Closure of residual leakage after the use of hybrid umbrella in umbrella technique: A case report.
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ABSTRACT:
SUBMITTER: Chen M
PROVIDER: S-EPMC7222629 | biostudies-literature | 2020 Feb
REPOSITORIES: biostudies-literature
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Closure of residual leakage after the use of hybrid umbrella in umbrella technique: A case report.
Chen Mingxian M Tang Jianjun J Fang Zhenfei Z Shen Xiangqian X Zhou Shenghua S
Anatolian journal of cardiology 20200201 3
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Project description:Abstract Background Severe residual shunts after percutaneous closure of atrial septal defects are unusual. These patients are usually considered candidates for surgery. Case summary We describe the transjugular closure of a residual atrial septal defect with significant left-to-right shunt due to a malpositioned large atrial septal device in a symptomatic 74-year-old female. Transjugular access was chosen first due to the unfavourable position of the device for delivery of a new one from the femoral approach. An overlapping Figulla® Flex II 27/30 mm PFO device was successfully implanted with the guidance of 3D-transoesophageal echocardiography. Discussion This case demonstrates the safety and feasibility of transjugular access as an alternative to femoral or transhepatic approaches in patients with difficult atrial septal anatomies, who are usually referred for surgery.
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Project description:BackgroundTranscatheter left atrial appendage occlusion (LAAO) using Watchman device has been demonstrated to be efficacious in decreasing stroke risk in patients with atrial fibrillation who are not suitable for long-term anticoagulation. Residual leaks are frequently encountered following LAAO procedures and their clinical implications and optimal management remain controversial.Case summaryIn this report, we describe a case of peri-Watchman device leak treated successfully with percutaneous device closure using an Amplatzer Vascular Plug II device.DiscussionThe clinical implications of peri-device leaks remain controversial with general consensus to continue anticoagulation along with serial imaging for larger leaks (>5 mm). As an alternative strategy, percutaneous closure of these leaks has been attempted in hope of avoiding anticoagulation and minimizing the risk of stroke and should be studied further.
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Project description:Introduction and importance Component separation technique is utilized in adults to repair large abdominal wall defects but rarely used in children. We report a successfully performed component separation technique in a child after neonatal Gross closure for large omphalocele without biologic mesh placement. Case presentation A 6-year-old girl was treated at the age of 4 days for omphalocele type 2 according to Gross technique. She reconsulted six years later. Clinical examination showed a large eventration measuring 150 ∗ 100 mm. CT scan revealed a broad collar of 150 mm and a large pocket containing liver, transverse colon, stomach and part of the small intestine. The child was proposed for a cure of the eventration using synthetic mesh type GORTEX. Intraoperatively, releasing bowel adhesions with abdominal wall resulted in perforation of the small intestine. Faced with the inability to use the mesh we resorted to abdominal closure with component separation technique. The postoperative was simple without complications or recurrence of the eventration. Follow up was of 4 years. Clinical discussion Staged surgical closure and non-operative delayed closure are the two distinct strategies for managing giant omphaloceles. By providing closure with less intra-abdominal pressure, the Component separation technique is a procedure which can be used in the two strategies. It may minimize the complications associated with large omphalocele management. Conclusion Faced with the impossibility of using a mesh, the component separation technique must be recognized as part of the therapeutic arsenal for secondary closure in children with a giant omphalocele. Highlights • We report a case of a secondary closure of large omphalocele using component separation technique in 12 years-old girl.• Our pediatric patient illustrates the safety and feasibility of this technique in children without any complication.• Component separation technique must be recognized in the therapeutic arsenal closure of large abdominal wall defect in children
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Project description:Paravalvular leakage (PVL) is a serious complication of prosthetic valve surgery. Surgical and transcatheter methods can be used for treatment. It is rare for closure devices to detach and free float in cardiac chambers. Transcatheter methods can be reused, but surgical treatment is more appropriate if this reuse is due to an increase in PVL. Here, we present a successfully operated case with a closure device freely passing through the PVL from the ventricle to the atrium, after four surgical valve replacements and two transcatheter device closures, owing to infective endocarditis.
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Project description:IntroductionWe report the case of a 60-year-old female with a history of perforated gastric ulcer, abdominal abscesses, enterocutaneous fistula, and small bowel obstruction requiring durable gastric decompression prior to delayed fistula takedown. The patient had contraindications to or failed attempts at traditional gastrostomy approaches (surgical, endoscopic, interventional radiology).Case reportGastrostomy was successfully performed via a novel technique combining interventional radiology and endoscopic placement.DiscussionIn certain patients with complex presentations, a hybrid approach to gastrostomy tube placement using fluoroscopy and endoscopy may prove a viable alternative when traditional methods are contraindicated or unsuccessful.
