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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe a 70-year-old woman who underwent successful percutaneous Inoue antegrade-technique mitral valvuloplasty. Three months later, the patient developed right-sided heart failure. Color Doppler echocardiography and cardiac catheterization demonstrated an atrial septal defect with bidirectional shunting and no restenosis of the mitral valve (iatrogenic Lutembacher's syndrome). Percutaneous treatment was successfully accomplished using a 13 mm Amplatzer Septal Occluder (AGA Medical Corporation, Golden Valley, Minnesota). The causes of right-to-left shunting and the effects of body position on gas exchange in such patients are also discussed.
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PMID:Use of Amplatzer septal occluder in a case of residual atrial septal defect causing bidirectional shunting after percutaneous Inoue mitral balloon valvuloplasty. 1123 48

The incidence of ventricular septal defect (VSD) occurs in up to 4.5% of penetrating cardiac trauma. We report a patient with persistent VSD who underwent surgical repair with significant left-to-right shunt and signs of heart failure. We performed a successful transcatheter closure of the VSD with an Amplatzer septal occluder (AGA Medical Corporation; Golden Valley, MN).
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PMID:Transcatheter closure of traumatic ventricular septal defect: an alternative to surgery. 1279 1

Transcatheter closure of atrial septal defects has been employed increasingly in the past decade. This technique is now regarded as the treatment of choice for patients with appropriate atrial septal defects. Transcatheter closure of ventricular septal defects (VSDs) has undergone fewer clinical trials, even though VSDs are more common than atrial septal defects. The implanted device does not seem to embolize and complications are few. Decreases in left ventricular and diastolic pressure and improvement of ventricular function have been reported early following device closure, and the left-to-right shunt has been either eliminated or dramatically reduced. In small infants who are in heart failure at a young age and who weigh less than 8 kg, which is below the recommended threshold for device closure, technological advancements in device size and catheter manipulation are needed before VSDs can be closed. A large number of VSDs, particularly if small to medium in size, will become smaller or close spontaneously, making intervention unnecessary. Muscular VSDs have been closed with transcatheter devices for the past 15 years. Although perimembranous defects are more common than muscular defects, they have not become more amenable to closure since the introduction of the Amplatzer VSD occluder device (AGA Medical Corporation, Golden Valley, MN). Previous devices, such as the Rashkind and button devices, have been unsuccessful in attempts at closure of the VSDs because of the proximity of the defects to the aortic valve and potential aortic valve damage. Before the transition is made to routine therapy, large, multicenter trials are justified to test the feasibility, safety and efficacy of nonsurgical closure of VSDs. In this review, I discuss the current applications of transcatheter closure of membranous, perimembranous and muscular VSDs, in particular with Amplatzer devices, and the implications for future development.
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PMID:Technology Insight: transcatheter closure of ventricular septal defects. 1625 71

Atrial septal defect (ASD) occlusion in adult patients with advanced age and left or right heart diastolic or systolic heart failure and in patients with pulmonary arterial hypertension bears a considerable risk of deterioration of heart failure. Therefore, we conducted this feasibility trial in 15 ASD patients with pulmonary hypertension and/or right heart failure using a fenestrated Amplatzer septal occluder (AGA Medical Corporation, Golden Valley, MN), allowing an overflow of blood in both directions in case of univentricular diastolic or systolic heart failure. In all patients, the device could be implanted without complications. All symptomatic patients showed an improvement in the New York Heart Association (NYHA) class, and no right or left heart decompensation occurred. On echocardiography, right ventricular end diastolic dimension (RVEDD) and pulmonary artery pressure (PAP) decreased significantly, whereas left ventricular end diastolic dimension (LVEDD) increased. Our series of 15 patients with fenestrated ASD occlusion shows that high-risk ASD occlusion can safely be accomplished with excellent clinical results and without complications by a fenestrated occluder.
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PMID:Fenestrated occluders for treatment of ASD in elderly patients with pulmonary hypertension and/or right heart failure. 1808 35

Muscular ventricular septal defects (MVSDs) account for approximately 20% of all congenital ventricular septal defects. Large defects in infants result in early heart failure, failure to thrive and pulmonary hypertension. Although percutaneous closure of MVSDs has been employed safely and effectively in children, adolescents and adults, its application in the small infant (weight <6 kg) carries a higher risk for complications including arrhythmias, hemodynamic compromise, cardiac perforation, tamponade and death. Perventricular closure of such defects, introduced by Amin and coworkers in the late 1990s, has become an attractive treatment modality for these small and high-risk patients. Experience worldwide has shown that the procedure is feasible, reproducible, safe and effective. In this article, the authors review the indications, the step-by-step technique and the results of perventricular closure of MVSDs using the AMPLATZER mVSD device (AGA Medical, MN, USA).
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PMID:Perventricular device closure of congenital muscular ventricular septal defects. 2045 Mar

