The manuscript describes the efficacy of a new skin closure system(Zip Line?) for wound closure after pacemaker/implantable cardioverter defibrillator surgery. The system is particularly useful when wound healingis di...The manuscript describes the efficacy of a new skin closure system(Zip Line?) for wound closure after pacemaker/implantable cardioverter defibrillator surgery. The system is particularly useful when wound healingis difficult with traditional methods and in patients at high risk for surgical site infections(SSIs). This skin closure option is easy and quick to apply and remove, and produces excellent cosmetic results. Although it is associated with a minimal expense upcharge, the benefits, including the potential for decrease in SSI, make it attractive and worth considering for skin closure in device patients, particularly those at increased risk of complications.展开更多
Gastrointestinal perforations,which need to be managed quickly,are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays,with the ...Gastrointestinal perforations,which need to be managed quickly,are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays,with the development of new devices and techniques,endoscopic therapy is becoming more popular. However,there are different indications and clinical efficacies between different methods,because of the diverse properties of endoscopic devices and techniques. Successful management also depends on other factors,such as the precise location of the perforation,its size and the length of time between the occurrence and diagnosis. In this study,we performed a comprehensive review of various devices and intro-duced the different techniques that are considered effective to treat gastrointestinal perforations. In addition,we focused on the different methods used to achieve successful closure,based on the literature and our clinical experiences.展开更多
AIM To report 17-mo experience of femoral artery puncture site closure during angiographic procedures using Exo Seal vascular closure devices(VCDs).METHODS Between November 2015 and April 2017, we performed 179 diagno...AIM To report 17-mo experience of femoral artery puncture site closure during angiographic procedures using Exo Seal vascular closure devices(VCDs).METHODS Between November 2015 and April 2017, we performed 179 diagnostic and interventional angiographic procedures via a common femoral arterial access.The Exo Seal VCD was used at the puncture site to achieve hemostasis in 125 patients.We evaluated the technical and procedural success rates, the complications, and the factors affecting the hemostasis time of the ExoSeal VCDs.RESULTS Technical and procedural successes were achieved in 176 cases(98.0%) and 128 cases(71.5%), respectively.Device failure occurred in 3(1.7%) cases.In 1 case(0.6%) a small hematoma developed, but there were no major complications.Among the hemostasis-relevant variables, a history of drinking alcohol, low platelet(PLT) count, and high prothrombin time-international normalized ratio(commonly known as PT-INR) values were the statistically significant predictors of the need for longer manual compression(MC).There was no difference in the success rates between the repeat and single Exo Seal procedure groups, and repeated use of the ExoSeal did not affect hemostasis time.CONCLUSION The ExoSeal VCD effectively achieves hemostasis, with few complications.Longer light MC may be needed with alcohol drinkers, low PLT count, and high PT-INR values.展开更多
Transcatheter closure of the left atrial appendage with the Amplatzer cardiac plug device and double antiplatelet treatment for 3 mo has become an alternative treatment for patients with atrial fibrillation at high em...Transcatheter closure of the left atrial appendage with the Amplatzer cardiac plug device and double antiplatelet treatment for 3 mo has become an alternative treatment for patients with atrial fibrillation at high embolism risk and contraindications for chronic oral anticoagulation.The inadequate implantation of the left atrial appendage closure device and the discontinuation of double antiplatelet therapy are well-known as factors related to device thrombosis.Nevertheless,device thrombosis after adequate implantation requiring surgical treatment or restarting chronic oral anticoagulation has been reported and can reach 15% of patients.The connector pin thrombosis of the Amplatzer cardiac plug,despite a good adherence to antiplatelet treatment,has been recently described as a potential mechanism for device thrombosis.Our clinical case reports the management of this condition for the first time,showing that the early detection of thrombotic complications by transesophageal echocardiography permits solving this serious complication with medical treatment only.展开更多
An atrial septal defect (ASD) may cause right heart dysfunction, pulmonary hypertension and atrial fibrillation (AF), and atrial septal defect occlusion (ASDO) is the first choice for treating secundum defects when th...An atrial septal defect (ASD) may cause right heart dysfunction, pulmonary hypertension and atrial fibrillation (AF), and atrial septal defect occlusion (ASDO) is the first choice for treating secundum defects when the morphology permits. ASD and AF frequently coexist, and the risk of AF and stroke persists after ASDO.[1] In recent years, left atrial appendage occlusion (LAAO) has been recognized as an effective treatment for stroke prevention in nonvalvular AF patients with a high risk of stroke, systemic embolism and bleeding who are unwilling to take oral anticoagulants or cannot tolerate them.展开更多
