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Ductus arteriosus is a physiological structure if not closed after birth, may lead to many complications. Today, trans-catheter closure of patent ductus arteriosus with Occluder devices is the preferred method. Surgical ligation is used only in certain cases such as large symptomatic patent ductus arteriosus in very small infants and premature babies; unfavourable structure of the duct or economic considerations. In this article, we described haemodynamic and morphological characteristics of five patients with large patent ductus arteriosus which were occluded with Amplatzer device.From 23 January, 2010 to 31 July, 2018, five patients referred to our clinic with large patent ductus arteriosus and pulmonary arterial hypertension for further evaluation. After assessing them with various diagnostic methods, we decided to close defect with ventricular septal defect Occluder device. Patients aged 21–44 years and one of them was male. Ductus closure was successfully done with ventricular septal defect Occluder device. Closure was successful for all of them but in one case, whose device was embolized to pulmonary artery after 24 hr and he underwent surgery.Trans-catheter closure of large patent ductus arteriosus in adult patients with pulmonary hypertension is feasible. Despite the fact that complications may occur even with the most experienced hands, the ‘double disk’ Amplatzer ventricular septal defect muscular Occluder could be advantageous in this setting.

Background Bronchopleural fistula (BPF) refers to an abnormal channel between the pleural space and the bronchial tree. It is a potentially fatal postoperative complication after pulmonary resection and a complex challenge for thoracic surgeons because many patients with BPF ultimately develop refractory empyema, which is difficult to manage and has a major impact on quality of life and survival. Therefore, an operative intervention combined with conservative and endoscopic therapies may be required to control infection completely, to occlude BPF, and to obliterate the empyema cavity during treatment periods. Case presentation Two patients who suffered from BPF complicated with chronic empyema after lobectomy were treated in other hospitals for a long time and did not recover. In our department, we performed staged surgery and creatively combined an Amplatzer Septal Occluder (ASO) device (AGA Medical Corp, Golden Valley, MN, USA) with pedicled muscle flap transposition. First, open-window thoracostomy (OWT), or effective drainage, was performed according to the degree of contamination in the empyema cavity after the local infection was controlled. Second, Amplatzer device implantation and pedicled muscle flap transposition was performed at the same time, which achieved the purpose of obliterating the infection, closing the fistula, and tamponading the residual cavity. The patients recovered without complications and were discharged with short hospitalization stays. Conclusions We believe that the union of the Amplatzer device and pedicle muscle flap transposition seems to be a safe and effective treatment for BPF with chronic empyema and can shorten the length of the related hospital stay.

Background: Device closure of atrial septal defect (ASD) is a treatment of choice in selected patients with a suitable defect. We aimed to evaluate short- and intermediate-term outcomes with device closure in special reference to complications in Western Indian population. Materials and Methods: The present prospective observational study enrolled 184 patients with ASD who underwent Device closure. All patients were followed at 15–30 days (short) and 3–12 months (intermediate). Results: Device closure of ASD was done successfully in 180 (97.83%) patients. Systolic (P = 0.02), diastolic (P = 0.007), and mean PA (P = 0.0001) pressure were significantly decreased at postprocedure. Residual defect was resolved in 94.2% of patients by 6 months. Preprocedural Pulmonary artery hypertension was found in 36 (19.56%) patients and was reduced in 15 (8.15%) patients postprocedure and in 10 (5.43%) patients at 1 year. Residual shunt was reported in 34% of patients which was resolved in all by 6 months. At postprocedure and follow–up, patients were developed minor complications included (0.5%) moderate MR, 1 (0.5%) lower respiratory tract infection, and 3 (1.6%) local site hematoma. Eleven (5.98%) major complications involved arrythmia (2.17%), infective endocarditis (0.54%), LAA perforation (0.54%), cardioembolic shock (0.54%), device embolization (0.54%), sudden cardiac arrest (0.54%), intraprocedural acute coronary syndrome (0.54%), and cardiac tamponade (0.54%). Conclusion: Device closure appears to be best available option at the present time. Careful attention to the details of the technique is mandatory to achieve a successful outcome in order to avoid complication related to procedure. Patients of all ages experience reduction in pulmonary artery pressure after percutaneous device closure of ASD.

