Background: We reviewed our experience using the Amplatzer septal occluder (AGA Medical, Golden Valley, MN) to close large, secundum-type atrial septal defects (ASDs) in children. Methods: Between June 2002 and December 2005, 52 patients (mean age 13.5 ¡Ó 8.7 years) underwent transcatheter closure of large (≥25 mm), secundum ASDs by using the Amplatzer septal occluder (ASO). Groups 1 and 2 included patients with a retroaortic rim of <5 mm (n = 39) or ≥5 mm(n = 13), respectively. All procedures were performed with general anesthesia and transesophageal echocardiographic guidance except for 10 patients, which involved local anesthesia and 3-dimensional transthoracic echocardiography. Successful device implantations, device sizes, approaches, complications, and closure rates were assessed. Results: Device implantation was successful in 50 patients (96.1%), with no difference between groups (95% vs 100%, P > 0.05). In 2 patients, implantation failed because of embolism or deployment failure. Devices were larger in group 1 than in group 2 (29.7 ¡Ó 3.9 vs 26.7 ¡Ó 3.0 mm, P =0.04). The right upper pulmonary-vein approach was more common in group 1 than in group 2 (P = .0001). Complications and closure rates did not differ between the groups (P > .05). Conclusions: Transcatheter closure of large, secundum ASD by using the ASO device was feasible, and complication rates were low. A deficient retroaortic rim did not preclude successful device implantation; however, a large device may be needed to close large ASD. Close long-term follow-up is necessary to determine the safety of transcatheter closure of large ASDs in children.

A real-time self-shadowing technique is described. State of the art shadowing techniques that utilize modern hardware often require multiple rendering passes and introduce rendering artifacts. Combining separate ideas from earlier techniques which project geometry onto a plane and project imagery onto an object results in a new real-time technique for self-shadowing. This technique allows an artist to construct occluder textures and assign them to shadow planes for a self-shadowed model. Utilizing a graphics processing unit (GPU), a vertex program computes shadowing coordinates in real-time, while a fragment program applies the shading and shadowing in a single rendering pass. The methodology used to create shadow planes and write the vertex and fragment programs is given, as well as the relation to the previous work. This work includes implementing this technique, applying it to a small set of test models, describing the types of models for which the technique is well suited, as well as those for which it is not well suited, and comparing the technique’s performance and image quality to other state of the art shadowing techniques. This technique performs as well as other real-time techniques and can reduce rendering artifacts in certain circumstances.

Abstract: Background: At present, device closure of interatrial communication has become a well established technique in order to adequately treat severe left-to-right shunt associated with ASDs. During the traditional procedure, fluoroscopy with the waist of a compliant balloon is used to determine the appropriate size of the closure device and defect sizing. Choice of adequate closure device using transthoracic echocardiography (TTE) has been hitherto unreported. Methods & Materials: Between December 2002 and October 2004, 40 patients (15 males, 25 females, mean age; 11.7 ¡Ó 7.8 years ) with secundum ASDs underwent transcatheter closure at our institution. In group 1, 30 patients had the procedure by balloon sizing and TTE sizing. In 10 patients (group 2), TTE sizing was used as the sole too l for selecting device size and the device size was chosen to be based on the Amplatzer septal occluder ( ASO ) size and TTE size ratio in group 1. The procedure was performed under continuous transoesophageal echocardiographic monitor with general anesthesia. Results: The correlation was found between TTE and stretched balloon sizing diameter SBD ( y= 1.2645x-1.4465; R&#x00B2;=0.9861 ), and between TTE size and ASO size ( y = 1.3412x-1.2864; R&#x00B2;=0.9929 ) in group 1. In group 2, statistical correlation between TTE and ASO ( y=1.3419x-0.1172; R&#x00B2;=0.9934 ) was also found. Good linear regression between TTE size and ASO chosen size was noted in group 1 and group 2 (R&#x00B2;=0.99).In group 2, successful device implantation was accomplished in all patients whose device size was chosen to be based on the ASO and TTE ratio in group 1. Conclusions: TTE sizing is a safe and ideal method to measure interatrial defect and choose the occluding device respectively. With our experience, the sizing based on the TTE is generally easier than measurement from the balloon sizing.

No description available.

