Percutaneous mitral valve repair has shown to be a less-invasive treatment option for patients with symptomatic severe mitral regurgitation (MR) with multiple comorbidities. We describe a case of improved mitral regur...Percutaneous mitral valve repair has shown to be a less-invasive treatment option for patients with symptomatic severe mitral regurgitation (MR) with multiple comorbidities. We describe a case of improved mitral regurgitation due to improved atrial fibrillation secondary to left atrial pressure relief after the inter-atrial defect created during an unsuccessful mitraclip placement attempt. Transthoracic Echocardiogram that was performed on admission showed severe mitral valve regurgitation. She was not a surgical candidate due to multiple co-morbidities. Patient was then medically optimized and a percutaneous MitraClip placement (PMCP) was attempted but was unsuccessful due to excessive trans-mitral gradient and the procedure was aborted. However, left atrial pressure decreased, likely secondary to inter-atrial septal defect created by the procedure. Transesophageal echocardiogram performed post-op showed moderate and improved mitral regurgitation and sinus rhythm. Attempts to convert atrial fibrillation to sinus rhythm to improve mitral regurgitation had to be made before continuing with a mitral clip placement procedure in our case. In our case, the procedure itself did not help patient’s symptoms, but the resulting acute atrial pressure relief improved mitral regurgitation overall due to left to right shunt from iASD, which also helped the rhythm.展开更多
Congenital atrial septal defect(ASD)with severe scoliosis is a rare compound malformation inchildren.Severe sco liosis should be corrected as soon as possible.The growth rod is suitable for patients withearly scoliosi...Congenital atrial septal defect(ASD)with severe scoliosis is a rare compound malformation inchildren.Severe sco liosis should be corrected as soon as possible.The growth rod is suitable for patients withearly scoliosis and obvious scoliosis under 10 years old.However,the fluoroscopic radiopaque of titaniumalloy plate will inevitably partly make the operative field of interventional occlusion blind.We presenta7-year-old Chinese girl with ASD and scoliosis who underwent spinal correction with a dual-growthrod.In this case,we performed transcatheter closure of ASD solely under the guidance of transthoracicechocardiography.Transthoracic echocardiography(TTE)has been reported as efficacious and safe forassessment and guidance of ASD occlusion.For patients with visual field occlusion under fluoroscopy,theapplication of TTE is efficacious and safe for assessmnent and guidance of ASD occlusion.展开更多
BACKGROUND The Food and Drug Administration has approved percutaneous atrial septal defect(ASD)and patent foramen ovale(PFO)closure devices for hemodynamically significant interatrial shunts,paradoxical emboli includi...BACKGROUND The Food and Drug Administration has approved percutaneous atrial septal defect(ASD)and patent foramen ovale(PFO)closure devices for hemodynamically significant interatrial shunts,paradoxical emboli including stroke,and decompression sickness.We aimed to study the trends in utilization and reimbursements of transcatheter ASD/PFO closure devices.AIM To analyze trends in utilization and Medicare reimbursements for transcatheter ASD/PFO closure procedures from 2013 to 2022.METHODS A query of administrative data on United States Medicare beneficiaries undergoing transcatheter ASD/PFO was conducted from 2013 to 2022 using the Centers for Medicare and Medicaid Services Part B National Summary Data File.Inflation adjustments were made using the 2023 Consumer Price Index.Trend analysis was quantified using growth rate and simple linear regression calculations.All analyses were performed using Microsoft Excel 16.77.1(2023).RESULTS The annual number of transcatheter ASD/PFO closure procedures increased by 81%since 2013,with an average yearly growth rate of 44%cases per year(P<0.001).Annual Medicare reimbursements for transcatheter ASD/PFO therapies mirrored the annual procedure trends.The per-case reimbursements decreased by 18%,i.e.,$1128.80 in 2013 and$770.21 in 2022(P<0.001).There was a significant drop in the number of procedures in the year 2020,which correlates to the onset of the coronavirus disease 2019 pandemic,followed by a sharp uptick in the number of cases in 2021 and 2022.CONCLUSION Medicare utilization of transcatheter ASD/PFO closure therapies has grown significantly in procedural volume from 2013 to 2022.However,this has been accompanied by a decrease in per-case reimbursements.展开更多
