Michal Galeczka1, Jan Glowacki2, Nataliia Yashchuk3, Igor Ditkivskyy4, Dominika Rojczyk5, Mateusz Knop5, Sebastian Smerdzinski5, Bogdan Cherpak3, Malgorzata Szkutnik5, Jacek Bialkowski5, Roland Fiszer5, Vasyl Lazoryshynets4. 1. Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland. Electronic address: michalgaleczka@gmail.com. 2. Department of Radiology and Radiodiagnostics, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland. 3. Department of Interventional Cardiology for Congenital and Acquired Heart Disease, National Amosov Institute, Kyiv, Ukraine. 4. Department of Cardiovascular Surgery, National Amosov Institute, Kyiv, Ukraine. 5. Department of Congenital Heart Defects and Paediatric Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland.
Abstract
BACKGROUND: We aimed to evaluate medium- and long-term outcomes of transcatheter closure (TC) of ruptured sinus of Valsalva aneurysm (RSVA), which is a rare and mostly congenital heart disease. METHODS: Retrospective analysis included 23 patients (14 males) aged 15-79 years (y; 39.9±18.5) selected for TC of RSVA between 2007 and 2017 in two tertiary centers in Poland and Ukraine. Fifteen patients were in New York Heart Association (NYHA) class III or IV before TC; 5 patients had acquired RSVA after previous cardiac surgery. We applied 22 duct, 3 muscular, and 1 atrial septal Amplatzer or Amplatzer-like occluders by the anterograde venous approach after arterio-venous loop creation in all but 1 patient. Mean follow-up conducted in outpatient clinic was 5.5±3.5 (1-11)y. RESULTS: The procedure was successful in 19/23 patients (82.6%). Four procedures were abandoned and the device percutaneously retrieved due to coronary artery compression (1 patient), transient increase of aortic regurgitation (AR; 1 patients) or embolization (2 patients). New onset of significant AR was noted in one of the latter patients after device removal. NYHA class improved in all treated patients but 2, in whom it remained stable (p<0.05), with 10 patients in class I. Three patients needed percutaneous re-intervention during follow-up because of significant residual shunt in 1 and late recurrent RSVA in 2 patients. The follow-up of the remaining patients was uneventful. Neither erosion, embolization, new AR, nor death were observed. CONCLUSIONS: The percutaneous closure of RSVA is a safe and effective method of treatment with good clinical outcome. However, although not described previously, recurrent shunts after TC of RSVA are possible and can be treated successfully with another transcatheter intervention.
BACKGROUND: We aimed to evaluate medium- and long-term outcomes of transcatheter closure (TC) of ruptured sinus of Valsalva aneurysm (RSVA), which is a rare and mostly congenital heart disease. METHODS: Retrospective analysis included 23 patients (14 males) aged 15-79 years (y; 39.9±18.5) selected for TC of RSVA between 2007 and 2017 in two tertiary centers in Poland and Ukraine. Fifteen patients were in New York Heart Association (NYHA) class III or IV before TC; 5 patients had acquired RSVA after previous cardiac surgery. We applied 22 duct, 3 muscular, and 1 atrial septal Amplatzer or Amplatzer-like occluders by the anterograde venous approach after arterio-venous loop creation in all but 1 patient. Mean follow-up conducted in outpatient clinic was 5.5±3.5 (1-11)y. RESULTS: The procedure was successful in 19/23 patients (82.6%). Four procedures were abandoned and the device percutaneously retrieved due to coronary artery compression (1 patient), transient increase of aortic regurgitation (AR; 1 patients) or embolization (2 patients). New onset of significant AR was noted in one of the latter patients after device removal. NYHA class improved in all treated patients but 2, in whom it remained stable (p<0.05), with 10 patients in class I. Three patients needed percutaneous re-intervention during follow-up because of significant residual shunt in 1 and late recurrent RSVA in 2 patients. The follow-up of the remaining patients was uneventful. Neither erosion, embolization, new AR, nor death were observed. CONCLUSIONS: The percutaneous closure of RSVA is a safe and effective method of treatment with good clinical outcome. However, although not described previously, recurrent shunts after TC of RSVA are possible and can be treated successfully with another transcatheter intervention.
Authors: Stefana Maria Moisa; Alexandru Burlacu; Crischentian Brinza; Elena Țarcă; Lăcrămioara Ionela Butnariu; Laura Mihaela Trandafir Journal: Diagnostics (Basel) Date: 2022-05-10