- Email: [email protected]
Transcatheter Closure of a Post-Myocardial Infarction Ventricular Septal Rupture Using a Parachute Device
JACC: CARDIOVASCULAR INTERVENTIONS
VOL. 8, NO. 2, 2015
ª 2015 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION PUBLISHED BY ELSEVIER INC.
ISSN 1936-8798/$36.00 http://dx.doi.org/10.1016/j.jcin.2014.09.019
Transcatheter Closure of a Post-Myocardial Infarction Ventricular Septal Rupture Using a Parachute Device Daxin Zhou, MB,* Wenzhi Pan, MD,* Lihua Guan, MB,* Cuizhen Pan, MB,y Junbo Ge, MD*
A
58-year-old man with exertional dyspnea (New York Heart Association class II) was
F I G U R E 1 Pre-Procedure and Post-Procedure Color
Doppler Flow Images
admitted to our hospital. He suffered from
acute anterior myocardial infarction 1 year earlier and had undergone percutaneous coronary intervention and closure of ventricular septal rupture (VSR) with an Amplatzer Septal Occluder (St. Jude Medical, St. Paul, Minnesota) 9 months before admission. Echocardiography taken on admission showed large residual apical ventricular septal shunts near the occluder (Figure 1A, Online Video 1) and left ventricular aneurysm, with left ventricular ejection fraction of 49%. An 85-mm Parachute device (CardioKinetix, Inc., Menlo Park, California) was used to restore the left ventricle and close the apical VSR simultaneously, with the method reported previously (1). After the procedure, the Qp /Q s ratio decreased from
1.8 to 1.2. An x-ray showed that the Parachute device was located at the left ventricular apex and the Amplatzer occluder intruded into the device (Figure 2). At 3-month follow-up, the patient’s symptom was relieved, and New York Heart Association class was improved to class I. Echocardiography demonstrated that apical ventricular septal shunts decreased significantly (Figure 1B, Online Video 2). The Amplatzer occluder intruded into the Parachute device, causing incomplete apposition of the device and a blood flow run into the partitioned apical cavity from left ventricular chamber (Figure 3), and then went through the apical ventricular septal
(A) Before the procedure, large residual ventricular septal shunts could be seen between the occluder and the peak of apex (Online Video 1). (B) After the procedure, the shunts decreased significantly (Online Video 2). LV ¼ left ventricle; RV ¼ right ventricle.
(Figure 1B). Post-myocardial infarction VSR is a serious disease. Even if treated with surgery or percutaneous
effective for multi-holes VSR. This is the first time
intervention, it is still associated with high mor-
we have explored the feasibly of transcatheter
tality. Previously, VSR was percutaneously closed
closure of apical VSR using a Parachute device (the
using double-umbrella devices (2), which were not
schematic diagram is given in Figure 4). Because
From the *Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; and the yDepartment of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. The first 3 authors contributed equally to this work. Manuscript received July 27, 2014; revised manuscript received September 2, 2014, accepted September 13, 2014.
370
Zhou et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 8, NO. 2, 2015 FEBRUARY 2015:369–71
Closure of VSR Using Parachute
F I G U R E 2 X-Ray Taken During the Procedure
F I G U R E 4 Schematic Diagram of Transcatheter Closure
of Apical VSR Using a Parachute Device
The Parachute device was located at the left ventricular apex
The Parachute device partitions the apical cavity, as well as
and the Amplatzer occluder intruded into the device.
the apical ventricular septal rupture (VSR).
the Amplatzer occluder affected the partitioning effect of the Parachute device, residual shunts still
REPRINT REQUESTS AND CORRESPONDENCE: Dr.
existed. If the case had not been treated by
Junbo Ge, Department of Cardiology, Zhongshan
Amplatzer occluder previously, the result might be
Hospital, No. 180, Fenglin Road, Shanghai, 200032,
better.
China. E-mail: [email protected].
F I G U R E 3 Echocardiography After the Procedure
The Amplatzer occluder intruded into the Parachute device, causing incomplete apposition of the device and a blood flow run into the partitioned apical cavity from the left ventricular chamber. Abbreviations as in Figure 1.
Zhou et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 8, NO. 2, 2015 FEBRUARY 2015:369–71
Closure of VSR Using Parachute
REFERENCES 1. Mazzaferri EL Jr., Gradinac S, Sagic D, et al. Percutaneous left ventricular partitioning in patients with chronic heart failure and a prior anterior myocardial infarction: results of the PercutAneous Ventricular RestorAtion in Chronic Heart failUre PaTiEnts Trial. Am Heart J 2012;163:812–20.e1.
2. Assenza GE, McElhinney DB, Valente AM, et al. Transcatheter closure of post-myocardial infarction ventricular septal rupture. Circ Cardiovasc Interv 2013;6:59–67.