Background:Totally thoracoscopic surgery(TTS)and right lateral thoracotomy(RLT)are both extensively utilized in the surgical repair for atrial septal defect(ASD).However,RLT is generally considered in low-weight pedia...Background:Totally thoracoscopic surgery(TTS)and right lateral thoracotomy(RLT)are both extensively utilized in the surgical repair for atrial septal defect(ASD).However,RLT is generally considered in low-weight pediatric patients as a result of restricted surgical exposure.This study aims to introduce an RLT approach for ASD repair in adults and compare its clinical outcomes with TTS.Methods:We conducted a retrospective analysis of the clinical data of 23 adult patients who underwent ASD repair at Guangdong Provincial People’s Hospital between June and October 2024.Patients were divided into two groups based on the surgical approach they adopted:group totally thoracoscopic surgery(TTS,n=12)and group right lateral thoracotomy(RLT,n=11).All individuals finished a follow-up three months after surgery.Operative parameters,postoperative courses,echocardiographic measurements and laboratory investigations were compared between the two groups.Results:The total surgical duration was significantly longer in group RLT compared with group TTS[(234.00±47.93)min vs.(175.17±52.36)min,p=0.011].Group RLT exhibited a significantly higher respiratory index(RI)at<6 h postoperatively(1.00±0.58 vs.0.30±0.37,p=0.01)and significantly lower levels of soluble suppression of tumorigenicity 2(sST2)[(136.61±43.12)ng/mL vs.(199.08±33.56)ng/mL,p=0.037]and cardiac troponin(cTnT)[(277.04±89.85)pg/mL vs.(343.30±482.40)pg/mL,p=0.047]at 12-24 h postoperatively.Echocardiographic measurements showed no significant differences between two groups,except for a more pronounced reduction in left atrial(LA)size at discharge in group TTS[(5.00±3.64)mm vs.(0.09±4.44)mm,p=0.008].Conversely,group RLT demonstrated a less significant decrease in glutamyl transpeptidase(GGT)[(1.00±6.00)U/L vs.(5.25±3.86)U/L,p=0.026]but a more significant decrease in blood urea nitrogen(BUN)[(1.81±1.10)mg/dL vs.(0.81±1.07)mg/dL,p=0.038].Conclusions:RLT for ASD repair in adults demonstrated comparable clinical outcomes to TTS in terms of postoperative recovery and cardiac function and also produced fewer scars than TTS.Our study proved the feasibility,safety and cosmetic effects of uniport RLT for ASD repair in adults when compared with TTS.展开更多
Residual atrioventricular valve regurgitation after correction of complete atrioventricular septal defect(cAVSD)is still not ideal.As a modification of the double-patch method,our technique comprises a suture-bite-wid...Residual atrioventricular valve regurgitation after correction of complete atrioventricular septal defect(cAVSD)is still not ideal.As a modification of the double-patch method,our technique comprises a suture-bite-wide strip of a third patch that is incorporated to the upper margin of the left side of the ventricular septal defect(VSD)patch.This third patch counteracts not only the valvular tissue loss caused by the suture bites but also the rightward displacement of the VSD patch in a bulged fashion that occurs with increased left ventricular pressure after weaning from cardiopulmonary bypass.This unfavorable outcome was addressed with the current technique through augmentation of the left-sided bridging leaflets serving to prevent the separation of them from their corresponding mural leaflets.The concept was applied in two cases with Down syndrome aged 5 months and 6 months,respectively,as a rescue procedure in the same session just after a failed cAVSD repair.Since the immediate-and short-term outcomes of the atrioventricular valves in regard to regurgitation are satisfying,we believe that the technique proposed herein holds promise for the future in terms of tackling residual atrioventricular valve regurgitation.展开更多
Objective: To evaluate of the role of transesophageal echocardiography (TEE)in percutaneous closure of atrial septal defects (ASD) with the Amplatzer septal occluder. Methods:Sixty- two patients (10 to 55 years of age...Objective: To evaluate of the role of transesophageal echocardiography (TEE)in percutaneous closure of atrial septal defects (ASD) with the Amplatzer septal occluder. Methods:Sixty- two patients (10 to 55 years of age) were selected for percutaneous closure of ASD bytrans-esophageal echocardiography, which was also used to monitor the procedure, to select theappropriate size of the Amplatzer device, to verify its position, and to access the immediateresults of the procedure. During the follow-up, transthoracic echocardiography (TTE) or TEE was usedto evaluate the presence and magnitude of residual shunt (RS), device position, and right cardiacchamber diameters. Results: The mean ASD diameter by TTE ([19. 1 +- 5. 8] mm) was significantlysmaller (P< 0. 001) than the stretched diameter of the ASD (25. 1 +- 6. 4) mm. There are nosignificant differences between the TEE -measured value (23. 5+_6. 2) mm and the stretched diameterof the ASD (P > 0. 05). Due to proper patient selection all procedures were successful. There wasimmediate and complete closure in 61/62 patients, only one patients had trivial residual shunt.Follow- up was performed using TTE or TEE right after operation, 1 d, 1 month, 3 months, 6 monthsand yearly thereafter. Ail, patients remain asymptomatic without any clinical or technical problems.Conclusion: With the aid of TEE, percutaneous closure of ASD can be performed successfully, safely,and effectively.展开更多
