Flip-over of blood vessel intima caused by vascular closure device:A case report

BACKGROUND Complications of vascular closure devices mainly include bleeding,vascular injury,and trapped device that cannot be removed percutaneously.However,arterial stenosis or occlusion induced by vascular injury is rare.This article introduces a rare case with severe acute limb ischemia after using the vascular closure device(StarClose).CASE SUMMARY A 54-year-old man was admitted because of necrosis of the second toe of the left foot for 2 mo.Ultrasound showed left femoral artery stenosis,and occlusion of the left popliteal,posterior tibial,peroneal,anterior tibial and dorsalis pedis arteries,suggesting arteriosclerosis obliterans of low extremities,gangrene and type 2 diabetes.He underwent an interventional procedure of drug-eluting balloon in the left lower limb via antegrade puncture of the left common femoral artery.He developed acute limb ischemia after 1 h,and severe pain,numbness,pale skin,low skin temperature and weakened sensation in the left foot.Injury of the common femoral artery intima was considered.Exploratory surgery showed occlusion at the puncture point accompanied with bulged vascular lumen and flipped vascular intima caused by StarClose.The flipped intima was removed.The limb blood supply was restored and the limb was saved post-surgery.He recovered well at final follow-up.CONCLUSION Incorrect use of the vascular closure device was the main cause of severe acute limb ischemia in this case.

Perpulmonary Device Closure of Patent Ductus Arteriosus with Minimum Diameter More Than 4 mm in Infants

Background:Closure of large patent ductus arteriosus(PDA)in older children has been accomplished using surgical and percutaneous techniques with remarkable outcomes.However,outcomes amongst infants have been variable with several drawbacks.Here we describe a novel minimally invasive technique,a product of mini-thoracotomy and traditional percutaneous technique skills,accomplished exclusively under echocardiography guidance.Methods:Symptomatic infants with a significant left-to-right shunt from PDA measuring more than 4 mm were selected.The symptoms were varying degrees of tachypnea,tachycardia,heart failure,failure to thrive,recurrent respiratory tract infections,or intensive care unit treatment for a longer duration.Through a left parasternal mini-thoracotomy,two parallel purse-string sutures were placed on the pulmonary trunk.After purse-string circle puncture,under exclusively transesophageal echocardiography guidance,a device secured to the safety-suture was implanted on the ascending aorta via pulmonary trunk using a specially designed set.The safety-suture prevented device migration in case of dislocation.The basic demographics,PDA size,device size and type,intrapulmonary manipulation time,operation time,PDA parameters(length,diameter,type of duct),redeployment of the device,residual shunt,and retention of safety-suture were all recorded and analyzed.The follow-up was done with transthoracic echocardiography on the 2^(nd)postoperative day,1,3,6,and 12 months,and yearly thereafter.Results:Fifty-two infants with a mean age of 8 months±2.8 months(Interquartile range=0)underwent Perpulmonary device closure of PDA.Successful PDA occlusion was accomplished event-free in all subjects.The mean PDA,mean device,and mean operation time were 5.6 mm±1.4 mm,7.9 mm±1.7 mm,and 61.2 min±12.9 min,respectively.The immediate acceptable residual shunt was noted among 3 subjects and disappeared at a 1-month follow-up.Eighteen infants had retained safety-suture for added safety.There were no reports of the device or procedure-related complications.Conclusion:Perpulmonary device closure is an effective and safe approach to PDA with a diameter measuring>4 mm among infants.The safety-suture,in case of dislocation,prevents migration and associated complications.

The role of echocardiography in mini-invasive surgical device closure of ventricular septal defect

Objective To assess the application of echocardiography in mini-invasive surgical device closure of ventricular septal defect (VSD) . Methods 73 VSD patients including 35 with aneurysm formation and among them 21 with multi-defects in the aneurysm were treated by mini-invasive device closure. A closure device was positioned to the defect through parasternal mini-incision in all patients. TEE was used to monitor the whole procedure。

Percutaneous closure of secundum type atrial septal defects:More than 5-year follow-up

AIM: To investigate long-term efficacy of two different devices more than five years after percutaneous atrial septal defect(ASD) closure in adults.METHODS: All patients who underwent percutaneous closure of an ASD in the St. Antonius Hospital, Nieuwegein, The Netherlands, between February 1998 and December 2006 were included. Percutaneous closure took place under general anaesthesia and transesophageal echocardiographic moni toring. Transthoracic echocardiography(TTE) was performed 24 h post-procedure to visualize the device position and to look for residual shunting using color Doppler. All complications were registered. All patients were invited for an outpatient visit and contrast TTE more than 5-years after closure. Efficacy was based on the presence of a residual right-to-left shunt(RLS), graded as minimal, moderate or severe. The presence of a residual left-to-right shunt(LRS) was diagnosed using color Doppler, and was not graded. Descriptive statistics were used for patients' characteristics. Univariate analysis was used to identify predictors for residual shunting.RESULTS: In total, 104 patients(mean age 45.5 ± 17.1 years) underwent percutaneous ASD closure using an Amplatzer device(ASO) in 76 patients and a Cardioseal/Starflex device(CS/SF) in 28 patients. The mean follow-up was 6.4 ± 3.4 years. Device migration occurred in 4 patients of whom two cases occurred during the index hospitalization(1 ASO, 1 CS/SF). The other 2 cases of device migration occurred during the first 6 mo of follow-up(2 CS/SF). The recurrent thrombo-embolic event rate was similar in both groups: 0.4% per follow-up year. More than 12 mo post-ASD closure and latest follow-up, new-onset supraventricular tachyarrhythmia's occurred in 3.9% and 0% for the ASO and CS/SF group, respectively. The RLS rate at latest follow-up was 17.4%(minimal 10.9%, moderate 2.2%, severe 4.3%) and 45.5%(minimal 27.3%, moderate 18.2%, severe 0%) for the ASO- and CS/SF groups, respectively. There was no residual LRS in both groups.CONCLUSION: Percutaneous ASD closure has good long-term safety and efficacy profiles. The residual RLS rate seems to be high more than 5 years after closure, especially in the CS/SF. Residual LRS was not observed.