A 60-year-old female with underlying emphysema and left ventricular assist device (LVAD) HeartMate 3 presented with progressive hemoptysis, dyspnea, and right chest pain. Baseline hemoglobin was 11.1 g/dL and INR 2.9.

Quite often the iatrogenic atrial septal defect created after percutaneous transcatheter mitral valve replacement procedures is closed with an atrial septal occluder device thus precluding further transseptal interventions if required. In this case report, we describe a patient who previously underwent a valve-in-valve transcatheter mitral valve replacement and iatrogenic atrial septal defect closure with an Amplatzer device, who developed severe prosthetic mitral valve stenosis. This patient required a second percutaneous valve-in-valve in-valve procedure with a transseptal puncture in the presence of an atrial septal occluder device.

Transcatheter atrial septal defect (ASD) device closure has emerged as a safe and effective alternative procedure for surgical ASD repair. However, ASD device malposition and embolization has been reported with an incidence of 0.5 to 1.1%. We report here a case of a 32-year-old male, who presented to the hospital 5 months after ASD device closure for routine follow-up. This case reports highlights the significance of transesophageal echocardiography (TEE) evaluation in successful surgical retrieval of a dislodged ASD Amplatzer device.

Graphical abstract, Highlights • Thrombosis of devices as amplatzer could happen late as in this case, 8 years after. • Caution should be exercised with symptoms suggestive of embolism • A formal anticoagulation regimen may be sufficient in some cases. • Individualized follow up and treatment is required with this type of devices.

Background Bronchopleural fistula (BPF) is a relatively rare complication after various types of pulmonary resection. The double-sided mushroom-shaped occluder (Amplatzer device, AD) has been gradually used for BPF blocking due to its reliable blocking effect. We have improved the existing AD implantation methods to facilitate clinical use and named the new approach Sheath-free method (SFM). The aim of the present report was to explore the reliability and advantages of the SFM in AD implantation. Methods We improved the existing implantation methods by abandoning the sheath of the AD and using the working channel of the bronchoscope to directly store or release the AD without general anesthesia, rigid bronchoscopy, fluoroscopy, or bronchography. A total of 6 patients (5 men and 1 woman, aged 66.67 ± 6.19 years [mean ± SD]) had BPF blocking and underwent the SFM in AD implantation. Results AD implantation was successfully performed in all 6 patients with the SFM, 4 persons had a successful closure of the fistula, one person died after few days and one person did not have a successful closure of the fistula. The average duration of operation was 16.17 min (16.17 ± 4.67 min [mean ± SD]). No patients died due to operation complications or BPF recurrence. The average follow-up time was 13.2 months (range 10–17 months). Conclusion We observed that the SFM for AD implantation—with accurate device positioning and a clear field of vision—is efficient and convenient. The AD is effective in BPF blocking, and could contribute to significantly improved symptoms of patients.

Iatrogenic femoral artery pseudoaneurysm is an infrequent but troublesome complication of vascular access during transcatheter aortic valve implantation. There are non-invasive, percutaneous and surgical treatment options for management of this complication. This case series report demonstrates a novel technique using an Amplatzer Duct Occluder II closure device to successfully treat iatrogenic common femoral pseudoaneurysm following transcatheter aortic valve implantation.

There are surgical and percutaneous interventional strategies to treat ASD, each with its own advantages and inevitable drawbacks too. Here, we described a case of large size secundum type ASD (30 mm x 31 mm) that first underwent percutaneous closure with ASD Amplatzer device number 33. The day after the procedure, although the patient was asymptomatic, on follow-up echocardiography, it was found that the device was embolized into the right ventricle within Moderator Bands. Hence, the cardiac surgery was performed.