Percutaneous Patent Foramen Ovate PFO/Atrial Septal Defect (ASD) closure has become an increasingly simplified procedure over the past decade. The main advantages of a percutaneous approach include avoidance of surger...Percutaneous Patent Foramen Ovate PFO/Atrial Septal Defect (ASD) closure has become an increasingly simplified procedure over the past decade. The main advantages of a percutaneous approach include avoidance of surgery, short procedure time and hospital stay. Device embolization is seen rarely but it can be fatal. We report this complication following a percutaneous PFO closure in a 44-year-old man. The device was embolized into the distal part of the right pulmonary artery. We removed the device surgically and closed the PFO/ASD.展开更多
Context: Atrial septal defect may rarely be associated with other cardiac diseases such as arrhythmia, and may require additional intervention. Case report: A 16-year-old boy presented with effort dyspnea, tiredness, ...Context: Atrial septal defect may rarely be associated with other cardiac diseases such as arrhythmia, and may require additional intervention. Case report: A 16-year-old boy presented with effort dyspnea, tiredness, and fatigue. The electrocardiograph revealed right bundle branch block, atrioventricular block, and left axis deviation. Ostium secundum type of atrial septal defect was detected by transthoracic echocardiography and was confirmed by transesophageal echocardiography. The patient was advised to undergo percutaneous device closure. Permanent pacemaker implantation was also suggested considering the risk of fatal arrhythmias associated with atrioventricular block. Consequently, patient underwent percutaneous atrial septal defect closure and implantation of pacemaker in a single sitting. Both the procedures were successful, after which the patient showed remarkable symptomatic improvement. Conclusion: In atrial septal defect patients with unexplained atrioventricular block, closure of atrial septal defect and implantation of pacemaker in single sitting appear to be an attractive modality.展开更多
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 ...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.展开更多
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 i...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.展开更多
Inadvertent puncture of the subclavian artery is an uncommon but potentially fatal complication of the commonly performed internal jugular vein catheterization.We report a case of accidental subclavian artery catheter...Inadvertent puncture of the subclavian artery is an uncommon but potentially fatal complication of the commonly performed internal jugular vein catheterization.We report a case of accidental subclavian artery catheterization close to the vertebral artery during internal jugular venous cannulation,which was successfully managed in the interventional suite with catheter removal and use of a vascular closure device.展开更多
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...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。展开更多
文摘The manuscript describes the efficacy of a new skin closure system(Zip Line?) for wound closure after pacemaker/implantable cardioverter defibrillator surgery. The system is particularly useful when wound healingis difficult with traditional methods and in patients at high risk for surgical site infections(SSIs). This skin closure option is easy and quick to apply and remove, and produces excellent cosmetic results. Although it is associated with a minimal expense upcharge, the benefits, including the potential for decrease in SSI, make it attractive and worth considering for skin closure in device patients, particularly those at increased risk of complications.
基金Supported by Guangdong Province Universities and Colleges Pearl River Scholar Funded SchemeGuangzhou Pilot Project of Clinical and Translational Research Center,early gastrointestinal cancers,No.7415696196402Guangdong Provincial Bioengineering Research Center for Gastroenterology Diseases
文摘Gastrointestinal perforations,which need to be managed quickly,are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays,with the development of new devices and techniques,endoscopic therapy is becoming more popular. However,there are different indications and clinical efficacies between different methods,because of the diverse properties of endoscopic devices and techniques. Successful management also depends on other factors,such as the precise location of the perforation,its size and the length of time between the occurrence and diagnosis. In this study,we performed a comprehensive review of various devices and intro-duced the different techniques that are considered effective to treat gastrointestinal perforations. In addition,we focused on the different methods used to achieve successful closure,based on the literature and our clinical experiences.
