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Goodwill and Intangible Assets
9 Months Ended
Sep. 30, 2015
Goodwill and Intangible Assets Disclosure [Abstract]  
Goodwill and Intangible Assets
Goodwill and Intangible Assets. The changes in the carrying amount of goodwill for the nine months ended September 30, 2015 are as follows (in thousands):

 
2015
Goodwill balance at December 31, 2014
184,464

Effect of foreign exchange
(40
)
Additions as the result of acquisitions
60

Goodwill balance at September 30
$
184,484



There were no changes in the carrying amount of goodwill for the nine months ended September 30, 2014.

As of September 30, 2015, we had recorded $8.3 million of accumulated goodwill impairment charges. All of the goodwill balance as of September 30, 2015 and December 31, 2014 related to our cardiovascular segment.

Other intangible assets at September 30, 2015 and December 31, 2014, consisted of the following (in thousands):

 
September 30, 2015
 
Gross Carrying
Amount
 
Accumulated
Amortization
 
Net Carrying
Amount
Patents
$
11,484

 
$
(2,476
)
 
$
9,008

Distribution agreements
5,626

 
(2,705
)
 
2,921

License agreements
18,463

 
(2,271
)
 
16,192

Trademarks
7,268

 
(2,435
)
 
4,833

Covenants not to compete
1,029

 
(815
)
 
214

Customer lists
20,806

 
(14,572
)
 
6,234

Royalty agreements
267

 
(267
)
 

 
 
 
 
 
 
Total
$
64,943

 
$
(25,541
)
 
$
39,402


 
December 31, 2014
 
Gross Carrying
Amount
 
Accumulated
Amortization
 
Net Carrying
Amount
Patents
$
10,199

 
$
(2,196
)
 
$
8,003

Distribution agreements
5,376

 
(2,285
)
 
3,091

License agreements
8,995

 
(1,823
)
 
7,172

Trademarks
7,298

 
(2,079
)
 
5,219

Covenants not to compete
1,029

 
(636
)
 
393

Customer lists
20,452

 
(13,194
)
 
7,258

Royalty agreements
267

 
(267
)
 

 
 
 
 
 
 
Total
$
53,616

 
$
(22,480
)
 
$
31,136



Aggregate amortization expense for the three and nine-month periods ended September 30, 2015 was approximately $3.7 million and $11.1 million, respectively, and approximately $3.8 million and $11.2 million for the three and nine-month periods ending September 30, 2014, respectively.

Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of September 30, 2015 (in thousands):

Year Ending December 31
 
Remaining 2015
$
4,446

2016
15,906

2017
15,274

2018
14,849

2019
14,527