Key Clinical Message The vertical vein is sometimes left open in repair of total anomalous pulmonary venous connection. It usually closes later but can remain patent leading to a significant shunt. We describe a recanalized vertical vein in a 7‐year‐old having undergone repair in infancy. It was closed using an Amplatzer device.

We describe the case of a 32-year-old man with history of patent ductus arteriosus (PDA) closed with an Amplatzer device 12 years earlier. Imaging investigations revealed a persistent large PDA and the device migrated in the right pulmonary artery. A new transcatheter PDA occlusion was attempted with optimal post-procedural results. (Level of Difficulty: Advanced.), Graphical abstract, We describe the case of a 32-year-old man with history of patent ductus arteriosus (PDA) closed with an Amplatzer device 12 years earlier…

A 60-year-old woman with progressive dyspnea and cyanosis, O2-dependent pulmonary hypertension despite optimal medical therapy and remote atrial septostomy presented with worsening cyanosis and right-to-left shunting. The creation of a "fenestrated" ASD closure device with the insertion of a peripheral stent through an AMPLATZER™ ASD closure device was deployed to minimize right to left shunting and allow for enlargement of the shunt if needed. This case demonstrates the benefit of diminishing a right to left shunt with a self-fabricated fenestrated AMPLATZER device to improve symptoms in pulmonary hypertension patients with a pre-existing ASD.

Aims Transoesophageal echocardiography (TEE) and multidetector computed tomography (MDCT) currently serve as imaging modalities for left atrial appendage (LAA) occlusion preprocedural planning. We assessed the feasibility of MDCT-based models to predict the correct size of device for LAA occlusion procedures. Methods and results Patients planned for LAA occlusion underwent MDCT before implantation, which was used for creating and printing 3D LAA models. Three cardiologists evaluated the 3D models and predicted the correct size of the device by manual manipulation. These predictions were compared with the actual device implanted during the procedure. Twenty-nine patients were included in this study. AMPLATZER and WATCHMAN devices were deployed in 12 and 17 patients, respectively. Two procedures were aborted due to failure of occlusion; all three physicians predicted it. There was good correlation between the 3D models and the inserted device for AMPLATZER devices with a concordance correlation coefficient of 0.778 (p=0.001) and poor agreement for WATCHMAN devices - concordance correlation coefficient of 0.315 (p=0.203). Agreement among the three physicians for AMPLATZER and WATCHMAN devices was excellent, with a calculated average intra-class correlation of 0.915 and 0.816, respectively. Conclusions We found LAA printed 3D models to be accurate for prediction of LAA occluder device size for the AMPLATZER device but not for the WATCHMAN device.

An 80-year-old male with aortic stenosis underwent transcatheter aortic valve replacement through a transcaval approach. The aorta was closed with an Amplatzer device without retroperitoneal leak or fistula. The patient developed a stroke three hours after the procedure and was treated with tissue plasminogen activator. Imaging after thrombolytic therapy revealed no aortic extravasation from the puncture site. To our knowledge, this demonstrates the first case in which thrombolytic therapy was used after transcaval access to the abdominal aorta for transcatheter aortic valve replacement and suggests that patients without leak after transcaval aortic closure, thrombolytic therapy is not contraindicated.

This case study describes the successful percutaneous transcatheter retrieval of an embolized Amplatzer occluder device using the "waist capture technique" in a patient with an atrial septal defect. This technique allowed for stability of the Amplatzer device, compression of the atrial discs for easier removal, prevention of further embolization, and minimal injury to vasculature during device retrieval. This novel and effective technique can be used safely for the retrieval of Amplatzer devices in the venous system.

