Abraham Matitiau, MD, Einat Birk, MD, Ludmyla Kachko, MD, Leonard C. Blieden, MD and Elchanan Bruckheimer, MB, BS
Background: Secundum atrial septal defect is a common congenital heart defect that causes right heart volume overload and produces symptoms usually after the third decade of life. Treatment until the last few years has been open heart surgery.
Objective: To review our early experience with transcatheter closure of ASD2 using the Amplatzer septal occluder.
Methods: Between November 1999 and February 2000, 20 children and young adults with a median age of 9.1 years (4.2-35.1 years) were referred for transcatheter closure of ASD2. Diagnosis was established by transthoracic echocardiography. Implantation was performed under general anesthesia through the femoral vein with the guidance of transesophageal echocardiography and fluoroscopy. Femoral arterial puncture was performed for blood pressure monitoring during the procedure. The device size chosen was similar to the balloon-stretched diameter of the ASD2.
Results: Implantation was completed successfully in 18 patients. Two patients were referred for elective surgery: one had an unsuitable anatomy for transcatheter closure by TEE in the catheterization laboratory and the device could not implanted properly, the other patient had a large multiperforated septal aneurysm that was retrieved. Mean ASD2 diameter by TTE and TEE was similar (13.9 + 3 mm, 13.4 + 3.5 mm) and mean stretched diameter was 18.3 + 4.3 mm. Mean Qp:Qs (pulmonary flow: systemic flow) was 2.2 + 0.6. Mean fluoroscopy time for the procedure was 14.8 + 4.8 minutes.
The patients were discharged the day after the procedure.
Four patients had a tiny leak immediately post-procedure, and none had a leak at one month follow-up. The only complication was a small pseudoaneurysm of the femoral artery in one patient, that resolved spontaneously.
Conclusion: Transcatheter closure of ASD2 with the Amplatzer septal occluder is a safe and effective alternative to surgical closure. Long-term outcome has to be evaluated.
Petri T. Kovanen, MD, PhD and Matti Manttari, MD, FESC
Eran E. Weinmann, MD and Arie Bass, MD
Patrick Sorkine, MD, Ron Ben Abraham, MD, Shlomo Brill, MD and Oded Szold, MD
In recent years liver transplantation was shown to be the only clinically effective method of treating acute or chronic hepatic failure due to various causes. However, this ultimate therapeutic approach is limited by the growing disparity between organ donation and the number of patient on the waiting list.
Factors such as high cost, morbidity, and the need for lifelong immunosuppression accelerated the research on alternative methods to support the failing liver. Recently, new technologies incorporating hepatocytes and extracorporal circulation devices were introduced for liver support systems and their role in the treatment of acute liver failure.
Rasmi Magadle, MD, Paltiel Weiner, MD, Alexander Sotzkover, MD and Noa Berar-Yanay, MD
Robert Slater, DPM Yoram Ramot, MD and Micha Rapoport, MD
Ofer Levy, MD, Marcel Topilski, MD, Eli Brazowski, MD, Michael Yaron, MD and Moshe Tishler, MD
Aharon Kessel, MD, Elias Toubi, MD, Theo Dov Golan, MD, Aurora Toubi, MD, Jorge G. Mogilner, MD and Michael Jaffe, MB ChB, CPD, CH
Haim Mayan, MD, Rami Kantor, MD, Arie Wollner, MD and Zvi Farfel, MD
Paul E. Slater, MD, MPH, Alex Leventhal, MD, MPH, MPA and Emilia Anis, MD, MPH