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Transcatheter closure has become the method of choice for treatment of many heart defects. Recently, Lifetech Scientific introduced the Cera occluder (CO), a self-expandable nitinol wire-mesh device covered with ceramic coating. We present our preliminary experience in transcatheter closure of atrial septal defect (ASD), patent foramen ovale (PFO), patent ductus arteriosus (PDA), and post-infarction ventricular septal defect (PIVSD) with the CO.The study population consisted of 25 patients (17 female) ages 1.1-82 years (median age, 34.0 years) with either ASD (n = 7), PFO (n = 11), PDA (n = 6), or PIVSD (n = 1). All patients were treated percutaneously with appropriate CO devices, without any preliminary patient selection. The implantation technique applied in these procedures was the same as previously described for Amplatzer occluders.All procedures were performed successfully. Complete shunt closure was achieved in all but 1 patient with PIVSD. No complications were observed during procedures or during follow-up of 0.5-4 months.Our preliminary experience in the clinical application of COs for transcatheter closure of ASD, PFO, PDA, and PIVSD has confirmed their utility, feasibility, and safety, at least in the short-term follow-up.

The E xtreme UV I maging D etector EUVID consists of a compact “micro-channel-plate-wedge-and-strip anode” imaging system and corresponding data read-out electronics with 32 MB of memory. EUVID is suited for imaging in the wavelength range 20 ≤ λ ≤ 1200 A . The performance of this space-qualified, 2.5 kg detector system was measured in the FUV. We obtained a spatial resolution of about 70 μm over the full detector area of ∼ 7 cm2. Image distortions are small and can easily be corrected for. Detector efficiency depends on the choice of photocathode and ranges between 50% in the FUV up to 90% in the EUV.

Rupture of the interventricular septum is an uncommon and often fatal complication of myocardial infarction. Herein, we report the successful deployment of the Amplatzer® Multi-Fenestrated Septal Occluder–“Cribriform” (AGA Medical Corporation; Plymouth, Minn) during 2 procedures to close multiple postinfarction ventricular septal defects in a severely ill patient. We show that, in selected patients who have multi-fenestrated multiple postinfarction ventricular septal defects, transcatheter implantation of the Amplatzer Cribriform Occluder can be a good therapeutic option.

The VUV (30–1200A) detector described consists of a compact ‘Micro-Channel-Plate-Wedge-and-Strip anode’ imaging system and of the corresponding data read-out electronics with 32 Mbyte of memory. The performance of this space qualified detector system was measured in the FUV. We obtained a spatial resolution of about 70 μm over the full detector area of ∼7 cm 2 . Image distortions are small and can easily be corrected for. Detector efficiency depends on the choice of photo-cathode and ranges between 50% in the FUV up to 90% in the EUV.

Venous access through the superior caval vein is mandatory to study the pulmonary arteries in patients with a Glenn anastomosis. In complex congenital heart disease, repeat catheterizations may lead to iliac vein thrombosis and superior access is needed. In order to avoid the internal jugular venous puncture, we have used puncture of the antecubital vein as an elective access.Brachial puncture was attempted in 37 patients. Mean age: 10 years (3.1-33.5). 2.45 heart surgeries and 3.6 cardiac catheterizations per patient had been previously performed in this group. 40% of patients had bilateral iliac vein thrombosis.Axillary vein external compression, venous puncture and introduction of 4-6 F sheath.Venous access through brachial vein was achieved in 34 of 37 pts (91.8%). Diagnostic catheterization was done in all, balloon test occlusion of the pulmonary valve in 3 and pulmonary artery branch dilation in 6 pts.2 late thrombosis of the right brachial vein (6%).Antecubital venous puncture is an alternative and useful technique that allows easy catheterization of superior caval vein, pulmonary artery and right heart chambers. It is associated with minor complication rate, avoiding internal jugular vein puncture. Certain therapeutic procedures can be performed through such route.

Percutaneous closure of atrial septal defects (ASD) is becoming more frequent.From October 1997 to October 2002, 209 patients, age 0.4-70 (mean 19.5) years, were catheterized to close an ASD or patent foramen ovale (PFO). Transesophageal echocardiography was performed simultaneously in all patients. Two hundred and six patients had ASD (25 multiple ASDs) and 3 had PFO. Three devices were used, the Amplatzer Atrial Septal Occluder (ASO), CardioSeal (CS), and Starflex (SF).Device implantation was achieved in 181 patients (87%) but had to be abandoned in 28 patients, generally because the ASD was too large. One hundred and seventy-four ASOs were implanted in 172 patients with ASD (2 ASOs were implanted in 2 patients with double ASD) and CS/SF in 9 patients (3 patients with PFO and 6 with ASD). The procedure was effective in 166/172 (96%) ASO implantations and in 8/9 (89%) CS/SF implantations. The procedure was unsuccessful in 7 patients and the device had to be removed (6 ASO and 1 SF). The occlusion rate with ASO was 88% after 24 hours, 91% after 1 month, 95% after 1 year, 97% after 2 years, and 100% after 4 and 5 years. All defects treated with SF/CS were closed successfully after 24 hours. In one case the ASO device was embolized to the aorta. In the first month after ASO implantation, supraventricular tachycardia appeared in 2 patients and transient left ventricular failure in 2 patients. No late complications were observed.Percutaneous catheter closure of selected types of ASD using the Amplatzer Atrial Septal Occluder, CardioSeal, or Starflex should be offered to patients as non-surgical alternative. The type of device used depends on the defect size and morphology as well as the surgeon's experience. The presence of multiple defects does not exclude the possibility of a successful percutaneous catheter closure.