Transcatheter closure of atrial septal defects (ASDs) using nickel titanium Naval Ordnance Laboratory (Nitinol)-containing devices (Amplatzer, AGA Medical, Golden Valley, Minnetosa) is being widely practiced. Controversies still exist regarding the release of nickel from these devices and the allergy and other ill effects of nickel and also the duration of antiplatelet therapy to aid endothelization of the device. Objective: To study the nickel levels in patients who underwent ASD closure with platinum-coated Nitinol-containing Amplatzer septal occluder. Methodology: A prospective study was conducted on 25 patients, between 6 years and 40 years of age who underwent ASD closure with Amplatzer septal occlude sizes ranging from 12 to 36 mm from January 2009 to January 2010. Blood nickel levels were estimated using atomic absorption photometry before and 24 h after the procedure and later at 1 month, 3 months, and 6 months postprocedure. A value of

To compare planned and achieved device position in patients undergoing left atrial appendage occlusion (LAAO). It is unclear how devices used for LAAO position themselves compared to what is planned. All patients undergoing LAAO at our institution had pre- and post-procedural multi detector-row computed tomography (MDCT) at 3 months (N = 52). Using dedicated software, both datasets were fused to superimpose the left atria in all planes. The effective device position was traced on the post-procedural MDCT and then imported in the pre-procedural dataset to allow comparisons. Planned and effective landing zones were compared with respect to size, location and orientation. The device’s final position was in a significantly larger landing zone than planned (452 ± 174 vs. 351 ± 112 mm2 for effective and planned landing zones, respectively, paired t-test: p

Objective To report on a new technique that increases the safety of percutaneous atrial septal defect (ASD) closure using a goose-neck snare system. Background ASD transcatheter closure is a widespread procedure. However, in some cases, ASDs may be large and with soft rims. In these situation, a potential risk exists for device malposition or embolization. Methods When transesophageal echocardiography (TEE) evaluation and balloon sizing showed large defects with floppy rims the chosen Amplatzer device was implanted in a standard way. In large defects with floppy rims, before release a 5-mm goose-neck snare with its 4 Fr catheter was placed across the delivery cable and fixed to catch the screwing mechanism of implanted Amplatzer device. The delivery cable was unscrewed and the device reached its final position without any tension. If the position was considered satisfactory the device was released from the goose-neck snare. Results Thirteen patients had a snare-assisted ASD transcatheter closure. Median device size was 24 mm (range 14-38 mm). Retrieval or repositioning of the device using the goose-neck snare was performed in four cases: in three patients, because of device malposition after delivery cable release and in one patient, because of unsuitability of closure of a second significant defect. Furthermore, in two subjects with multiple ASDs, a second fenestration looked quite significant with the device still attached to the delivery cable while it appeared smaller after release. Conclusions Snare-assisted Amplatzer ASD device placement is a new method for ASD percutaneous closure and adds safety to the procedure. © 2016 Wiley Periodicals, Inc.

A 6-month-old, 17 kg, male Labrador Retriever was presented for an evaluation of a suspected patent ductus arteriosus (PDA). Transthoracic echocardiography confirmed a left-to-right shunting PDA with a minimal ductal diameter of 3.5 mm. A transcatheter PDA occlusion was performed, and a 16 mm Amplatzer Vascular Plug II was selected for the procedure. Within 13 days of discharge, the dog developed sudden lethargy, tachypnea, and coughing after physical activity. Thoracic radiographs showed the Amplatzer device to be abnormally positioned in the lumen of the pulmonary artery with a distinct alveolar pattern. Given the progressive cardiopulmonary distress of the dog, the owners opted for euthanasia. In the present case study, the authors have not been able to satisfactorily explain why the device migrated several days after the procedure. In order to avoid device migration, greater emphasis should be placed on strict activity restriction in dogs after percutaneous PDA occlusion.

We report this case, which described the echocardiographic and chest X-ray appearance of the amplatzer device. The echo images raised suspicion of a mass in the left atrium, but a simple X-ray showed that the mass is an amplatzer device for left atrial appendage closure.

