Paravalvular leak closure under intracardiac echocardiographic guidance.

Objectives: The objective of this study was to determine the safety and efficacy of intracardiac echocardiography (ICE) to guide percutaneous paravalvular leak (PVL) closure.

Background: PVL following surgical valve replacement occurs in 2%-15% of patients. Percutaneous treatment is an accepted management strategy in patients deemed to be too high risk for redo surgery.

Initial use of the new GORE(®) septal occluder in patent foramen ovale closure: implantation and preliminary results.

Background: A number of devices are available for percutaneous closure of a clinically significant patent foramen ovale (PFO). The new GORE(®) septal occluder (GSO) is a nonself-centering device consisting of an expanded polytetrafluoroethylene tube supported by a frame of nitinol wire conforming into a double disk. This study reports the first clinical GSO implantation experience.

Prominence of the Eustachian valve in paradoxical embolism.

Aims: to investigate the relationship between Eustachian valve (EV) length and degree of atrial septal movement in patients with patent foramen ovale (PFO) and presumed paradoxical cerebral embolism. PFO is a well-established risk factor for cryptogenic stroke. However, due to the high prevalence of PFO, many of these are bystanders rather than true pathological entities.

Intracardiac echocardiography off piste? Closure of the left atrial appendage using ICE and local anesthesia.

Left atrial appendage (LAA) occlusion is increasingly accepted to reduce the risk of stroke in patients with atrial arrhythmia who are unsuitable for routine anticoagulation. It is generally performed under general anesthesia, guided by transoesophageal echocardiography with accurate imaging being essential for correct deployment of the device. We present a case where LAA occlusion was done under local anesthesia in a high-anesthetic risk patient, using novel placement of an intracardiac echo probe via a Mullins sheath in the right ventricular outflow tract and pulmonary artery.

Acute worsening in migraine symptoms following PFO closure: a matter of fact?

There is currently conjecture in the literature as to whether percutaneous closure of patent foramen ovales (PFO) leads to an improvement in migraine symptoms. The present study reports the migraine status at 30 days, of 57 consecutive patients who underwent closure PFO closures for cryptogenic stroke at our institution. Our findings suggest a significant change in migraine character following PFO closure with the majority of these patients reporting a worsening in migraine severity.

Percutaneous retrieval of an embolized pacemaker lead from the pulmonary artery.

Migration of retained fractured pacemaker electrodes to the pulmonary artery is a rare but recognised complication. It is imperative that if this occurs the electrode is removed from this position due to the increased risk of associated infection and thrombus formation. Historically open surgery has been required to manage this potentially serious complication, however as illustrated by this case, a percutaneous approach can be employed successfully.

Stent-graft repair of coronary vein graft aneurysm.

The authors describe treating a 6-cm right coronary artery bypass graft aneurysm that was causing recurrent angina. With use of the combined skills of interventional radiologists and cardiologists, the aneurysm was successfully occluded by using a stent-graft typically used to treat aneurysms in the peripheral circulation. One month after the procedure, the aneurysm had sealed at follow-up computed tomographic angiography.

Surgery Insight: percutaneous treatment of prosthetic paravalvular leaks.

Serious paravalvular leakage occurs in 1-5% of patients who have undergone surgical cardiac valve replacement procedures. Clinical manifestations include hemolysis, heart failure and arrhythmias. Presently, the gold standard treatment for severe paravalvular leakage is surgery; however, the outcomes remain far from optimum.

Mammoth interatrial septal aneurysm in the ICE age.

Background: Intracardiac echocardiography (ICE) is a useful imaging modality that is now being used more widely to assist in the percutaneous closure of atrial septal defects (ASD) and patent foramen ovales (PFO).

Case Presentation: A 42 year old lady with a history of transient ischaemic attacks and migraine underwent percutaneous closure of an ASD. Intraprocedural ICE demonstrated a mammoth billowing multiperforated interatrial septal aneurysm in association with a secondum ASD.