Claudio Bussadori

Recent technological progresses have led to the development of new devices and procedures which have greatly improved the chance to effectively treat structural heart diseases in both children and adults. Interventional cardiology has been receiving fast and wide implementation as an effective alternative treatment to surgery for several congenital and acquired diseases. The advent of transcatheter valve implantation/repair techniques constitutes one of the main breakthroughs of the last decades. Such development and implementation is strictly related to a continuous progress in cardiac imaging as well. Indeed, multimodality cardiac imaging (such as X-ray, echocardiography, MRI, multidetector computed tomography) has become essential in providing accurate patient selection and in monitoring the interventional procedures in order to optimize the success rate and minimize the frequency of complications. The current article aims at reviewing the role of multimodality imaging for planning and guiding interventions in several structural heart diseases.

Different devices are used for transcatheter occlusion of patent ductus arteriosus (PDA), each with its own limitations and complications. We report our initial single-center experience with the new Amplatzer Duct Occluder II (ADO II), which has been designed to address some of these issues. From April until October 2008, 10 consecutive patients with PDA (minimal diameter > or = 2 mm) were enrolled for intention-to-treat with ADO II. The median age was 10.2 years (7 months to 51.4 years); the median weight was 35.5 kg (6.3-70 kg). ADO II implantation was attempted in 10/10 patients. The mean PDA diameter was 3.1 mm (+/- 1.0 mm), and the mean device waist diameter was 4.0 mm (+/- 1.3 mm). In 1 patient, the ADO II encroached upon the left pulmonary artery, hence it was changed to an Amplatzer Duct Occluder I. In another patient, the shape and size of the duct necessitated the use of a Cook detachable coil. Complete angiographic closure was achieved in 8/8 ADO II implantations (100%) and in the patient with the coil. In the patient with an ADO I, complete echocardiographic closure was demonstrated at 24 hours. No device embolization or complications related to implantation occurred. This initial experience demonstrates the feasibility and efficacy of the ADO II to occlude PDA with a minimum diameter > or = 2 mm. It is especially useful in smaller children with larger duct diameters. Longer-term follow up in a larger cohort of patients is required to establish safety and long-term results.

To evaluate the possibility to perform both percutaneous coronary interventions (PCI) and atrial septal defect (ASD) transcatheter treatment during the same session. Transcatheter ASD closure is a well-established alternative to surgery and the treatment of choice for single vessel coronary artery disease (CAD) is accepted to be PCI. From January 2000 to December 2005, 985 patients were referred to our center for ASD closure. One hundred thirty four patients (59 males, mean age 58 +/- 4 years, range 45-72 years) were included in a prospective protocol of ASD transcatheter closure and coronary angiography. In 7 patients we found a coronary artery disease. A combined single setting definitive percutaneous approach (ASD closure and PCI) was performed in 6 patients. The patient number 4 was judged unsuitable for PCI and then was referred for surgery. There was no acute intra-procedural complication in all patients; renal functions pre and post procedure showed no change despite the increase in the amount of contrast used. Our report showed the feasibility of both PCI and ASD transcatheter treatment during the same session.