A 73-year-old patient was referred to our clinic after diagnosis of a left atrial structure attached to a displaced Amplatzer device. Initially, the patient presented himself in the emergency ward complaining about dizziness and chest pain. Because of elevated troponin values, a coronary angiography was performed which showed normal coronary arteries, but an uncommon, almost horizontal position of an Amplatzer device. The indication for implantation has been a patent foramen ovale with recurrent thromboembolic events in 2013. Transthoracic echocardiography confirmed the displacement of the Amplatzer device. More specifically, the device was still in the interatrial septum but rotated toward the …

In this issue of Circulation: Cardiovascular Interventions , a Polish institution carefully analyzed ≈100 patients undergoing left atrial appendage (LAA) occlusion with serial transesophageal echocardiographies or computer tomographies at 1.5 (early), 3 to 6 (late), and 12 (very late) months with particular focus on device-related thrombus (DRT) and peridevice leak (PDL).1 The patients were treated without oral anticoagulation but with dual antiplatelet therapy for 1 to 6 months at the discretion of the operators. DRT was diagnosed in 7%. The distribution of DRTs to the 3 control intervals was quite even: 2% early, 2% late, and 3% very late. Of these 7 DRTs, 4 resolved by adding low–molecular weight heparin to the antiplatelet treatment and 3 persisted in spite of treatment adjustment. One of the patients with DRT had a stroke which was fatal. None of the patients without DRT had an embolic event during the 1-year follow-up. See Article by Pracon et al The 2 most common devices, the Amplatzer and the Watchman occluders, were used for about half of the cases each. Deep implantation was found to be the most significant predictor for DRT. The distance of the most proximal part of the device to the tip of the pulmonary ridge, the structure separating the LAA from the left upper pulmonary vein, was used for the definition of deep implantation. For the Amplatzer device, a 2-component structure consisting of an anchoring lobe and a covering disc according to the pacifier principle2 any position not covering the peak …

Introduction: A case of difficult RV lead placement of single chamber ICD with (ASD) Amplatzer septal occluder device delivery system. Implantation of pacemaker leads can be challenging sometimes. Various non-conventional tools have been used in such difficult cases. Case report: We report a case of single chamber ICD implantation in a patient with severe LV dysfunction as primary prevention strategy where RV lead placement was done with the use of 80 cm 10 F delivery system of ASD septal occluder amplatzer device. Conclusion: Innovative lead placement strategies with the use of appropriately selected tools is helpful in facilitating difficult cases.

ResumoCom o uso crescente do dispositivo Amplatzer® para diversos procedimentos endovasculares, dentre os quais a comunicação interatrial, complicações decorrentes de seu uso vêm sendo descritas. Relatamos um caso em que o dispositivo foi empregado para correção de comunicação interatrial e, seis meses depois, migrou para a bifurcação da aorta abdominal. A retirada do corpo estranho foi realizada por cirurgia convencional, após insucesso de tentativa por via endovascular.

Background Trans-catheter closure of atrial septal defects (ASD) with the Amplatzer Septal Occluder (ASO) device is safe and effective, but concern over erosions has increased. Devices are placed in growing children but septal growth after ASOs is ill-defined. Understanding the device relationship to cardiac structures as a child grows may help us understand erosions. Objective: To define (1) how preprocedural septal measurements change after ASO and (2) the effect of somatic growth on these dimensions. Methods: Data were collected retrospectively. Echocardiograms were reviewed and rims measured prior to ASO, immediately after ASO, and at follow-up. Demographic, procedural and device data were collected. Results: Thirty-three patients were enrolled; mean age 5.2 ± 3.2 years with 4.0 ± 2.2 years follow-up. All septal measurements decreased after ASO. Thirty-one of 33 devices (94%) contacted the aortic root after ASO; all remained in contact at follow-up with only the IVC rim growing significantly over time. Change in BSA predicted an asymmetric septal growth with increases in superior (P = 0.01) and IVC (P = 0.005) rims and no increase in aortic or AVV rims. No episodes of erosion occurred. Conclusions: ASDs in young children are not central in the septum, but proximate to the aorta. After ASO, the device remains in close proximity to the aorta. With somatic growth, the septum grows asymmetrically, and device position relative to the aorta is constant. Our study was not powered to detect rare serious adverse events such as erosion, but aortic rims were consistently zero and yet no events occurred. © 2015 Wiley Periodicals, Inc.

