Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
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Catheter Cardiovasc Interv · Nov 2011
Case ReportsThrombus formation after left atrial appendage exclusion using an Amplatzer cardiac plug device.
The feasibility and safety of left atrial appendage closure with the Amplatzer cardiac plug (AGA Medical Corp., Minneapolis, MN) have been recently published; no thrombus formation on the device surface has been reported previously. We describe a case of a 66-year-old man with permanent atrial fibrillation, previous stroke, and contraindication for long-term oral anticoagulant therapy. A 22-mm ACP device was deployed successfully without complications. ⋯ A 3-month follow-up echocardiogram confirmed the exclusion of the LAA but it demonstrated the presence of a thrombus on the atrial surface of the device. It was decided to keep the patient on acetyl salicylic acid 100 mg with the addition of enoxaparin 60 mg bid. Transesophageal echocardiogram demonstrated total resolution of the thrombus after 2 months.
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Catheter Cardiovasc Interv · Nov 2011
Case ReportsTrans-pleural pericardiocentesis: revisiting an old technique.
Percutaneous access to the pericardial space serves both diagnostic and therapeutic purposes. Multiple approaches have been described, which include the apical, sub-xiphoid, trans-atrial, and trans-bronchial techniques. ⋯ Here we revisit the use of this technique in a patient. Future development of this technique, using a noncompliant balloon to expand the pleuropericardial interface, may avoid the need for a pericardial window in oncology and rheumatology patients with recurrent pericardial effusions.
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Catheter Cardiovasc Interv · Nov 2011
Comparative StudyFeasibility of transcatheter closure in unselected patients with secundum atrial septal defect, using Amplatzer devices and a modified sizing balloon technique.
We aimed to assess (1) the role of surgical versus transcatheter closure techniques and (2) the impact of a modified implantation technique to optimize closure of secundum septal defects with the Amplatzer device. ⋯ The majority of secundum atrial septal defect is amenable to transcatheter closure, using a modified implantation technique in 16% of cases.
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Catheter Cardiovasc Interv · Nov 2011
Case ReportsPotential risk of provisional stenting in left main coronary artery bifurcation in multivessel-related acute coronary syndrome.
We present a case of an elderly man suffering from an acute coronary syndrome (ACS) with preshock vital signs and remarkable ST-T wave depression in leads V4-V6, and ST elevation in lead aVR. Coronary angiography showed total occlusion of the right coronary artery (RCA) and impending occlusion in the distal left main coronary artery (LMCA) with a tandem lesion in the proximal left anterior descending artery (LAD). After insertion of an intra-aortic balloon pump both the LAD and left circumflex artery (LCX) were dilated alternatively; and cross-over stenting in the LMCA bifurcation was subsequently performed. ⋯ Immediate installation of percutaneous cardio-pulmonary support system allowed stent deployment to be performed in the RCA and subsequent reopening of the LCX that led to a return to sinus rhythm. The patient recovered almost normal left ventricular wall motion and previous activity without any neurological deficit within 2 weeks. Provisional stenting in ACS in the LMCA bifurcation with multivessel disease has a potential risk of acute hemodynamic collapse; a planned two-stent deployment strategy may assure a higher rate of safety in such cases.