Percutaneous patent foramen ovale closure during live case demonstrations.

BACKGROUND: Live case demonstrations serve as an educational tool for interventional techniques in cardiology. The aim of this study was to assess the safety and technical success of percutaneous patent foramen ovale (PFO) closure during live case demonstrations. METHODS: All patients who had undergone percutaneous PFO closure with Amplatzer devices during live case demonstrations at our institution were consecutively included in this retrospective analysis. Procedure related events were compared with summary event rates derived from the eight randomized controlled trials (RCTs) investigating PFO closure, as well as with a propensity matched cohort of patients treated under usual conditions. RESULTS: From April 2004 to June 2015, 142 patients underwent percutaneous PFO closure during live demonstrations, mainly for secondary prevention of cryptogenic cerebrovascular events. The interventions were fluoroscopy guided and successful in all but three cases (2%). Minor adverse events occurred in nine patients (6%). Contrast TEE performed at about 6 months showed complete closure in 84%. No significant differences with regard to technical success and major complications rate were found compared to RCTs, except for an increased rate of minor bleeding observed during live case demonstrations (P for difference < 0.001), mainly attributable to concomitant arterial access for incidental coronary angiography performed in 70% of patients. Except for slightly longer procedure duration, no difference was found compared to a matched population treated under usual conditions. CONCLUSION: Percutaneous PFO closure can be performed during live case demonstrations with the same high technical success as during routine cases.

Second transcatheter closure for residual shunt following percutaneous closure of patent foramen ovale.

AIMS: Residual shunt following percutaneous patent foramen ovale (PFO) closure has been described in up to 49% of patients and is associated with recurrent cerebrovascular events. Our aim was to evaluate the safety, feasibility, and midterm outcomes of transcatheter residual shunt closure. METHODS AND RESULTS: From 1994 to July 2016, 2,679 patients underwent transcatheter PFO closure for treatment of presumed paradoxical embolism at our institution. Among them, 100 patients (3.7%) were referred for residual shunt closure. They constituted the study population for which a retrospective analysis of the prospectively gathered procedural data was performed along with prospective acquisition of follow-up data. The indication for initial PFO closure was an ischaemic cerebrovascular event in 85% of the patients. Patients underwent transoesophageal echocardiography (TOE) for PFO diagnosis and again for residual shunt assessment at about six months. All procedures were performed under fluoroscopic guidance only. At the first procedure, 10 different devices had been used. The AMPLATZER PFO Occluder accounted for 54% and the AMPLATZER Cribriform Occluder for 28%. Compared to the whole population (n=2,679), a significantly higher rate of atrial septal aneurysm (58% versus 36%; p=0.024), a larger proportion of shunt grade 3 at baseline (97% versus 78%; p<0.001), and a larger size (≥30 mm) of the first implanted device (47% versus 13%; p<0.001) were observed in the patients with residual shunt. Six patients (6%) experienced a recurrent TIA or ischaemic stroke before the second intervention. Residual shunt closure was successful in all but two patients. A second AMPLATZER PFO Occluder was used in the majority of the repeat interventions (76%). There were no complications. TOE, obtained again after 7±5 months in 88 of the 98 patients with a device in place (90%), showed complete closure in 81%. In eight patients (0.3% of the whole cohort), a third device was implanted, resulting in complete closure in all. CONCLUSIONS: Transcatheter residual shunt closure after initial percutaneous PFO closure can be safely performed under fluoroscopic guidance only and achieves complete closure in most patients. The use of larger devices, typically prompted by intricate anatomy, represents a risk factor for shunt persistence and the need for reintervention.

HGF Expressing Stem Cells in Usual Interstitial Pneumonia Originate from the Bone Marrow and Are Antifibrotic.

BACKGROUND: Pulmonary fibrosis may result from abnormal alveolar wound repair after injury. Hepatocyte growth factor (HGF) improves alveolar epithelial wound repair in the lung. Stem cells were shown to play a major role in lung injury, repair and fibrosis. We studied the presence, origin and antifibrotic properties of HGF-expressing stem cells in usual interstitial pneumonia. METHODS: Immunohistochemistry was performed in lung tissue sections and primary alveolar epithelial cells obtained from patients with usual interstitial pneumonia (UIP, n = 7). Bone marrow derived stromal cells (BMSC) from adult male rats were transfected with HGF, instilled intratracheally into bleomycin injured rat lungs and analyzed 7 and 14 days later. RESULTS: In UIP, HGF was expressed in specific cells mainly located in fibrotic areas close to the hyperplastic alveolar epithelium. HGF-positive cells showed strong co-staining for the mesenchymal stem cell markers CD44, CD29, CD105 and CD90, indicating stem cell origin. HGF-positive cells also co-stained for CXCR4 (HGF+/CXCR4+) indicating that they originate from the bone marrow. The stem cell characteristics were confirmed in HGF secreting cells isolated from UIP lung biopsies. In vivo experiments showed that HGF-expressing BMSC attenuated bleomycin induced pulmonary fibrosis in the rat, indicating a beneficial role of bone marrow derived, HGF secreting stem cells in lung fibrosis. CONCLUSIONS: HGF-positive stem cells are present in human fibrotic lung tissue (UIP) and originate from the bone marrow. Since HGF-transfected BMSC reduce bleomycin induced lung fibrosis in the bleomycin lung injury and fibrosis model, we assume that HGF-expressing, bone-marrow derived stem cells in UIP have antifibrotic properties.