第80回東京女子医科大学学会総会シンポジウム「東京女子医大 小児医療の最前線！－“なおらない”から“なおる”へ－」 Part1 平成26年9月27日(土) 東京女子医科大学 弥生記念講堂

Closure of patent ductus arteriosus (PDA) with device or coil is presently the first line of therapy.but it has got different acute and late complications. A 3 years old male child presented with history of percutaneous closure of the PDA Amplatzer device 18 months back. Now he presented with dislodgement of the device to descending thoracic aorta and reappearance of a large PDA. The child underwent surgical closure of PDA and removal of the device from descending thoracic aorta. We are presenting this case as one of the uncommon late complications of device closure of PDA.Cardiovasc. j. 2016; 8(2): 158-160

We present two cases of congenital intrahepatic portosystemic shunts in which the right portal vein directly communicated with the inferior venacava (IVC) in one patient and with the hepatic vein in the other. Multiple hepatic nodules consistent with focal nodular hyperplasia (FNH) were seen in the first patient. The second patient presented with recurrent history of hepatic encephalopathy. Percutaneous transhepatic embolization was performed using coils and Amplatz device following which she completely recovered.

Traumatic ventricular septal defect (VSD) resulting from chest trauma, either penetrating or blunt, is a relatively rare occurrence. Herein, we describe the case of a previously healthy 26-year-old man who presented with congestive heart failure, which was secondary to a large traumatic VSD following violent blunt chest trauma. The traumatic VSD was initially closed percutaneously using an Amplatzer atrial septal defect occluder. Post-device closure, however, the patient developed severe intravascular hemolysis refractory to medical treatment. The patient subsequently underwent surgical removal of the Amplatzer device, with concomitant VSD patch closure.

The Amplatzer family of vascular devices has been used off-label for the treatment of complex gastrointestinal and airway fistulas. We report a case in which closure of a benign gastrobronchial fistula with the use of an Amplatzer device resulted in massive hemoptysis and death.

Fallot’s trilogy is a relatively uncommon form of cyanotic congenital heart disease characterized by severe valvular pulmonary stenosis (PS), right ventricular hypertrophy and right to left interatrial shunt via an atrial septal defect (ASD) or patent foramen ovale (PFO). Historically, patients with the combination of these lesions were routinely treated by surgical correction. In recent times, transcatheter repair has become an increasingly attractive modality of treating such patients. There is limited experience with such combined transcatheter interventions, and from the scarce data available in published literature it seems that such approach has promising safety and efficacy. Herein, we describe a case of an 18 year old cyanotic male patient who was diagnosed of having severe valvular PS with supra systemic right ventricular pressures and reversed interatrial shunt via a large secundum ASD. We successfully treated him percutaneously with serial balloon pulmonary valvuloplasty, using single balloon and Inoue balloon techniques, followed by Amplatzer device closure of the ASD. The outcome was excellent with marked reduction of trans-pulmonary valvular gradient, complete cessation of shunting across the ASD, dramatic improvement of symptoms and completes disappearance of cyanosis. There were no procedure related complications and the benefits were sustained at follow up of three years. Our case demonstrates that transcatheter repair is a feasible, safe and effective alternative to surgery in selected patients with Fallot’s trilogy. With further experience, it may well become the standard of care in the management of such patients.