Objective: To evaluate the therapeutic effect, safety and complications oftranscathetering Amplatzer device in the closure of patent ductus arteriosus (PDA) and atrial septaldefects (ASD) in children. Methods: Patient...Objective: To evaluate the therapeutic effect, safety and complications oftranscathetering Amplatzer device in the closure of patent ductus arteriosus (PDA) and atrial septaldefects (ASD) in children. Methods: Patients with PDA (n = 25) and ASD ( n = 16), confirmed byechocardiography, were treated by transcatheterization. Amplatzer occluder device was placed by thetranscatheterization with the image support of X-ray and transthoracic echocardiography ( TTE) . TheTTE, ECG and X-ray examination were engaged to evaluate the therapeutic results on the time pointsof 24 h , 1, 3 , 6, 12 months after the operation, and all these cases were engaged to the follow-upexamination. Results: The cardioangiographic diameter was 13.0-28.0 mm ([19.3+-4.9] mm) in ASD and2.0-7.7 mm ([3.9+-1.5] mm) in PDA . The diameter of the Amplatzer occluder selected were 13.0-30.0mm ( [20.6+-5.1] mm) in ASD and 4.0-12.0 mm ([6.6+-1.9] mm) in PDA , respectively. All the Amplatzeroccluders were placed successfully. There were no complications during and after the operation.Very small residual shunt was still found soon after the operation in 10 cases , and there were noresidual or recanalization after three months of the operation. The pulmonary artery pressure andheart size were significantly decreased in follow-up examination . Conclusion: Transcatheteringclosure with Amplatzer device is an effective, simple and safe technique in the treatment of ASD andPDA in children.展开更多
Objective:To evaluate the feasibility,safety and efficacy of transcathcter closure of ventricular septal defect(VSD)in patients with aortic valve prolapse(AVP)and mild aortic regurgitation(AR).Methods:Between January ...Objective:To evaluate the feasibility,safety and efficacy of transcathcter closure of ventricular septal defect(VSD)in patients with aortic valve prolapse(AVP)and mild aortic regurgitation(AR).Methods:Between January 2008 and July 2014,transcatheter closure of VSD was attempted in 65 patients.Results:The total intermediate closure successful rate in all subjects was 96.9%.During the perioperative period,no death,major bleeding,pericardial tamponade,occluder dislodgement,residual shunt or hemolysis occurred.Two procedures had been forced to suspend due to significant aggregation of device related aortic regurgitation,three cases of transient complete left bundle branch block occurred but did not sustain.At 1-year followup,no patients had residual shunts and complications.Furthermore,grade of residual AR were relieved in 61.9%(39/63)cases and degree of AVP were ameliorated in 36.5%(23/63)patients;Conclusions:Transcatheter closure VSD in selected patients with AVP and mild AR is technically feasible and highly effective.Long term safety and efficacy needs to be assessed.展开更多
An atrial septal defect (ASD) may cause right heart dysfunction, pulmonary hypertension and atrial fibrillation (AF), and atrial septal defect occlusion (ASDO) is the first choice for treating secundum defects when th...An atrial septal defect (ASD) may cause right heart dysfunction, pulmonary hypertension and atrial fibrillation (AF), and atrial septal defect occlusion (ASDO) is the first choice for treating secundum defects when the morphology permits. ASD and AF frequently coexist, and the risk of AF and stroke persists after ASDO.[1] In recent years, left atrial appendage occlusion (LAAO) has been recognized as an effective treatment for stroke prevention in nonvalvular AF patients with a high risk of stroke, systemic embolism and bleeding who are unwilling to take oral anticoagulants or cannot tolerate them.展开更多
Congenital heart disease （CHD） is the leading cause of birth defects, and its etiology is not completely understood. Atrial septal defect （ASD） is one of the most common defects of CHD. Previous studies have demon...Congenital heart disease （CHD） is the leading cause of birth defects, and its etiology is not completely understood. Atrial septal defect （ASD） is one of the most common defects of CHD. Previous studies have demonstrated that mutations in the transcription factor T-box 20 （TBX20） contribute to congenital ASD. Whole-exome sequencing in combination with a CHD-related gene filter was used to detect a family of three generations with ASD. A novel TBX20 mutation, c.526G〉A （p.D176N）, was identified and co-segregated in all affected members in this family. This mutation was predicted to be deleterious by bioinformatics programs （SIFT, Polyphen2, and MutationTaster）. This mutation was also not presented in the current Single Nucleotide Polymorphism Database （dbSNP） or National Heart, Lung, and Blood Institute （NHLBI） Exome Sequencing Project （ESP）. In conclusion, our finding expands the spectrum of TBX20 mutations and provides additional support that TBX20 plays important roles in cardiac development. Our study also provided a new and cost-effective analysis strategy for the genetic study in small CHD pedigree.展开更多