文摘AIM To report 17-mo experience of femoral artery puncture site closure during angiographic procedures using Exo Seal vascular closure devices(VCDs).METHODS Between November 2015 and April 2017, we performed 179 diagnostic and interventional angiographic procedures via a common femoral arterial access.The Exo Seal VCD was used at the puncture site to achieve hemostasis in 125 patients.We evaluated the technical and procedural success rates, the complications, and the factors affecting the hemostasis time of the ExoSeal VCDs.RESULTS Technical and procedural successes were achieved in 176 cases(98.0%) and 128 cases(71.5%), respectively.Device failure occurred in 3(1.7%) cases.In 1 case(0.6%) a small hematoma developed, but there were no major complications.Among the hemostasis-relevant variables, a history of drinking alcohol, low platelet(PLT) count, and high prothrombin time-international normalized ratio(commonly known as PT-INR) values were the statistically significant predictors of the need for longer manual compression(MC).There was no difference in the success rates between the repeat and single Exo Seal procedure groups, and repeated use of the ExoSeal did not affect hemostasis time.CONCLUSION The ExoSeal VCD effectively achieves hemostasis, with few complications.Longer light MC may be needed with alcohol drinkers, low PLT count, and high PT-INR values.
文摘Transcatheter closure of the left atrial appendage with the Amplatzer cardiac plug device and double antiplatelet treatment for 3 mo has become an alternative treatment for patients with atrial fibrillation at high embolism risk and contraindications for chronic oral anticoagulation.The inadequate implantation of the left atrial appendage closure device and the discontinuation of double antiplatelet therapy are well-known as factors related to device thrombosis.Nevertheless,device thrombosis after adequate implantation requiring surgical treatment or restarting chronic oral anticoagulation has been reported and can reach 15% of patients.The connector pin thrombosis of the Amplatzer cardiac plug,despite a good adherence to antiplatelet treatment,has been recently described as a potential mechanism for device thrombosis.Our clinical case reports the management of this condition for the first time,showing that the early detection of thrombotic complications by transesophageal echocardiography permits solving this serious complication with medical treatment only.
文摘An atrial septal defect (ASD) may cause right heart dysfunction, pulmonary hypertension and atrial fibrillation (AF), and atrial septal defect occlusion (ASDO) is the first choice for treating secundum defects when the morphology permits. ASD and AF frequently coexist, and the risk of AF and stroke persists after ASDO.[1] In recent years, left atrial appendage occlusion (LAAO) has been recognized as an effective treatment for stroke prevention in nonvalvular AF patients with a high risk of stroke, systemic embolism and bleeding who are unwilling to take oral anticoagulants or cannot tolerate them.
文摘Percutaneous Patent Foramen Ovate PFO/Atrial Septal Defect (ASD) closure has become an increasingly simplified procedure over the past decade. The main advantages of a percutaneous approach include avoidance of surgery, short procedure time and hospital stay. Device embolization is seen rarely but it can be fatal. We report this complication following a percutaneous PFO closure in a 44-year-old man. The device was embolized into the distal part of the right pulmonary artery. We removed the device surgically and closed the PFO/ASD.
文摘Context: Atrial septal defect may rarely be associated with other cardiac diseases such as arrhythmia, and may require additional intervention. Case report: A 16-year-old boy presented with effort dyspnea, tiredness, and fatigue. The electrocardiograph revealed right bundle branch block, atrioventricular block, and left axis deviation. Ostium secundum type of atrial septal defect was detected by transthoracic echocardiography and was confirmed by transesophageal echocardiography. The patient was advised to undergo percutaneous device closure. Permanent pacemaker implantation was also suggested considering the risk of fatal arrhythmias associated with atrioventricular block. Consequently, patient underwent percutaneous atrial septal defect closure and implantation of pacemaker in a single sitting. Both the procedures were successful, after which the patient showed remarkable symptomatic improvement. Conclusion: In atrial septal defect patients with unexplained atrioventricular block, closure of atrial septal defect and implantation of pacemaker in single sitting appear to be an attractive modality.
文摘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.
基金Supported by the Traditional Chinese Medicine Science,No.2017-057,2017-058 and 2019-0969Technology Development Project of Shandong Province,No.2019-0971
文摘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.
文摘Inadvertent puncture of the subclavian artery is an uncommon but potentially fatal complication of the commonly performed internal jugular vein catheterization.We report a case of accidental subclavian artery catheterization close to the vertebral artery during internal jugular venous cannulation,which was successfully managed in the interventional suite with catheter removal and use of a vascular closure device.
文摘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。