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Project description:BackgroundHaemolytic anaemia is a complication of paravalvular leak (PVL). The correlation between the size of the leak and the severity of haemolysis is unclear. Small leaks can cause severe haemolysis, whereas significant leaks may cause no haemolysis.Case summaryWe report the case of a 40-year-old male who underwent mechanical mitral and aortic valve replacement 20 years ago. In the last 3 years, the procedure was repeated three times due to infective endocarditis. He presented with severe shortness of breath. A transoesophageal echocardiogram with three-dimensional surgical view showed that both discs of the mechanical mitral valve opened sufficiently but a severe PVL had occurred at the 9-12 o'clock position. The location of the mitral valve was abnormal, the sewing ring was inserted high at the mid-interatrial septum. The mechanical aortic valve functioned well. Closure of the transcutaneous PVL was accomplished with two percutaneously implanted devices, leaving a small leak in between. After closure, he developed haemolytic anaemia (haemoglobin: 6 g/dL, lactate dehydrogenase: 1896 units/L, reticulocyte count: 4.6%). He then received 16 units of packed red blood cells. He developed acute kidney injury and was started on haemodialysis. We then installed two additional devices to completely close the mild residual leak and another device to resolve the bidirectional transseptal defect. After 2 days, his renal function returned to normal and anaemia improved (haemoglobin: 9.1 g/dL).DiscussionMild residual paravalvular leak can cause severe haemolytic anaemia that is correctable via percutaneous closure of the leak.
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Project description:Coronary artery fistulas (CAFs) are rare congenital heart defects that are typically managed through interventional closure, traditional surgery, or minimally invasive hybrid closure surgery. However, treating CAFs with complex anatomy, such as tortuous vessels, presents a significant challenge, particularly in young children. We report the case of a 3.8-year-old child (15 kg/100 cm) with a complex CAF, treated using a minimally invasive hybrid closure surgery approach with a 4 × 4 mm Amplatzer Duct Occluder II (ADO II) (Abbott, USA). Three-dimensional (3D) imaging was utilized to visualize the CAF's anatomy, guide the surgical planning, and accurately determine the puncture site on the right ventricular free wall, as well as the optimal sheath direction and insertion depth. The procedure was carried out efficiently and safely, guided by preoperative 3D imaging and intraoperative transesophageal echocardiography. Follow-up at one year demonstrated excellent outcomes with no complications.
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Project description:BackgroundEven though the optimal management of a moderate or large residual shunt following patent foramen ovale (PFO) closure is open to question, recent data confirmed that it is associated with an increased risk of stroke recurrence.Case summaryA 48-year-old woman, a migraineur with visual aura, was diagnosed with a PFO associated with a huge multifenestrated atrial septal aneurysm (mfASA) and a moderate right-to-left shunt, detectable only after a Valsalva maneuver on contrast-transthoracic echocardiography. Brain magnetic resonance imaging showed a 1-mm silent white matter lesion in the right frontal lobe. Although the indication was not supported by guidelines, a transcatheter PFO closure was performed at another center with implantation of a large, equally sized, double-disc device (Figulla UNI 33/33 mm). At 6-month follow-up, a 2D/3D transesophageal echocardiography (TEE) color Doppler showed incorrect orientation of the device, which was not parallel to the interatrial septum, with two discs failing to capture the aortic muscular rim and partially protruding in the right atrium; furthermore, a 4 mm × 7 mm ASA fenestration was documented with a residual bidirectional shunt. Thereafter, the same team performed a minimally invasive cardiac surgery under femoro-femoral cardiopulmonary bypass; however, the procedure proved ineffective and was complicated by postoperative pericarditis with pericardial effusion, requiring further rehospitalization 1 month later due to persistent pericarditis, bilateral pleuritis, phrenic nerve palsy, and atrial flutter, which was treated with amiodarone. The patient asked for a second opinion, and our multidisciplinary heart team decided to offer a percutaneous redo intervention. An uneventful implantation of a regular PFO occluder (Figulla Flex II 16/18 mm) across the septal defect was performed successfully. Twelve-month follow-up with 2D TTE color Doppler and contrast transcranial Doppler showed correct position and good interaction between the two devices, with no residual shunt.DiscussionIn addition to the incorrect indication for PFO closure and the failure of minimally invasive surgery, the procedural mishap in this case could have been due to the inappropriate implantation of the first large device within the tunnel. It would have been better to deploy the same large device in the most central fenestration, covering the PFO and a greater part of the remaining mfASA at the same time.
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