Objective To evaluate the efficacy of minimally invasive perventricular device closure of ventricular septal defect(VSD). Methods Between September 2011 and February 2013, we collected 40 patients who underwent perven...Objective To evaluate the efficacy of minimally invasive perventricular device closure of ventricular septal defect(VSD). Methods Between September 2011 and February 2013, we collected 40 patients who underwent perventricular closure via a small lower sternal incision(minimally invasive group), aged 15.5±3.5 years(12 months to 32 years) with a body weight of 24.2±7.5 kg(10.8-58.0 kg). The mean size of VSD was 5.6±0.5 mm(2-14 mm). Another 40 patients were included as the surgical group, receiving the conventional surgical repair of VSD. The device of the minimally invasive group was released under the guidance of transesophageal echocardiography. Success rate, cardiac indicators, and clinical outcomes of the 2 groups were compared. Results The patients in the surgical group and those in the minimally invasive group showed similar results in success rate(both 97.5%). The procedure time, intensive care unit stay, hospital stay, and postoperative recovery time in the minimally invasive group were significantly shorter than those in the surgical group(58±21 minutes versus 145±26 minutes, 2±1 days versus 8±3 days, 5±1 days versus 16±6 days, 3±1 days versus 90±20 days, all P<0.05). The minimally invasive group had a higher incidence of conduction anomalies(17.5% versus 2.5%, P<0.05). In the follow-up period of 3-12 months, there was no new residual shunt, noticeable aortic regurgitation, significant arrhythmias, or device failure except for new complications in the surgical group. Conclusions The success rate of minimally invasive perventricular device closure of VSD under transesophageal echocardiography guidance is similar to that of conventional surgical repair, but the short-term outcomes of the minimally invasive approach is much better. Long-term follow-up is necessary to confirm the effectiveness of this technique.展开更多
Background: Perimembranous ventricular septal defect combined with right coronary cusp bulge generally should be treated with surgical thoracotomy, owing to the potential aortic regurgitation. However, the minimally i...Background: Perimembranous ventricular septal defect combined with right coronary cusp bulge generally should be treated with surgical thoracotomy, owing to the potential aortic regurgitation. However, the minimally invasive method of transcatheter closure has always attracted the attention of cardiologists and patients. The present study aimed to apply transcatheter occlusion in treating ventricular septal defect with right coronary cusp bulge and further evaluate the clinical effect through follow-up. Materials and methods: A total of 40 children diagnosed as having a ventricular septal defect with right coronary cusp bulge, examined using transthoracic echocardiography and cardiovascular angiography, were enrolled in this study. The ventricular septal defects were closed by placing occluders through transcatheter occlusion treatment. During the operation process, the children underwent angiography and transthoracic echocardiography examinations to check the position of the occlude and the extent of aortic regurgitation. The influence of occlusion on the conduction system was evaluated using a surface electrocardiogram. The children were followed up after their procedures. Results: All 40 patients were immediately and successfully occluded. Three patients with filament residual shunts were observed during the operations. No major surgical complications occurred during the perioperative period. During the follow-up period, the positions of all the occluders were good, the residual shunts in the three patients disappeared, and no new or aggravated aortic regurgitation occurred. Electrocardiogram did not reveal any atrioventricular blocks. Only one patient suffered from an incomplete right bundle branch block. Conclusions: Children diagnosed with ventricular septal defect combined with right coronary cusp bulge could be considered for transcatheter occlusion. With appropriate indications and methods, the effect may be favorable.展开更多