El cierre percutaneo de la comunicacion interauricular es una alternativa al tratamiento quirurgico. Objetivos: Comunicar los resultados del cierre percutaneo de la comunicacion interauricular con el dispositivo Amplatzer®. Metodo: Se incluyeron los pacientes sometidos a hemodinamia de septiembre de 1997 a diciembre de 2011. Resultados: Se procedio al cierre del defecto en 721 pacientes y en 85 no se cerro por considerarse no apto anatomicamente. El diametro expandido del defecto fue de 23 ± 6.7 mm (limites, 5-42). Todos los dispositivos se colocaron con exito. En 15 casos (2.1%) se cambio el dispositivo por considerarse inestable y en 6 (0.8%) se presento embolizacion en las primeras 24 h, 4 fueron rescatados y recolocados (exito final con intencion de tratamiento 719/806-89.2%). El control inmediato mostro oclusion completa en 247 pacientes (34.3%), fuga intradispositivo en 395 (54.9%), ligera en 75 (10.4%) y moderada en 2 (0.3%). Se hace seguimiento en 626 pacientes (87.1%) durante 33 ± 27.5 meses, presentandose cefalea en 54 (8.6%), arritmias supraventriculares nuevas en 10 (1.6%), complicaciones en el sitio de puncion en 4 (0.6%) y accidente vascular cerebral en uno (0.1%). Conclusion: El diseno del dispositivo Amplatzer® permite el cierre de la comunicacion interauricular con una tecnica sencilla y con seguridad para el paciente

Hepatic encephalopathy is a frequent complication of cirrhosis, when this event becomes persistent, treatment compliance should be verified and any precipitating factor need to be identified. Also the presence of portosystemic shunts, which are a rare cause of decompensation or persistence hepatic encephalopathy need to be ruled out. In this paper we report the case of a 57 year old man with persistent hepatic encephalopathy secondary to the presence of a porto-onfalo-femoral shunt successfully closed with the placement of an Amplatzer device.

Persistent left superior vena cava (PLSVC) with an absent right superior vena cava (RSVC) is an extremely rare congenital anomalie in normal atrial situs. Isolated cases are diagnosed incidentally during catheterization. In patients with PLSVC, due to frequent drainage of upper extremity, head and neck veins into coronary sinus, patients with enlarged coronary sinus should be suspected to have absence of the RVCS. In this report, we presented a 7-year-old girl who was diagnosed perimembranous VSD (ventricular septal defect), apparently enlarged coronary sinus, PLSVC with transthoracic echocardiography, and incidentally was recognized absence of RSVC during percutaneouse VSD closure. Consequently, we wanted to draw attention to echocardiographic and angiocardiographic findings of this rare venous anomaly., Persistan sol vena kava süperiyor ile birlikte sağ vena kava süperiyorun olmaması, normai atriyal situs varlığında son derece nadir bir doğumsal anomalidir. İzole vakalar, kateterizasyon sırasında tesadüfen saptanır. Baş, boyun ve üst extremitenin venöz drenajı sol persistan vena kava aracılığıyla sıklıkla koroner sinüse olduğundan dolayı, genişlemiş koroner sinüsü olan hastalarda vena kava superiyor yokluğundan şüphelenilmelidir. Bu yazıda, transtorasik ekokardiyografiyle VSD, belirgin geniş koroner sinus ve sol persistan vena kava süperiyor tanısı konan ve transkateter kapama sırasında tesadüfen sağ vena kava superiyorunun olmadığı saptanan 7 yaşında kız hasta sunuldu. Böylece, bu nadir venöz anomalinin ekokardiyografik ve anjiyokardiyografik bulgularına dikkat çekilmek istendi.

Persistent left superior vena cava (PLSVC) with an absent right superior vena cava (RSVC) is an extremely rare congenital anomalie in normal atrial situs. Isolated cases are diagnosed incidentally during catheterization. In patients with PLSVC, due to frequent drainage of upper extremity, head and neck veins into coronary sinus, patients with enlarged coronary sinus should be suspected to have absence of the RVCS. In this report, we presented a 7-year-old girl who was diagnosed perimembranous VSD (ventricular septal defect), apparently enlarged coronary sinus, PLSVC with transthoracic echocardiography, and incidentally was recognized absence of RSVC during percutaneouse VSD closure. Consequently, we wanted to draw attention to echocardiographic and angiocardiographic findings of this rare venous anomaly.