KEY WORDS Parachute device, percutaneous ventricular restoration, transcatheter closure, ventricular septal rupture A PPE NDI X For accompanying videos, please see the online version of this paper.
371
VOL. 8, NO. 2, 2015
ª 2015 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION PUBLISHED BY ELSEVIER INC.
ISSN 1936-8798/$36.00 http://dx.doi.org/10.1016/j.jcin.2014.09.019
Transcatheter Closure of a Post-Myocardial Infarction Ventricular Septal Rupture Using a Parachute Device Daxin Zhou, MB,* Wenzhi Pan, MD,* Lihua Guan, MB,* Cuizhen Pan, MB,y Junbo Ge, MD*
A
58-year-old man with exertional dyspnea (New York Heart Association class II) was
F I G U R E 1 Pre-Procedure and Post-Procedure Color
Doppler Flow Images
admitted to our hospital. He suffered from
acute anterior myocardial infarction 1 year earlier and had undergone percutaneous coronary intervention and closure of ventricular septal rupture (VSR) with an Amplatzer Septal Occluder (St. Jude Medical, St. Paul, Minnesota) 9 months before admission. Echocardiography taken on admission showed large residual apical ventricular septal shunts near the occluder (Figure 1A, Online Video 1) and left ventricular aneurysm, with left ventricular ejection fraction of 49%. An 85-mm Parachute device (CardioKinetix, Inc., Menlo Park, California) was used to restore the left ventricle and close the apical VSR simultaneously, with the method reported previously (1). After the procedure, the Qp /Q s ratio decreased from
1.8 to 1.2. An x-ray showed that the Parachute device was located at the left ventricular apex and the Amplatzer occluder intruded into the device (Figure 2). At 3-month follow-up, the patient’s symptom was relieved, and New York Heart Association class was improved to class I. Echocardiography demonstrated that apical ventricular septal shunts decreased significantly (Figure 1B, Online Video 2). The Amplatzer occluder intruded into the Parachute device, causing incomplete apposition of the device and a blood flow run into the partitioned apical cavity from left ventricular chamber (Figure 3), and then went through the apical ventricular septal
(A) Before the procedure, large residual ventricular septal shunts could be seen between the occluder and the peak of apex (Online Video 1). (B) After the procedure, the shunts decreased significantly (Online Video 2). LV ¼ left ventricle; RV ¼ right ventricle.
(Figure 1B). Post-myocardial infarction VSR is a serious disease. Even if treated with surgery or percutaneous
effective for multi-holes VSR. This is the first time
intervention, it is still associated with high mor-
we have explored the feasibly of transcatheter
tality. Previously, VSR was percutaneously closed
closure of apical VSR using a Parachute device (the
using double-umbrella devices (2), which were not
schematic diagram is given in Figure 4). Because
From the *Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; and the yDepartment of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. The first 3 authors contributed equally to this work. Manuscript received July 27, 2014; revised manuscript received September 2, 2014, accepted September 13, 2014.
370
Zhou et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 8, NO. 2, 2015 FEBRUARY 2015:369–71
Closure of VSR Using Parachute
F I G U R E 2 X-Ray Taken During the Procedure
F I G U R E 4 Schematic Diagram of Transcatheter Closure
of Apical VSR Using a Parachute Device
The Parachute device was located at the left ventricular apex
The Parachute device partitions the apical cavity, as well as
and the Amplatzer occluder intruded into the device.
the apical ventricular septal rupture (VSR).
the Amplatzer occluder affected the partitioning effect of the Parachute device, residual shunts still
REPRINT REQUESTS AND CORRESPONDENCE: Dr.
existed. If the case had not been treated by
Junbo Ge, Department of Cardiology, Zhongshan
Amplatzer occluder previously, the result might be
Hospital, No. 180, Fenglin Road, Shanghai, 200032,
better.
China. E-mail: [email protected].
F I G U R E 3 Echocardiography After the Procedure
The Amplatzer occluder intruded into the Parachute device, causing incomplete apposition of the device and a blood flow run into the partitioned apical cavity from the left ventricular chamber. Abbreviations as in Figure 1.
Zhou et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 8, NO. 2, 2015 FEBRUARY 2015:369–71
Closure of VSR Using Parachute
REFERENCES 1. Mazzaferri EL Jr., Gradinac S, Sagic D, et al. Percutaneous left ventricular partitioning in patients with chronic heart failure and a prior anterior myocardial infarction: results of the PercutAneous Ventricular RestorAtion in Chronic Heart failUre PaTiEnts Trial. Am Heart J 2012;163:812–20.e1.
2. Assenza GE, McElhinney DB, Valente AM, et al. Transcatheter closure of post-myocardial infarction ventricular septal rupture. Circ Cardiovasc Interv 2013;6:59–67.
KEY WORDS Parachute device, percutaneous ventricular restoration, transcatheter closure, ventricular septal rupture A PPE NDI X For accompanying videos, please see the online version of this paper.
371