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A 79-year-old man with stable chronic obstructive pulmonary disease was found to have an abdominal aortic aneurysm and worsening dyspnoea. Echocardiography demonstrated critical aortic stenosis. Simultaneous endovascular aneurysm repair (EVAR) and transcatheter aortic valve replacement (TAVR) was recommended due to high surgical risk. Procedural strategy was to perform balloon valvuloplasty (BAV), followed by EVAR then TAVR. The initial 25 mm Lotus valve adopted a barrel shape suggestive of an undersized valve and was thus replaced with a 27 mm valve. Post procedural echo revealed no regurgitation. We report here for the first time a successful simultaneous TAVR/EVAR using the fully retrievable Lotus Valve.Copyright © 2016, Japanese Association of Cardiovascular Intervention and Therapeutics.

Introduction: Reduced blood flow into the fetal left ventricle (LV) may underlie development of Hypoplastic Left Heart Syndrome (HLHS), for which palliative surgery is the only treatment option. Currently there is no HLHS model in a large fetal mammalian animal for testing and clinical translation of new therapy. We have recently published a percutaneous trans-hepatic technique to catheterise the fetal heart, which could be utilised to produce an animal model of HLHS. Using a percutaneous trans-hepatic technique to deliver an occluder into the fetal heart, we aimed to create a fetal lamb model of HLHS by occluding the foramen ovale (FO). Method(s): Three fetal lambs (110-117days, term=147days) under maternal general anaesthesia were used. Under ultrasound guidance, the fetal hepatic vein was percutaneously punctured through the maternal abdomen using a 14GA IV-cannula. A coronary catheter and guidewire were inserted and advanced into the fetal IVC and right atrium. An Amplatzer Duct Occluder II (ADO II 4x4 mm, St Jude Medical) was delivered to occlude the fetal FO. In 2 fetuses, a self-expandable stent (8x12mm Superflex-DS 4Fr deliverable stent, Opti-Med Inc. Germany) was positioned across the FO first, and the ADO II was anchored within the stent. Serial ultrasounds were performed to monitor cardiac development. Euthanasia and post-mortem examination was performed 3 weeks after. A twin fetus which did not undergo the procedure was used as control for comparison. Morphometric measurements were made on digital images (Image J1.48b, NIH) of transverse sections of the heart at the level of atrioventricular valves. Result(s): All 3 fetal lambs survived well to 3 weeks without any fetal compromise. At post-mortem examination, the LV lumen was markedly reduced (Fig 1a) with lower LV/right ventricular (RV) chamber volume ratio, LV/RV lumen area ratio and increased septal thickness at level of atrioventricular valves (Table), compared with the control fetal heart (Fig 1b).

Alterations in aneurysm size and mass effect can result in alleviation or aggravation of symptoms. We assessed the effects of flow diversion with SILK stents on aneurysm sac size and associated factors. A retrospective evaluation of 14 aneurysms treated with SILK stents alone with MRI follow-up was performed. Aneurysm sac size was measured using the sequence best demonstrating the sac. Aneurysm characteristics and flow-related enhancement on time of flight images were documented. Clinical histories were reviewed for evolution of symptoms. Complete collapse of the aneurysm sac was demonstrated at three and 18 months in 2/14 aneurysms. Increase in size was observed in 2/14 aneurysms with associated persistent flow on time of flight MRA. Blister formation with aggravation of symptoms was observed in one aneurysm, and subsequent decrease in size occurred after treatment with a second SILK. The other aneurysm which increased in size initially continued to enlarge asymptomatically despite retreatment with a second SILK, however at 24 months thrombosis of the sac and decrease in size was observed. The remaining 10/14 aneurysms decreased in size. Nine had corresponding MRA occlusion and the tenth demonstrated decreased but persistent flow on the time of flight MRA. No aneurysm with MRA occlusion increased in size. Decrease in sac size was associated with MRA occlusion in our study. Persistence of flow and blistering were associated with increased sac size. As previously demonstrated flow diversion may be effective in the treatment of large aneurysms presenting with mass effect, however rates of sac obliteration in this small series were not as high as previously reported.Copyright © The Author(s) 2015.

