Transcatheter treatment of coronary artery disease and atrial septal defect with sequential implantation of coronary stent and Amplatzer septal occluder: Preliminary results

Abstract

Coronary stent implantation had been established as a highly effective revascularization technique in patients with occlusive coronary artery disease. Transcatheter closure of atrial septal defects is becoming a definite alternative to surgery in properly selected patients. During a 19-month period, 6 patients (50% women; mean age, 58 +/- 17 years; range, 32-73 years) of a consecutive series of 176 prospective multicenter registry patients undergoing transcatheter atrial septal defect closure were treated with sequential percutaneous coronary revascularization and Amplatzer septal occluder implantation. Indication for revascularization was stable angina in four patients and unstable angina in two. Indication for defect closure was significant left-to-right shunt with right ventricular enlargement. Defect diameter ranged from 13 to 20 mm by transesophageal echocardiography, and the stretched diameter measured 13 to 25 mm. Procedural success of both interventions was achieved in all cases without in-hospital complications. A total of seven stents were successfully implanted in five coronary vessels. No stent was used in one patient after successful PTCA. Immediate total closure of the defect was obtained in five patients. Trivial residual shunting, observed in one patient, disappeared at 24 hr. No adverse cardiac events, recurrence of anginal symptoms, or evidence of residual shunt were observed at clinical and echocardiographic follow-up, which ranged from 60 to 390 days (mean, 258 +/- 150 days). These results suggest that sequential transcatheter therapy of coronary artery disease and atrial septal defect is safe and efficacious in selected patients.

Successful Transcatheter Atrial Septal Defect Closure Prior to Coronary Artery Bypass Grafting Using Anti-Congestive Therapies and Intraaortic Balloon Pumping in a Patient with Severe Ischemic Cardiomyopathy and Triple-Vessel Coronary Artery Disease

“…5,6) Onorato, et al reported successful sequential percutaneous coronary intervention (PCI) for CAD and transcatheter ASD closure in 6 cases with angina pectoris, where four patients underwent PCI prior to ASD closure. 13) Tomai, et al reported an unsuccessful case that developed acute left HF after a simultaneous approach of PCI and transcatheter ASD closure. 4) They proposed possible reasons for the development of acute left HF such as myocardial stunning following PCI adding to the mildly reduced LVEF at the baseline.…”

Combined Percutaneous Intervention of Coronary Artery Disease and Atrial Septal Defect

“…Very few reports of combined percutaneous procedure are available in the literature. Sequential ASD device closure and PTCA have been reported with ASD closure before [5] or after [6] PTCA. Successful combined procedure was later reported by Yalonetsky et al [7].…”

Congenital Heart Diseases in Aged Patients

“…As a result of the frequent coexistent coronary atherosclerosis, combined intervention of percutaneous revascularization and transcatheter closure could be a good treatment option. 30 Transcatheter closure of patent ductus arteriosus with ϾAmplatzer Occluder devices or detachable coils is effective in the elderly because they avoid morbility associated with surgery 31 ; care should be taken in the case of very enlarged or heavily calcified ductus, which are relative contraindications for transcatheter closure. Although technically difficult, surgical repair has low mortality and excellent follow up in patients Ͼ50 years, especially with Qp/Qs Ͼ 1.5 and pulmonary pressure Ͻ75 mm Hg.…”