Transcatheter closure of patent ductus arteriosus with the Amplatzer duct occluder shows excellent results. However, there is a risk of device embolization after deployment. We report the case of a 33-year-old man in whom an embolized Amplatzer device was retrieved from the right pulmonary artery by a percutaneous method. We also review this uncommon severe complication and offer technical tips for percutaneous removal.

Endoscopically superimposed Amplatzer (St. Jude Medical, St. Paul, Minnesota, United States) septal occluder plug was successfully used in the treatment of septic right main bronchus fistula having developed after extrapleural pneumonectomy and heated chemotherapy in two patients with malignant pleural mesothelioma. In the first case the method was curative and in the other Amplatzer served as temporary bridging allowing rehabilitation from empyema and sepsis. After 4.5 and 4.2 years both patients are alive with no sign of relapse of mesothelioma or infection.

Ventricular septal rupture is a rare complication of acute myocardial infarction with important hemodynamic consequences. Without a rapid diagnosis and correction by surgical intervention, the short-term mortality of these patients is higher than 90%. Early diagnosis is based on clinical examination and transthoracic echocardiography. Transcatheter closure of ventricular septal rupture in selected patients may save lives. We report a patient with ventricular septal rupture in acute myocardial infarction that was closed by an Amplatzer device. DOI: http://dx.doi.org/10.3329/cardio.v7i2.22264 Cardiovasc. j. 2015; 7(2): 150-152

Bronchopleural fistulas can occur as a rare but severe complication after pulmonary resection. Established guidelines for the proper treatment of patients with bronchopleural fistulas do not exist. Apart from attempts to close the fistula, emphasis is placed on preventive measures, early treatment with antibiotics, drainage of the empyema and aggressive nutritional and rehabilitative support. For inoperable patients, endoscopic procedures are the only therapeutic option. Unfortunately, large (>8 mm) or central bronchopleural fistulas are usually not suitable for such endoscopic management. Recently, some groups have published a few case reports about a novel technique for the endobronchial closure of bronchopleural fistulas, using an Amplatzer device, originally designed for transcatheter closure of cardiac septal defects. We applied the same technique as a life-saving treatment in a ventilated patient who was considered inoperable due to a high oxygen need. The operation was successful. The patient could be weaned from ventilation and was eventually discharged from the hospital to a rehabilitation facility several weeks after the insertion of the device. Until now, endoscopic techniques have only been useful for the treatment of small, peripheral, bronchopleural fistulas and even then only as a bridge to surgery in high-risk surgical patients. In this case report, we demonstrate that the use of an Amplatzer device can expand the importance of endoscopic techniques in the treatment of bronchopleural fistulas. An Amplatzer device, for endobronchial closure, can indeed be administered for large and central bronchopleural fistulas. Moreover, it can be considered as a definite alternative to surgery in inoperable patients.

While percutaneous intervention is an alternative for patients who are not surgical candidates, the rate of morbidity and mortality is comparable to open repair. Appending the reported complications associated with percutaneous intervention (device mal-positioning, dislodgement, and entrapment in the sub-valvular apparatus), we report mechanical damage to the tricuspid valve (TV). Percutaneous closure with an Amplatzer septal occluder device was attempted on three patients who developed a ventricular septal defects (VSD) after myocardial infarction. In all three cases, damage to the tricuspid leaflet was noted post-procedure. The accompanying severe tricuspid regurgitation led to right ventricular failure, even in the patients where the VSD was considered successfully occluded. Despite successful deployment of the Amplatzer device, complications with catheter manipulation may still arise. Damage to the TV can occur during percutaneous VSD closure with Amplatzer device. Periprocedure TEE monitoring can detect damage to the tricuspid leaflets. © 2013 Wiley Periodicals, Inc.