In this report, an object-space solution to occluder fusion of OBB occluders is explored. Two different approaches are considered were the object-space fusion is reduced to a 2D problem. The first approach finds axis-aligned silhouettes within the projection of occluder OBBs which are then fused together creating large axis-aligned silhouettes. The other approach creates concave hulls of the projected OBB silhouettes from which convex inscribed silhouettes are then found. These silhouettes are then converted back to object-space where shadow frusta created around the silhouettes are used for the culling operation. The effectiveness of the two approaches is evaluated considering the amount of culled geometry. It is shown that fused convex silhouettes are needed to produce competitive results.

As fístulas broncopleurais habitualmente decorrem de procedimentos cirúrgicos de ressecção pulmonar por diversas etiologias, com incidência na literatura de 0% a 28%, e mortalidade de 16% a 72%, sendo mais frequente em homens, e nos casos de pneumonectomia do que em lobectomia. As deiscências totais de coto brônquico apresentam indicação de tratamento cirúrgico, porém a condição clínica destes pacientes geralmente é precária com alto risco anestésico e cirúrgico. Os tratamentos endoscópicos de fístulas broncopleurais até então descritos foram utilizados apenas em fístulas parciais menores que 8 milímetros. Objetivo: Este estudo propõe-se a avaliar a viabilidade do tratamento endoscópico de fístulas totais de coto brônquico utilizando o dispositivo oclusor de defeitos septais cardíacos Occlutech-Fígulla®. Casuística e métodos: Foram incluídos pacientes com fistula broncopleural total secundária a ressecção pulmonar. Os pacientes foram submetidos inicialmente à broncoscopia para avaliação e medida da fístula e a uma cintilografia pulmonar de inalação para documentação do padrão inicial de vazamento. A colocação do dispositivo foi feita através da broncoscopia realizada sob sedo-analgesia com o paciente em ventilação espontânea com suplementação de oxigênio. Os pacientes foram acompanhados durante 12 meses e avaliados quanto à cobertura do dispositivo por tecido cicatricial, fechamento do trajeto fistuloso e desenvolvimento de complicações relacionadas como o deslocamento do dispositivo, lesões de estruturas adjacentes e desenvolvimento de infecção. As análises descritivas dos dados quantitativos com distribuição normal foram apresentadas através das médias acompanhadas dos respectivos desvios padrão. Os dados sem distribuição normal foram apresentados através de suas medianas com os respectivos intervalos interquartil 25-75%. A análise inferencial utilizou a Análise de Variância de Medidas Repetidas para os dados com distribuição normal e os testes não-paramétricos Anova de Friedman para os dados que não apresentavam distribuição normal. Foi considerada uma probabilidade de erro do tipo I (alfa) de 0,05. Resultados: Foram selecionados nove pacientes com predomínio do sexo masculino (77,8%), com média de idade de 45 ±11,1 anos, com ressecções motivadas em sua maioria por sequelas de doença infecciosa (78%), com predomínio de pneumonectomia direita (66,6%), com fístulas que apresentavam diâmetro de 6 a 17 mm. Do grupo de 9 pacientes tratados tivemos três casos de fechamento completo, dois casos de fechamento parcial, duas falhas sendo uma por deslocamento e retirada do dispositivo e outra por retirada ao término do período de seguimento com permanência dos sintomas e dois óbitos não relacionados. Durante o período de acompanhamento não evidenciamos complicações infecciosas ou lesão de estruturas adjacentes relacionadas à permanência do dispositivo. Conclusão: O dispositivo para tratamento de defeitos do septo atrial pode ser uma alternativa no tratamento endoscópico de fístulas totais de coto brônquico, funcionando como tratamento definitivo em alguns casos e servindo como suporte nos pacientes que aguardam melhora das condições clínicas para uma intervenção cirúrgica tardia com menor risco. Não foram detectados eventos graves como infecções ou lesão vascular relacionados à presença do dispositivo / Bronchopleural fistulas are possible complications following lung resection procedures for different etiologies. The reported incidence is 0 % to 28%, and the related mortality is 16% to 72%. More frequently in men and pneumonectomy cases than lobectomy cases. Total dehiscence of the bronchial stump should be treated by surgical interventions; however, the clinical status of these patients is generally poor with high anesthetic and surgical risks. Endoscopic treatment of bronchopleural fistulas previously described were used only in 8mm or smaller partial fistulas. Objective To evaluate the endoscopic treatment of total bronchial stump fistulas using the Occlutech - Fígulla®, a device used to close cardiac septal defects. Patients and methods: We select patients with total bronchial stump fistula. Patients underwent bronchoscopy for local fistula evaluation and an inhalation lung scintigraphy for the initial leak parameter documentation. The placement of the device was made by bronchoscopy performed under sedation - analgesia with the patient in spontaneous ventilation with oxygen supplementation. Patients were followed for 12 months and assessed for scar tissue coverage device, fistula closure and development of related complications such as displacement device, adjacent structures lesions and infection. The descriptive analysis of quantitative data with normal distribution were presented through the mean along with the related standard deviations. Non-normal distribution data were presented by their medians with their respective interquartile ranges 25-75 %. The inferential analysis used Repeated Measures Analysis of Variance for data with normal distribution and non-parametric tests of Friedman ANOVA to data with nonnormal distribution. It was considered an error probability of a type I (alfa) 0.05. Results: This study evaluated nine patients with a males predominance (77.8% ) with mean age of 45 ± 11.1 years with resections for sequelae of infectious disease (78%), predominantly right pneumonectomy (66.6% ), with fistulas diameter ranging from 6 to 17 mm. The group of 9 patients had three cases of complete closure, two cases of partial closure, two failures one per displacement and removal of the device another for withdrawal at the end of follow-up with persistence of symptoms and two unrelated death. During the follow-up period was not detect complications such as infections or injury to adjacent structures related to the device. Conclusion: The device for treatment of atrial septal defects can be an alternative to the endoscopic treatment of total fistula bronchial stump, functioning as definitive treatment in some cases and serving as a support for patients awaiting improvement of clinical conditions for a later surgical intervention with lower risk. No severe events were detected as infections or vascular injury related to the device