BACKGROUND The off-label use of various devices has been reported for the transcatheter closure of perimembranous ventricular septal defects(PmVSD) because of serious complications, such as heart block and tricuspid r...BACKGROUND The off-label use of various devices has been reported for the transcatheter closure of perimembranous ventricular septal defects(PmVSD) because of serious complications, such as heart block and tricuspid regurgitation(TR),associated with conventional ventricular septal defect devices. However, whether certain defects such as PmVSD with abnormally attached tricuspid are fit for interventional treatment is still disputable.AIM To explore the feasibility and safety of transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae using an improved patent ductus arteriosus(PDA) occluder.METHODS We retrospectively analyzed 20 patients diagnosed with PmVSD with abnormally attached tricuspid chordae tendineae who underwent interventional treatment using an improved PDA occluder at our center from January 2012 to January 2016. Baseline characteristics and procedural and follow-up data were analyzed.RESULTS All 20 patients achieved procedure success. No heart block occurred during the operation. One patient had a transient complete right bundle branch block within48 h post-procedure and reverted to normal rhythm after intravenous injections of dexamethasone for 3 d. For all 20 patients, no residual shunt was observed by transthoracic echocardiography post-procedure. During the average follow-up period of 2.4 years, no severe TR was observed.CONCLUSION Using of the improved PDA occluder for the transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae is a safe and promising treatment option. However, long-term follow-up in a large group of patients is still warranted.展开更多
AIM:To investigate long-term efficacy of two different devices more than five years after percutaneous atrial septal defect(ASD)closure in adults.METHODS:All patients who underwent percutaneous closure of an ASD in th...AIM:To investigate long-term efficacy of two different devices more than five years after percutaneous atrial septal defect(ASD)closure in adults.METHODS:All patients who underwent percutaneous closure of an ASD in the St.Antonius Hospital,Nieuwegein,The Netherlands,between February 1998 and December 2006 were included.Percutaneous closure took place under general anaesthesia and transesophageal echocardiographic moni toring.Transthoracic echocardiography(TTE)was performed 24 h post-procedure to visualize the device position and to look for residual shunting using color Doppler.All complications were registered.All patients were invited for an outpatient visit and contrast TTE more than 5-years after closure.Efficacy was based on the presence of a residual right-to-left shunt(RLS),graded as minimal,moderate or severe.The presence of a residual left-to-right shunt(LRS)was diagnosed using color Doppler,and was not graded.Descriptive statistics were used for patients'characteristics.Univariate analysis was used to identify predictors for residual shunting.RESULTS:In total,104 patients(mean age 45.5±17.1 years)underwent percutaneous ASD closure using an Amplatzer device(ASO)in 76 patients and a Cardioseal/Starflex device(CS/SF)in 28 patients.The mean follow-up was 6.4±3.4 years.Device migration occurred in 4 patients of whom two cases occurred during the index hospitalization(1 ASO,1 CS/SF).The other 2 cases of device migration occurred during the first 6 mo of follow-up(2 CS/SF).The recurrent thrombo-embolic event rate was similar in both groups:0.4%per follow-up year.More than 12 mo post-ASD closure and latest follow-up,new-onset supraventricular tachyarrhythmia's occurred in 3.9%and 0%for the ASO and CS/SF group,respectively.The RLS rate at latest follow-up was 17.4%(minimal 10.9%,moderate 2.2%,severe 4.3%)and 45.5%(minimal 27.3%,moderate 18.2%,severe 0%)for the ASO-and CS/SF groups,respectively.There was no residual LRS in both groups.CONCLUSION:Percutaneous ASD closure has good long-term safety and efficacy profiles.The residual RLS rate seems to be high more than 5 years after closure,especially in the CS/SF.Residual LRS was not observed.展开更多
Percutaneous left atrial appendage(LAA)occlusion evolved as an alternative treatment to the patients who are contraindicated or cannot tolerate oral anticoagulants with nonvalvular atrial fibrillation(AF)at risk of st...Percutaneous left atrial appendage(LAA)occlusion evolved as an alternative treatment to the patients who are contraindicated or cannot tolerate oral anticoagulants with nonvalvular atrial fibrillation(AF)at risk of stroke or systemic embolism.[1]Abnormal hemodynamic changes in elder atrial septal defect(ASD)patients cause remodeling of the left atrium,which eventually leads to right heart failure.[2]As the ASDs elderly are associated with a higher incidence of AF,simultaneous transcatheter ASD and LAA closure has become a new effective therapeutic strategy.However,only a limited number of articles involving cardiac tamponade complications have been published in the literature.What’s more,previous studies involving early hemodynamically irrelevant pericardial effusion after the procedure attribute to multiple repositioning attempts of LAA occluder or delivery sheath injured the atrial wall.展开更多
