0,0%. The complete closure rate at 10-year follow-up was 98,5%, as trivial residual shunts persisted in 8/508 patients (1,5%). A significant rate of the echocardiographic right ventricular end-diastolic diameter post-procedural normalisation (p < 0,05) was encountered. The rate of major complications was 0,5%. One device embolisation, one thrombus formation at the occluder surface, and one cardiac erosion in periprocedural or short post-procedural course were experienced. Only one late complication of infective endocarditis at the region of implanted occluder and the aortic valve was detected. The survival rate of all followed patients was 100%. CONCLUSIONS: Percutaneous closure of secundum-type atrial septal defect using Amplatzer Septal Occluder is a safe and effective procedure accounting for a very low incidence of major complications in the long-term follow-up.

Right aortic arch with isolated left subclavian artery: a rare association with coarctation of the left pulmonary artery.

We present a case report of rare association of right aortic arch with isolated left subclavian artery with coarctation of the left pulmonary artery.

First experience with AndraStent XL implantation in children and adolescents with congenital heart diseases.

OBJECTIVES: To present our experience with a new type of extra-large (dilatable up to 25 mm), balloon-expandable, nonpremounted, cobalt-chromium peripheral stent with semiopen designed cells: AndraStent. METHODS: Between December 2008 and August 2011, 21 AndraStents in 21 patients were implanted into vessel stenoses of varied localizations. AndraStents XL of 21, 30, and 39 mm in length were used. The median age and weight of patients at stent implantation were 11.6 years (range 2.1-19.1 years) and 36 kg (range 11-82 kg), respectively. The stent was implanted into the left pulmonary artery stenosis (n = 12), into the aortic isthmus (n = 7), into a stenosed aortopulmonary collateral artery (n = 1) and into a stenosed systemic venous tunnel postSenning operation (n = 1). RESULTS: All the implantations were successfully performed; there was one major vessel access complication necessitating vascular surgery. The diameter of the vessel stenosis increased significantly (P < 0.05) from a median of 5.7-11 mm. The stent foreshortening was only mild. CONCLUSIONS: Our initial results show that AndraStents are implantable and efficacious in different vascular stenoses and present a valuable alternative to the available large stents. With the application of a modified front-loading technique, they can also be implanted in smaller children.

The new Amplatzer duct occluder II: when is its use advantageous?

OBJECTIVES: To determine the safety and efficacy of the Amplatzer duct occluder and the Amplatzer duct occluder II in different types of arterial ducts, and to determine in which types of ducts the use of this new device can be advantageous. METHODS: All children with a device-based ductal closure between September, 2005 and February, 2010 were included. We retrospectively analysed the catheterisation and follow-up data. RESULTS: Between September, 2005 and February, 2010, 44 ducts were closed with the Amplatzer duct occluder - group Amplatzer duct occluder - and 52 ducts were closed with the Amplatzer duct occluder II - group Amplatzer duct occluder II. In the Amplatzer duct occluder group, the mean age was 3 years and 4 months, and the mean weight was 14.7 kilograms. Closure was successfully performed in all children. Complete closure at 24 hours was attained in 42 of 44 children (95.45%). No major complications occurred. In the Amplatzer duct occluder II group, the mean age was 6 years and 2 months, and the mean weight was 25.4 kilograms. Closure was successfully performed in all children, except in two children in whom the occluder protruded into the aortic isthmus and was replaced by the Amplatzer duct occluder. Complete closure at 24 hours was attained in 51 of 52 children (98.08%). No major complications occurred. CONCLUSION: In our experience, duct closure with the Amplatzer duct occluder II is a safe and effective method. The advantages of using it are the smaller sheath sizes and softer shape.