As fístulas broncopleurais habitualmente decorrem de procedimentos cirúrgicos de ressecção pulmonar por diversas etiologias, com incidência na literatura de 0% a 28%, e mortalidade de 16% a 72%, sendo mais frequente em homens, e nos casos de pneumonectomia do que em lobectomia. As deiscências totais de coto brônquico apresentam indicação de tratamento cirúrgico, porém a condição clínica destes pacientes geralmente é precária com alto risco anestésico e cirúrgico. Os tratamentos endoscópicos de fístulas broncopleurais até então descritos foram utilizados apenas em fístulas parciais menores que 8 milímetros. Objetivo: Este estudo propõe-se a avaliar a viabilidade do tratamento endoscópico de fístulas totais de coto brônquico utilizando o dispositivo oclusor de defeitos septais cardíacos Occlutech-Fígulla®. Casuística e métodos: Foram incluídos pacientes com fistula broncopleural total secundária a ressecção pulmonar. Os pacientes foram submetidos inicialmente à broncoscopia para avaliação e medida da fístula e a uma cintilografia pulmonar de inalação para documentação do padrão inicial de vazamento. A colocação do dispositivo foi feita através da broncoscopia realizada sob sedo-analgesia com o paciente em ventilação espontânea com suplementação de oxigênio. Os pacientes foram acompanhados durante 12 meses e avaliados quanto à cobertura do dispositivo por tecido cicatricial, fechamento do trajeto fistuloso e desenvolvimento de complicações relacionadas como o deslocamento do dispositivo, lesões de estruturas adjacentes e desenvolvimento de infecção. As análises descritivas dos dados quantitativos com distribuição normal foram apresentadas através das médias acompanhadas dos respectivos desvios padrão. Os dados sem distribuição normal foram apresentados através de suas medianas com os respectivos intervalos interquartil 25-75%. A análise inferencial utilizou a Análise de Variância de Medidas Repetidas para os dados com distribuição normal e os testes não-paramétricos Anova de Friedman para os dados que não apresentavam distribuição normal. Foi considerada uma probabilidade de erro do tipo I (alfa) de 0,05. Resultados: Foram selecionados nove pacientes com predomínio do sexo masculino (77,8%), com média de idade de 45 ±11,1 anos, com ressecções motivadas em sua maioria por sequelas de doença infecciosa (78%), com predomínio de pneumonectomia direita (66,6%), com fístulas que apresentavam diâmetro de 6 a 17 mm. Do grupo de 9 pacientes tratados tivemos três casos de fechamento completo, dois casos de fechamento parcial, duas falhas sendo uma por deslocamento e retirada do dispositivo e outra por retirada ao término do período de seguimento com permanência dos sintomas e dois óbitos não relacionados. Durante o período de acompanhamento não evidenciamos complicações infecciosas ou lesão de estruturas adjacentes relacionadas à permanência do dispositivo. Conclusão: O dispositivo para tratamento de defeitos do septo atrial pode ser uma alternativa no tratamento endoscópico de fístulas totais de coto brônquico, funcionando como tratamento definitivo em alguns casos e servindo como suporte nos pacientes que aguardam melhora das condições clínicas para uma intervenção cirúrgica tardia com menor risco. Não foram detectados eventos graves como infecções ou lesão vascular relacionados à presença do dispositivo / Bronchopleural fistulas are possible complications following lung resection procedures for different etiologies. The reported incidence is 0 % to 28%, and the related mortality is 16% to 72%. More frequently in men and pneumonectomy cases than lobectomy cases. Total dehiscence of the