Percutaneous closure of congenital Gerbode defect using Nit-Occlud^®LêVSD coil

We present a case report about percutaneous closure of a congenital Gerbode defect using Nit-Occlud~? Lê VSD coil. The patient was referred to our hospital with a diagnosis of ventricular septal defect(VSD) and severe pulmonary arterial hypertension. But transthoracic echocardiography revealed a communication between the left ventricle(LV) and the right atrial(RA), called Gerbode defect. Catheterization confirmed the shunt from the LV to the RA. We successfully closed the defect with a VSD coil. After uneventful 6 mo follow-up, the patient was out of dyspnea, the symptom urged him to have medical attention. This case report is to discuss the diagnosis and percutaneous treatment approach for this rare congenital heart disease.

Modification of Serum Galectin-3 and Reversal of Cardiac Remodeling Following Pediatric Transcatheter Atrial Septal Defect Closure

Objectives:We aimed to evaluate the effect of percutaneous atrial septal defect(ASD)closure in children using right heart indices and serum galectin-3(Gal-3),as potential biomarkers of right heart remodeling.Methods:This case–control prospective study included 40 children with ASD and 25 control subjects.An echocardiographic evaluation was performed before the procedure,as well as 24 h,1 month,and 6 months after intervention.Serum Gal-3 was measured before,and 1 month after the procedure.Results:Serum Gal-3 concentration,right atrial(RA)dimensions,right ventricular(RV)dimensions,indexed RA area,and right index of myocardial performance(RIMP)were significantly increased in children with ASD compared with control subjects while tricuspid annular plane systolic excursion(TAPSE)was significantly decreased.Six months after closure,RA,and RV dimensions significantly decreased and RVfunction improved(RIMP decreased and TAPSE increased).Gal-3 oncentration significantly decreased 1 month after ASD closure,but it did not reach normal range compared with control subjects.A positive correlation between Gal-3 and age at closure,RA area,RV dimensions,and RIMP was observed.A positive correlation was observed between the decrease in Gal-3 concentration and the decrease in RA area and RV dimensions 1 month after ASD closure.A significant negative correlation was observed between TAPSE and Gal-3 concentration before and after intervention.Conclusions:Percutaneous ASD closure can improve right-sided indices and decrease serum Gal-3 concentration.Gal-3 can be used as a sensitive biomarker of right heart remodeling,with a decrease in Gal-3 concentration suggesting reversal of maladaptive remodeling.

The ASD that Wouldn’t Go Away:An Unusual Case of ASD Device Failure in a Patient with Marfan Syndrome

Marfan syndrome patients have connective tissue abnormalities that predispose them to intracardiac defects and postoperative complications.We present a case of late onset ASD device failure secondary to device movement within the atrial septum in a girl with Marfan syndrome.This case study suggests that further studies are necessary to determine the optimal device and approach for ASD repair in this patient cohort.

Immediate and Long-Term Results of Transcatheter Closure of Patent Ductus Arteriosus—Comparison of Two Decades before and after Change in Antibiotic Infective Endocarditis Prophylaxis Guidelines

Objectives:To determine immediate and long-term follow-up of transcatheter closure of patent ductus arteriosus(PDA)in children.Background:National antibiotic prophylaxis(AP)guideline for infective endocarditis changed after 2009,the effect on practice of PDA closure is unknown.Methods:Observational single center study analyzing follow-up of PDA closure comparing two time periods before(2002–2009)and after(2010–2019)changes in AP guideline.Results:332 patients(68.1%female),median(interquartile range)age 3.0 years(1.5–5.7)and body weight 14.0 kg(10.0–19.3),were enrolled.PDA morphology was conical type A(50.3%),window type B(1.2%),tubular type C(40.1%),complex type D(2.1%),elongated type E(0.9%)and other(5.4%).Minimal PDA diameter and length were 1.9 mm(1.3–2.5)and 8.0 mm(6.2–10.2).PDA was closed using coils(56.3%),Amplatzer Duct Occluders(41.9%)and others(1.8%).Complete closure rate was 61.1%at catheter intervention,72.3%on day 1,87.7%after 6 months and 98.4%at last follow-up on echocardiography.Moderate complication rate(severity level 3)was 4.2%and major complication rate(severity level 4)0.3%,with no catastrophic complications(severity level 5).Annual PDA closure rate declined in the second time period(22.6/year vs.15.5/year,p=0.018),PDA size increased(1.6 mm vs.2.0 mm,p=0.002)and proportion of coils decreased(72.4%vs.37.1%,p<0.001).Conclusions:Interventional closure of PDA is associated with excellent closure rates during follow-up(>98%)and only a small number of complications leading to reintervention or surgery.Change in AP guidelines changed indication for and practice of PDA closure.