RHESSI uses nine Rotating Modulation Collimators (RMCs) for imaging, each consisting of a pair of grids mounted on the rotating spacecraft. The angular resolutions range from 2.3 arcsec to 3arcmin. The relative twist between the two grids of each pair is the most critical parameter. It must be less than 20 arcsec for the finest grid. After precision alignment, it is monitored by the Twist Monitoring System (TMS) to a few arcsec. The Sun-pointing must be known better than 0.4 arcsec for the image reconstruction. This is achieved by the Solar Aspect System (SAS), which consists of a set of three Sun sensors. Each sensor is focusing the filtered Sun light onto a linear CCD. The onboard Aspect Data Processor (ADP) selects the 6 limb positions, which over-define the pointing offset of the Sun center in respect to the imaging axis of the imager. The Roll Angle System (RAS) continuously measures the roll angle of RHESSI within arcmin accuracy. The RAS is a continuously operating CCD star scanner. The time of the passage of a star image over the CCD is recorded and defines the roll angle, comparing its pixel position and amplitude with a star map.

A 13-year-old girl with middle aortic syndrome caused by Takayasu's disease was treated by balloon angioplasty of the right renal artery stenosis and the implantation of 3 stents, 2 in the stenosed thoracic segment and 1 in the abdominal segment of the aorta. Spiral computed tomography one and two years after the stents were inserted showed that the disease had progressed despite treatment with immunosuppressants.

The purpose of the HESSI RAS is to provide information on the roll angle of the rotation spacecraft. Precise knowledge of the roll angle is a necessary ingredient for image reconstruction. The RAS is a continuously operating star scanner that points out radially and observes stars at 75 degrees from the Sun direction using a commercial lens and a fast CCD. The passage of a star image over the CCD charges one or several pixels above threshold and the timing of this signal defines the roll angle, once the star has been identified by comparing its pixel position and amplitude with a star map. Roll angles at intermediate times are inferred by assuming uniform rotation. With a limiting star magnitude of mv equals 3 we expect to observe at least 1 star per revolution over 1 year; on the average we will detect about 10 stars/revolution.© (1999) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

The HESSI SAS is a set of three Sun sensors, which shall provide high bandwidth information on the solar pointing of the rotating spacecraft. The precision of

We report the case of a 13-year-old girl with a diffusely hypoplastic right aortic arch, anomalous origin of the left subclavian artery, and a small, insignificant ventricular septal defect. The patient's pulse was forceful at the carotid arteries, but it was markedly weaker at all extremities. Catheterization revealed that both common carotid arteries arose from the dilated ascending aorta; the right subclavian and vertebral arteries arose from the hypoplastic posterior segment of the aortic arch, and the left subclavian artery arose from the normally developed descending aorta. The pressure gradient between the ascending and descending aorta was 80 mmHg. A bypass grafting procedure was performed to connect the ascending and the upper abdominal aorta. No pressure gradient remained after the operation, nor was a gradient detected during 2 years of follow-up. The origin of both subclavian arteries distal to the area of coarctation resulted in an atypical clinical picture and delayed diagnosis. Ten previously reported cases of coarctation of the aorta with right aortic arch are reviewed.

Patients with complex congenital cardiac malformations who have been converted to the Fontan circulation with partial exclusion of the hepatic veins may develop progressive cyanosis because of formation of intrahepatic veno-venous malformations. We describe transcatheter closure of a major intrahepatic fistula in such a setting using an Amplatzer septal occluder delivered by the left jugular venous approach in a 5 year old boy.

Transcatheter closure of patent ductus arteriosus is routinely performed using various devices. After the withdrawal of the Rashkind umbrella device from the market, the wide window-type patent ductus arteriosus has been difficult to close percutaneously. Two patients with this condition are presented: a 17-year-old man and a 62-year-old woman with short (4.5- and 5.2-mm-diameter, respectively) ductus. We successfully implanted a 17-mm CardioSEAL® device in the 1st patient and a 23-mm STARFle® in the 2nd, with no residual shunt at follow-up (22 and 8 months, respectively). Although these devices (which follow the general design of the Rashkind umbrella) are usually applied to atrial septal defect closure, we believe that CardioSEAL and STARFlex implants could be the treatment of choice in percutaneous treatment of window-type patent ductus arteriosus. (Tex Heart Inst J 2003;30:236–9)