bronchial stump should be treated by surgical interventions; however, the clinical status of these patients is generally poor with high anesthetic and surgical risks. Endoscopic treatment of bronchopleural fistulas previously described were used only in 8mm or smaller partial fistulas. Objective To evaluate the endoscopic treatment of total bronchial stump fistulas using the Occlutech - Fígulla®, a device used to close cardiac septal defects. Patients and methods: We select patients with total bronchial stump fistula. Patients underwent bronchoscopy for local fistula evaluation and an inhalation lung scintigraphy for the initial leak parameter documentation. The placement of the device was made by bronchoscopy performed under sedation - analgesia with the patient in spontaneous ventilation with oxygen supplementation. Patients were followed for 12 months and assessed for scar tissue coverage device, fistula closure and development of related complications such as displacement device, adjacent structures lesions and infection. The descriptive analysis of quantitative data with normal distribution were presented through the mean along with the related standard deviations. Non-normal distribution data were presented by their medians with their respective interquartile ranges 25-75 %. The inferential analysis used Repeated Measures Analysis of Variance for data with normal distribution and non-parametric tests of Friedman ANOVA to data with nonnormal distribution. It was considered an error probability of a type I (alfa) 0.05. Results: This study evaluated nine patients with a males predominance (77.8% ) with mean age of 45 ± 11.1 years with resections for sequelae of infectious disease (78%), predominantly right pneumonectomy (66.6% ), with fistulas diameter ranging from 6 to 17 mm. The group of 9 patients had three cases of complete closure, two cases of partial closure, two failures one per displacement and removal of the device another for withdrawal at the end of follow-up with persistence of symptoms and two unrelated death. During the follow-up period was not detect complications such as infections or injury to adjacent structures related to the device. Conclusion: The device for treatment of atrial septal defects can be an alternative to the endoscopic treatment of total fistula bronchial stump, functioning as definitive treatment in some cases and serving as a support for patients awaiting improvement of clinical conditions for a later surgical intervention with lower risk. No severe events were detected as infections or vascular injury related to the device

We present a case of a previously asymptomatic 63-year-old woman who presented with worsening dyspnoea for 3 weeks. Initial transthoracic and later transoesophageal echocardiography confirmed biventricular non-compaction cardiomyopathy and a large secundum atrial septal defect (ASD) measuring 1.4 cm. Additionally, there was a haemodynamically significant left to right shunt causing acute decompensated systolic heart failure. She eventually underwent closure of the septal defect using a AMPLATZER Septal Occluder device. Decision to close the defect was made as the left to right shunt was causing severe pulmonary hypertension and acute heart failure. Since most heart failure treatments involve lowering of the LV afterload there was consideration that this could cause right to left shunting and could cause an Eisenmenger physiology. Hence the AMPLATZER Septal Occluder device was placed to eliminate the shunt through the ASD. The ASD combined with the non-compaction posed significant treatment challenge in this case.