Background: Transcatheter device closure of ventricular septal defect (VSD) is an alternative to conventional surgical closure. Device closure of moderate to large perimembranous VSD (pmVSD) is considered technically challenging in smaller children weighing 10 kg. Very few studies are published on the outcomes of the same. Methods: Descriptive single-center retrospective study. Data of 49 children 10 kg with moderate to large pmVSDs taken up for transcatheter device closure in our institute were analyzed and their follow-up details were reviewed. Results: Of the 87 patients referred for VSD closure, 49 patients qualified for the inclusion criteria. Median age was 18 months (interquartile range: 13-22). Successful device deployment was achieved in 42 (85.7%) patients. Mean VSD size by transthoracic echocardiography was 5.98 mm (range: 4-12 mm). Mean waist size of the device used was 8.26 mm (range: 4-14 mm). There was one device embolization, requiring catheter-directed retrieval from the left ventricle and subsequent surgical referral for VSD closure. Minor complications such as device-related persistent new aortic regurgitation was noted in one patient and mild tricuspid regurgitation and transient heart block occurred in two patients each. There was no mortality or complete heart block requiring permanent pacemaker implantation immediately or during midterm follow-up (mean follow-up: 20 months; range: 6-72.5 months). Conclusion: Device closure of moderate to large pmVSDs in children weighing 10 kg is feasible and safe with a success rate of 85.7%. Careful selection of patients and avoidance of oversizing the defect makes the immediate and midterm results acceptable. Keywords moderate to large perimembranous VSD (pmVSD), transcatheter device closure, success rate, complete heart block (CHB), aortic regurgitation (AR), children 10 kg
Objective
This study was conducted to assess the incidence of sudden cardiac death (SCD) in post myocardial infarction patients and to determine the predictive value of various risk markers in identifying cardiac mortality and SCD.
Methods
Left ventricular function, arrhythmias on Holter and microvolt T wave alternans (MTWA) were assessed in patients with prior myocardial infarction and ejection fraction ≤ 40%. The primary outcome was a composite of cardiac death and resuscitated cardiac arrest during follow up. Secondary outcomes included total mortality and SCD.
Results
Fifty-eight patients were included in the study. Eight patients (15.5%) died during a mean follow-up of 22.3 ± 6.6 months. Seven of them (12.1%) had SCD. Among the various risk markers studied, left ventricular ejection fraction (LVEF) ≤ 30% (Hazard ratio 5.6, 95% CI 1.39 to 23) and non-sustained ventricular tachycardia (NSVT) in holter (5.7, 95% CI 1.14 to 29) were significantly associated with the primary outcome in multivariate analysis. Other measures, including QRS width, heart rate variability, heart rate turbulence and MTWA showed no association.
Conclusions
Among patients with prior myocardial infarction and reduced left ventricular function, the rate of cardiac death was substantial, with most of these being sudden cardiac death. Both LVEF ≤30% and NSVT were associated with cardiac death whereas only LVEF predicted SCD. Other parameters did not appear useful for prediction of events in these patients. These findings have implications for decision making for the use of implantable cardioverter defibrillators for primary prevention in these patients.
Background Acute myocardial infarction (AMI) secondary to coronary embolization is one of the rare complications of atrial myxoma. Takotsubo cardiomyopathy (TCM), a close mimic of AMI, is extremely rare in the setting of atrial myxoma. We report a patient with atrial myxoma presenting with features leading to a clinical dilemma between these two entities.
Case summary A 60-year-old woman presented with acute chest pain with ST segment elevation. Echocardiogram revealed left ventricular (LV) apical ballooning which is typical of TCM, coexisting with a fragile left atrial mass. Emergency coronary angiogram showed a hazy lesion in the circumflex ostium and an intermediate lesion in ramus without any obstruction. Surgical excision of the tumor was done due to features of recurrent coronary embolism. The histopathology examination confirmed it as a myxoma. Regional wall motion abnormalities reversed within a month and LV function normalized. Cardiac magnetic resonance (CMR) imaging at follow-up suggested myocardial infarction.
Discussion TCM can occur very rarely in the setting of atrial myxoma. In a patient with atrial myxoma presenting with features of TCM, differentiating it from coronary embolization is important.
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