Neonates presenting with intractable cardiac failure due to vein of Galen aneurysmal malformations (VGAMs) rapidly progress to multisystem organ failure and death if left untreated. Currently the only viable treatment option is endovascular embolization. Although intracranial embolization of a neonate is a high-risk procedure, successful treatment can reverse cardiac failure and prevent neurological complications associated with VGAMs. Embolization via the arterial route is thought to have a better outcome than embolization via the venous system. However, multiple transarterial embolizations in different sessions may well be contraindicated in neonates, because repeat access via the femoral artery, carries a risk of arterial trauma which, in turn, can jeopardize lower limbs. With this case study we show that after repeat failure of arterial embolization, the transcranial placement of an Amplatzer PFO occluder (AGA Medical, Plymouth, USA) in the aneurysm can effectively reduce intrafistular pressure and venous outflow velocity. We also propose a mathematical model that can be used to calculate flow velocity through the aneurysm, which, in turn, could be used to aid clinical decision-making. Unlike some conventional techniques, the placement of an Amplatzer occluder does not pose the risk of completely obstructing venous drainage and therefore does not increase the risk of venous breakthrough hemorrhage. We propose this endovascular technique as a treatment option for high risk neonates in need of emergency embolization of VGAMs, where multiple arterial embolizations failed to control the condition sufficiently.
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PMID:Trans-cranial placement of an amplatzer device to control intractable cardiac failure in an infant with a vein of galen anomaly. A case report. 2064 95

Patients who present with significant paravalvular regurgitation after mitral valve replacement remain a difficult patient population and high-risk surgical candidates. We present 3 cases of transapical closure of mitral valve paravalvular leak (PVL) after mitral valve replacement using Amplatzer closure devices (AGA Medical Corp, Plymouth, MN). All 3 patients experienced decreased regurgitation at the site of the closure as well as symptomatic improvement in their heart failure.
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PMID:Repair of prosthetic mitral valve paravalvular leak using an off-pump transapical approach. 2273 94

We report the case of a 78-year-old woman with severe aortic valve stenosis that was successfully treated with transcatheter aortic valve implantation, with initial good hemodynamic results and clinical improvement of the patient. After 3 weeks, her clinical condition worsened, with progressive heart failure. Transthoracic echocardiography revealed an iatrogenic large subaortic ventricular septal defect with important left-to right shunt (Qp/Qs 3:1). The patient underwent successful transcatheter closure of the ventricular septal defect with a 14-mm Amplatzer mVSD Occluder (AGA Medical, Plymouth, MN), resulting in dramatic clinical improvement.
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PMID:Percutaneous closure of a poorly tolerated post-transcatheter aortic valve implantation ventricular septal defect. 2544 95

Platypnea-orthodeoxia syndrome is a rare entity characterized by dyspnea and hypoxemia in the sitting position and usually resolved by lying down. Although it is not well understood, it is thought to be associated with either intracardiac or extracardiac factors. Within the group of intracardiac etiologies, it typically occurs in the presence of right heart failure or elevated right-sided filling pressures. When right heart failure is absent, platypnea-orthodeoxia is thought to be due to either anatomic changes that produce a baffle-directing flow across an atrial defect or to posture-dependent right-to-left pressure gradients. We report this case of a patient with no prior diagnosis of heart failure who presented to our hospital with 6 months of New York Heart Association class IV dyspnea and recent paradoxical embolus across a patent foramen ovale (PFO). Platypnea-orthodeoxia syndrome was diagnosed clinically. Transesophageal echocardiography revealed bidirectional shunting across the PFO. In the catheterization laboratory, invasive hemodynamics showed normal right and left atrial pressures and normal pulmonary arterial pressures. An Amplatzer Cribiform occluder device (AGA Medical Corp.) was used to close the PFO, completely curing the patient's symptoms. This is a novel case of subacute-onset severe platypnea-orthodeoxia associated with paradoxical embolus occurring while seated in the upright position. The cause of the patient's symptoms may have been progressive kyphosis or to increased pulmonary tidal volumes. Evaluation for platypnea-orthodeoxia is important in cases of occult dyspnea because the condition may be cured by closing the anatomic defect, as it was in this case.
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PMID:Treatment of Platypnea-Orthodeoxia Syndrome in a Patient with Normal Cardiac Hemodynamics: A Review of Mechanisms with Implications for Management. 2997 71