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BackgroundPercutaneous closure of interatrial septal communications (IASC) is generally being regarded as a safe and straightforward intervention. Reporting and classification of adverse events (AE) as is the case for percutaneous coronary intervention (PCI) is not standardized. Also, the focus of reported larger studies has not been primarily on AE and strategies to avoid them.MethodsThe data of all 112 consecutive patients undergoing IASC by a single operator were reviewed. In analogy to classification for PCI, an AE was considered to be major if any of the following occurred: death, major or minor stroke, myocardial infarction, the need for an originally unplanned additional surgery or intervention or blood transfusion. Every AE and how it may have been avoided is reviewed in detail.ResultsMajor AE according to the suggested classification occurred in 2.7% of patients, including tamponade in 1 patient necessitating thoracotomy 7 months after IASC, percutaneous retrieval of an embolized device in 1 patient, and ambulatory same day surgical treatment of an arteriovenous fistula in 1 patient.ConclusionsThe proposed new classification of AE provides a unified and comparable approach for IASC procedures. Retrospectively, two of the 3 major AE could have probably been avoided by more thoughtful patient and material selection.

Objectives: To assess the cardioprotective efficiency of an antioxidant regimen (vitamins E, C and N-acetylcysteine) in patients receiving high dose chemo-and/or radiotherapy for malignant disease. Methods: Prospective, placebo controlled, randomized and double blinded pilot study involving 13 patients receiving chemotherapy and 12 patients receiving radiotherapy.

BackgroundTranscatheter closure of interatrial septal communications (IASC) is being increasingly performed, while less is known about predictors and incidence of new onset atrial fibrillation (AF) after device closure. Hitherto, most studies have only analyzed some parameters potentially influencing the occurrence of AF, variously omitting others and thus limiting interpretation of results.MethodsDescriptive, single author, observational study with 68 consecutive patients [aged 53.6 ± 15.1 years; 32 females (47%)] undergoing IASC closure, being followed up for 16.8 (±9.9; 6–42) months. Two patients with AF previous to device implantation had been excluded. Parameters analyzed included age and gender as well as presence of coronary artery disease, hypertension, atrial size, body mass index, device size, and presence of residual shunt. Device size was normalized to maximal disk diameter as declared by the manufacturer.ResultsThe incidence of new onset AF was 10.3% in the first 6 months after IASC closure. The only two predictors linked to AF were device size (P = 0.002) and, although not reaching significance level, right atrial dilatation (P = 0.08).ConclusionOccluder size was the only significant predictor of post-procedural AF, especially after PFO closure. Although there may be constraints (defect size, presence of an atrial septal aneurysm) that may dictate implantation of a larger device, it is reasonable to implant them “as large as necessary, as small as possible”. The influence of atrial dimensions on post-procedural onset of AF must be further investigated.

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