299 Reconstruction of mitral and tricuspid valves in patients with heart failure

Patients & Methods: Ten patients (pts) with a mean age of 62 (from 51 to 76) years were included. One pt had two VSDs (residual shunts post surgery) and another 3 pts coexisting critical stenosis of the right and/or left coronary artery (LRA & RCA). The procedure was performed between 2 and 16 weeks (mean 10) after myocardial infarction (MI) with different AD atrial,muscular VSD, postinfact VSD. All pts were in the IIUIV NYHA class all recived inotropic infusion and 2 IABP before and during procedure. Venous transjugular only approach was used in 8 pts, while in 1 pt implantation was performed through femoral vein (after a-v loop creation). Results: All procedures, but 3 were finished successfully. In one pt the defect could not be entered neither from the venous nor the arterial side due to an unusual oblique course (which was confirmed during subsequent operation), in another one (2 weeks after MI) 24ram AD passed through the defect without possiblity to place it correctly, in the third pt with aneurysmatic and dissected septum it was impossible to implant AD becauase of kinking of the long shear. In the postsurgical pt with double PIVSD 2 AD were used. Immediate significant clinical improvement was achieved in all treated pts. In 3 pts prior to VSD closure, PTCA and stent implantation into the RCA and/or LCA were performed. The stretched diameter of the VSDs ranged from 10 to 19 (mean 15) mm, the size of implanted AD devices from 10 to 20 m m (mean 17). Fluoroscopy time was 62 (18-120) rain. During the procedure, ventricular fibrillation required defibrillation was observed in three pts. Two pts died during the first week after the procedure both because of multiorgan failure. Conclusions: Despite some technical problems, implantation of Amplatzer occluders, is an attractive option of treatment of patients with posfinfarct VSD's. Best results are obtined in infarcts at least 6 weeks old, or shunts after surgical patch closure when a firm scar has been formed.