Background: Reduced blood flow into the fetal left ventricle (LV) may underlie development of Hypoplastic Left Heart Syndrome (HLHS). Currently there is no animal model of HLHS for testing new therapy. We recently published a percutaneous trans-hepatic technique for catheterising the fetal heart under ultrasound guidance. We aimed to create a lamb model of HLHS, by percutaneous catheterisation and occlusion of the fetal foramen ovale (FO). Method(s): In three fetal lambs (110-117 days, term = 147 days) under maternal anaesthesia, the fetal hepatic vein was percutaneously punctured through the maternal abdomen under ultrasound guidance using a 14GA IV-cannula. A coronary catheter was advanced into the fetal IVC and right atrium. A self-expandable stent (8 x 12 mm Superflex-DS stent, Opti-Med Inc.) was positioned across the FO, followed by an Amplatzer Duct Occluder II (4 x 4 mm, St Jude Medical) being anchored within the stent to occlude the FO. Serial ultrasounds were performed to monitor cardiac development. Post-mortem examination was performed 3 weeks after. Morphometric measurements were made at the level of atrioventricular valves and compared with 6 controls. Result(s): All 3 fetal lambs survived well to 3 weeks post procedure. The LV lumens were markedly reduced, with lower LV/right ventricular (RV) chamber volume ratio (0.2-0.6) and LV/RV lumen area ratio (0.8-1.0) compared with the control fetal heart (1.0 and 1.5 respectively). Conclusion(s): Occlusion of the fetal FO using percutaneous catheterisation leads to phenotype simulating HLHS. Our results demonstrate the potential to develop the world's first large animal model of HLHS, critical for understanding the disease and devising new therapies.

Introduction: Reduced blood flow into the fetal left ventricle (LV) may lead to development of Hypoplastic Left Heart Syndrome (HLHS), for which palliative surgery is the only treatment option. Currently there is no large fetal animal model of HLHS for testing and clinical translation of new therapies. We have recently published a percutaneous transhepatic technique of cardiac catheterisation in a fetal lamb model, which could be utilised to produce an animal model of HLHS. Objective(s): To use a percutaneous transhepatic catheter technique to deliver an occluder into the foramen ovale (FO) of the fetal heart, with the aim of creating a fetal lamb model of HLHS. Method(s): Three fetal lambs (110-117days, term=147days) under maternal general anaesthesia were used. Under ultrasound guidance, the fetal hepatic vein was percutaneously punctured through the maternal abdomen using a 14GA IV-cannula. A coronary catheter and guidewire were inserted and advanced into the fetal IVC and right atrium. An Amplatzer Duct Occluder II (4x4mm, St Jude Medical) was delivered to occlude the fetal FO. In 2 fetuses, a self-expandable stent (8x12 mm Superflex-DS, 4Fr deliverable stent, OptiMed Inc., Germany) was positioned across theFO first, and theADOII was anchored within the stent. Serial ultrasounds were performed to monitor cardiac development. Euthanasia and postmortem examination was performed after 3 weeks. A twin fetus, which did not undergo the procedure, was used as control. Morphometric measurements were made on digital images (Image J1.48b, NIH) of transverse sections of the heart at the level of the atrioventricular valves. Result(s): All fetal lambs survived, without evidence of compromise, until the planned euthanasia. At postmortem examination, the LV lumen was markedly reduced (Fig 1a) with lower LV/right ventricular (RV) chamber volume ratio and LV/RV lumen area ratio, as well as increased septal thickness at the level of the atrioventricular valves (Table 1), in comp

Background. Self-expandable metal stents (SEMs) are increasingly being utilised instead of invasive surgery for the palliation of patients with malignant gastroduodenal outlet obstruction. Aim. To review two tertiary centres' experience with placement of SEMs and clinical outcomes. Methods. Retrospective analysis of prospectively collected data over 12 years. Results. Ninety-four patients (mean age, 68; range 28-93 years) underwent enteral stenting during this period. The primary tumour was gastric adenocarcinoma in 27 (29%) patients, pancreatic adenocarcinoma in 45 (48%), primary duodenal adenocarcinoma in 8 (9%), and cholangiocarcinoma and other metastatic cancers in 14 (16%). A stent was successfully deployed in 95% of cases. There was an improvement in gastric outlet obstruction score (GOOS) in 84 (90%) of patients with the ability to tolerate an enteral diet. Median survival was 4.25 months (range 0-49) without any significant differences between types of primary malignancy. Mean hospital stay was 3 days (range 1-20). Reintervention rate for stent related complications was 5%. Conclusion. The successful deployment of enteral stents achieves excellent palliation often resulting in the prompt reintroduction of enteral diet and early hospital discharge with minimal complications and reintervention. © 2013 Nik S. Ding et al.