Flexible Subclavian Artery Closure for an Inadvertent Injury to the Internal Mammary Artery During Internal Jugular Vein Catheterization

Central vein catheter （CVC） placement, which is widely utilized in clinical departments, is also highly important in preoperative preparations for radiofrequency catheter ablation （RFCA）. The internal jugular vein or subclavian vein is the routine target. Arterial injury is not uncommon during the procedure but is potentially devastating in spite of the safety and advantages of the Seldinger technique. Compressing of the airway by a hematoma, as well as hemothorax, pseudoaneurysm, arteriovenous fistula, stroke, and even death, has been well-described.

Outcomes of Clinical Application of Boomerang Closure Wire System

To evaluate the efficacy and safety of clinical application of a novel type of vascular closure device named Boomerang closure wire system （BCWS）. Methods BCWSs were hemostasis after transfemoral coronary angiography （CAG） or percutaneous used in 288 patients （BCWSs group） for coronary intervention （PCI）. Device success rate, hemostasis success rate, manual compression time, recumbent time, minor peripheral complication rate, severe peripheral complication rate and hospital staying time after procedure were analyzed. Results were compared to those from 300 patients （control group） who received manual compression in our hospital during the same period Results In BCWS group, device success rate was 97.2 %, hemostasis success rate was 95.1%. Manual compression time in CAG subgroup and PCI subgroup was 7.8 min and 11.2 min, respectively. Recumbent time was 136. 3 min in CAG subgroup, 284.6 min in PCI subgroup. Minor peripheral complication rate was 4.5 %, severe peripheral complication rate was 2. 4 %. Hospital-staying time after procedure in CAG group and PCI group was 1.8 d and 6. 6 d, respectively. Compared to control group, manual compression time, recumbent time and hospital-staying time of BCWSs group had statistical significance; hemostasis success rate, minor peripheral complication rate and severe peripheral complication rate of BCWSs group had no statistical difference. Conclusions BCWS provides satisfied haemostatic effect. Compared to routine manual compression, BCWS shortens manual compression time, recumbent time and hospital staying time. （ S Chin J Cardiol 2009; 10（1） ： 19 -22）

The Influence of Different Surgical Schemes on the Healing and Cosmetic Effects of Skin Lesions

Objective To analyze the effects of different surgical procedures on the healing and cosmetic effects of skin lesions.Methods 102 patients with skin defects after skin tumor resection in our hospital from January 2018 to December 2019 were selected and randomly divided into observation group and control group.The control group was treated with a traditional skin flap transplantation,while the observation group was treated with a skin stretch closure device.The effective rate,bleeding volume,wound healing time,total scar length,short-term and long-term complications and patient satisfaction were compared between the two groups.Results The effective rates of the observation group and the control group were 90.2%and88.24%,there was no significant difference in the treatment efficiency between the two groups(P>0.05),but there were significant differences in the amount of bleeding,the time of wound healing and the total length of postoperative scars between the two groups(all P<0.05);the short-term complication rates of the observation group and the control group were 5.88%and 19.61%,and long-term complications rate was 1.96%and 13.73%.The difference in the incidence of short-term and long-term complications between the two groups was statistically significant(all P<0.05);the satisfaction rate of patients in the observation group and the control group was 90.2%and 72.55%,the difference was statistically significant(P<0.05).Conclusion The former can effectively shorten wound healing time and scar length,reduce the incidence of short-term and long-term complications,and improve patients’satisfaction with the treatment,which is worthy of promotion.

Comparison of two hemostasis methods after percutaneous coronary intervention

To assess the safety and efficacy of Boomerang closure wire compared with traditional man-made compression in patients underwent coronary angiography (CAG) or percutaneous coronary intervention (PCI) .Meth-ods Three hundred and thirty-six cases who underwent transfemoral CAG or PCI were included in this study,221 ca-ses were treated with traditional compression of hemostasis,115 cases treated with Boomerang closure wire.The hemo-stasia time,immobilization time and relative vascular complications of the two groups were compared.Results There were obvious difference in the hemostasia time,immobilization time and the rate of the relative vascular complications (P <0.05) ,no patients experienced major complications in closure wire group,but one case experienced blood trans-fusion to retroperitoneal bleed in traditional man-made compression group.Conclusions closure wire is safe and effec-tive in patients undergoing CAG or PCI using the transfemoral approach,compared with tranditional man-made com-pression,closure wire can extremely decrease hemostasia time and immobilization time,there is a decreased trend in relative vascular complication,especially major complication.