Long-term transesophageal echocardiography after patent foramen ovale closure by BioSTAR and Amplatzer patent foramen ovale occluders.
- 作者列表："Suligoj NC","Rojko M","Suligoj B","Zorc M","Kar S","Noc M
OBJECTIVES:To compare transesophageal echocardiography (TOE) findings after patent foramen ovale (PFO) closure by BioSTAR (NMT Medical Inc, Boston, MA) and Amplatzer PFO occluders (Abbott Vascular, Plymouth, MN). BACKGROUND:PFO closure with a biodegradable device represents an attractive alternative to permanent devices. Long-term effectiveness and morphology after biodegradation remain unknown. METHODS:Between February 2008 and June 2014, 49 patients received BioSTAR and 48 Amplatzer PFO occluder. TOE was performed after closure, at 6 months and beyond 2 years. RESULTS:PFO features were comparable between the groups. Immediate effective closure (<5 bubbles on Valsalva) was obtained in 96% by BioSTAR and 88% by Amplatzer PFO occluder (p = .16). Except for transient fever after BioSTAR (10.8 vs. 0%; p = .08), there was no adverse events. TOE at 6 months revealed comparable effective closure (93 vs. 89%; p = .74), all devices in correct position and no thrombus/pericardial effusion. In the BioSTAR group, a peri-device left-to-right color Doppler shunt was documented in one patient (2.2%), protrusion of the nitinol framework strut(s) into the atrial cavity in two patients (4.3%), and both events in one patient (2.2%). TOE beyond 2 years showed comparable effective closure (92 vs. 96%; p = 1.00) and again BioSTAR-associated peri-device left-to-right shunt and metal framework strut(s) protrusion. There was no stroke or peripheral embolization in either group while TIA was numerically greater in BioSTAR patients (6.8 vs. 2.5%; p = .61). CONCLUSION:BioSTAR provided similar PFO closure rate as Amplatzer PFO occluder. As yet unreported BioSTAR-associated peri-device left-to-right shunt and metal framework strut(s) protrusion may have practical implications for further development of biodegradable devices.
目的: 比较BioSTAR (NMT Medical Inc，波士顿，MA) 和Amplatzer PFO封堵器 (Abbott Vascular，Plymouth，MN) 在卵圆孔未闭 (PFO) 封堵术后的经食管超声心动图 (TOE) 表现。 背景: 使用可生物降解装置的PFO封闭是永久性装置的一种有吸引力的替代方法。生物降解后的长期有效性和形态仍然未知。 方法: 2008年2月至2014年6月，49例患者接受BioSTAR和48例Amplatzer PFO封堵器。在闭合后，在6个月及2年以上进行脚趾。 结果: PFO特征在各组之间具有可比性。BioSTAR和Amplatzer PFO封堵器分别获得96% 和88% 的即时有效封闭 (Valsalva上的 <5个气泡) (p = .16)。除了BioSTAR术后的一过性发热 (10.8对0%; p = .08)，没有不良事件。6个月时的脚趾显示出相当的有效闭合 (93对89%; p = .74)，所有装置都处于正确位置并且没有血栓/心包积液。在BioSTAR组中，1例患者 (2.2%) 记录了围设备左向右彩色多普勒分流，2例患者 (4.3%) 记录了镍钛合金框架支柱突出到心房腔，1例患者 (2.2%) 记录了两种事件。超过2年的脚趾显示出相当的有效闭合 (92对96%; p = 1.00)，并再次显示BioSTAR相关的装置周围左向右分流和金属框架支柱突出。两组均无卒中或外周栓塞，而BioSTAR患者的TIA在数字上更大 (6.8对2.5%; p = .61)。 结论: BioSTAR提供了与Amplatzer PFO封堵器相似的PFO闭合率。迄今为止，未报道的与生物星相关的周边装置左向右分流和金属框架支柱突出可能对生物可降解装置的进一步开发具有实际意义。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.