Same-day discharge after percutaneous closure of persistent foramen ovale using intracardiac echocardiography and the Gore Septal Occluder

AimPeriprocedural and postinterventional care of patients undergoing closure of patent foramen ovale (PFO) varies significantly across care providers. Same-day discharge (SDD) after transcatheter interventions is an evolving concept. This study aimed to assess the same-day discharge rate and incidence of complications in patients undergoing PFO closure with intracardiac echocardiography (ICE) using the Gore®Cardioform Septal Occluder (GSO) device. The secondary aim was to analyse the efficacy of femoral vein closure with Perclose ProGlide.MethodsPatients who underwent PFO closure with the GSO device at a university hospital in Stockholm, Sweden, were retrospectively included between March 1, 2017, and June 30, 2020, all with cryptogenic stroke as the indication for the procedure. All patients underwent PFO closure with conscious sedation and local anaesthesia. The indication for all patients was a cryptogenic stroke. Periprocedural imaging was performed using ICE and fluoroscopy in all patients. Patient characteristics and periprocedural data were collected from patient charts. Patients were kept on bed rest for 4–6 h post-intervention. Transthoracic echocardiography and clinical examination, including groin status, were performed before discharge. No clinical routine follow-up was performed the day following the intervention. Clinical follow-up was done by phone call two weeks after the procedure, and echocardiographic follow-up was done after 12 months. Data were analysed using linear and logistic regression models.ResultsIn total, 262 patients were included, of which 246 (94%) had SDD. 166 patients (63%) received the ProGlide™ system for femoral vein access closure. Post-procedural arrhythmias occurred in 17 (6%) patients, and vascular complications in 9 patients (3%). The overall closure rate at follow-up was 98.5%. 25 out of 264 patients (9.5%) had to be readmitted within the first eight weeks after PFO closure, 16 due to atrial fibrillation warranting electric cardioversion, one due to an arteriovenous fistula that was operated, four due to chest pain/pain at the access site, and four patients developed fever. There was no difference in SDD among patients who received ProGlide™ vs. patients who did not receive ProGlide™.ConclusionSDD appears safe after transcatheter PFO closure with the GSO device with high procedural success rates. Low rates of complications and readmissions make the intervention suitable for this patient-friendly and cost-effective concept

Outbreak of Puumala Virus Infection, Sweden

An unexpected and large outbreak of Puumala virus infection in Sweden resulted in 313 nephropathia epidemica patients/100,000 persons in Västerbotten County during 2007. An increase in the rodent population, milder weather, and less snow cover probably contributed to the outbreak

Endothelial dysfunction in patients with glucose abnormalities and coronary artery disease : Studies of pathogenesis and treatment

Background Type 2 diabetes is associated with endothelial dysfunction, which is characterised by the reduced bioavailability of nitric oxide (NO). This is a result of increased oxidative stress and inflammation and the synthesis of endothelium-dependent vasoconstricting factors such as endothelin-1 (ET-1) caused by hyperglycaemia, insulin resistance and dyslipidemia. The dysfunction of the vascular endothelium is regarded as an important factor for the increased risk of cardiovascular disease seen in patients with type 2 diabetes and it is thought to play a major role in the pathogenesis of both micro- and macrovascular complications in this patient category. This thesis aims to further explore the pathogenesis and treatment options of endothelial dysfunction in patients with glucose abnormalities. Studies I-II The importance of the lipid-independent (pleiotropic) effects of statins was studied in 43 patients with dysglycemia and coronary artery disease. Intensive lipid lowering with either 80 mg of simvastatin or a combination of 10 mg of simvastatin together with 10 mg of ezetimibe improved macrovascular endothelial function and microvascular function (n=36) and reduced inflammation. No difference between the two treatment strategies was found, indicating that the improvements were mainly due to lipid lowering and not to the pleiotropic effects of statins. Study III The effect of endothelin-A-receptor blockade on nutritive skin capillary circulation in patients with type 2 diabetes and microangiopathy was studied. Intra-arterial infusions of an endothelin-A-receptor antagonist improved nutritive skin capillary circulation in patients with type 2 diabetes (n=10) but not in healthy controls (n=8). This finding suggests that ET-1 is involved in the pathogenesis of diabetic microangiopathy. Study IV The effect of L-arginine and tetrahydrobiopterin (BH4) infusion on ischemia/reperfusion (I/R)-induced endothelial dysfunction following 20 minutes of forearm ischemia was studied in 12 patients with type 2 diabetes and coronary artery disease. L-arginine and BH4 significantly attenuated I/R-induced endothelial dysfunction in comparison with placebo. Conclusions The present studies of patients with type 2 diabetes and vascular complications indicate that 1) lipid lowering is more important than the pleiotropic effects of statins for the improvement in macrovascular endothelial function and microvascular function and the reduction in inflammation, 2) targeting the ET-1 system might be of importance in the treatment of complications related to diabetic microangiopathy and 3) supplementation with L-arginine and BH4 may represent a future treatment strategy to limit the I/R injury in patients with type 2 diabetes