The present study evaluated the application of three dimensional echocardigraphy （3DE） in the diagnosis of atrial septal defect （ASD） and the measurement of its size by 3DE and compared the size with surgical find...The present study evaluated the application of three dimensional echocardigraphy （3DE） in the diagnosis of atrial septal defect （ASD） and the measurement of its size by 3DE and compared the size with surgical findings. Two-dimensional and real-time three dimensional echocardiography （RT3DE） was performed in 26 patients with atrial septal defect, and the echocardiographic data were compared with the surgical findings. Significant correlation was found between defect diameter by RT3DE and that measured during surgery （r=0.77, P〈0.001）. The defect area changed significantly during cardiac cycle. Percentage change in defect size during cardiac cycle ranged from 6%-70%. Our study showed that the size and morphology of atrial septal defect obtained with RT3DE correlate well with surgical findings. Therefore, RT3DE is a feasible and accurate non-invasive imaging tool for assessment of atrial septal size and dynamic changes.展开更多
We report the management of a patient with secundum atrial septal defect （ASD） and severe pulmonary hypertension. A 65-year-old male with recently diagnosed atrial septal defect was referred to our centre for decomp...We report the management of a patient with secundum atrial septal defect （ASD） and severe pulmonary hypertension. A 65-year-old male with recently diagnosed atrial septal defect was referred to our centre for decompensated right heart failure with rest and exercise induced dispnea and severe pulmonary hypertension. Right heart catheterization confirmed a mean pulmonary pressure of about 55 mmHg and a Qp/Qs of 2.7. An occlusion test with a compliant large balloon demonstrated partial fall of pulmonary arterial pressure. The implantation of a home-made fenestrated Amplatzer ASD Occluder （ASO） was planned in order to decrease left-to-right shunt and promote further decrease of pulmonary arterial pressure in the long-term. Thus, by means of mechanical intracardiac echocardiography study with a 9F 9 MHz Ultralce catheter （Boston Scientific Corp.）, we selected a 34 mm ASO for implantation. Four millimeter fenestration was made inflating a 4 mm non-compliant coronary balloon throughout the waist of the ASO, which was successfully implanted under intmcardiac echocardiography. After six months, a decrease of pulmonary arterial pressure to 24 mmHg and full compensated right heart failure was observed on transthoracic echocardiography and clinical examination. This case suggests that Wanscatheter closure with home-made fenestrated ASD in elderly patients with severe pulmonary hypertension is feasible.展开更多
A 54-year-old female patient with congenital heart disease had a persistent complete left bundle branch block three months after closure by an Amplatzer ventricular septal defect occluder. Nine months later, the patie...A 54-year-old female patient with congenital heart disease had a persistent complete left bundle branch block three months after closure by an Amplatzer ventricular septal defect occluder. Nine months later, the patient suffered from chest distress, palpitation, and sweating at daily activities, and her 6-min walk distance decreased significantly （155 m）. Her echocardiography showed increased left ventricular end-diastolic diameter with left ventricular ejection fraction of 37%. Her symptoms reduced significantly one week after received cardiac resynchronization therapy. She had no symptoms at daily activities, and her echo showed left ventricular ejection fraction of 46%and 53%. Moreover, left ventricular end-diastolic diameter decreased 6 and 10 months after cardiac resynchronization therapy, and 6-min walk dis-tance remarkably increased. This case demonstrated that persistent complete left bundle branch block for nine months after transcatheter closure with ventricular septal defect Amplatzer occluder could lead to left ventricular enlargement and a significant decrease in left ventricular systolic function. Cardiac resynchronization therapy decreased left ventricular end-diastolic diameter and increased left ventricular ejection fraction, thereby improving the patient’s heart functions.展开更多
The dynamic characteristics of the area of the atrial septal defect（ASD） were evaluated using the technique of real-time three-dimensional echocardiography（RT 3DE）, the potential factors responsible for the dynami...The dynamic characteristics of the area of the atrial septal defect（ASD） were evaluated using the technique of real-time three-dimensional echocardiography（RT 3DE）, the potential factors responsible for the dynamic characteristics of the area of ASD were observed, and the overall and local volume and functions of the patients with ASD were measured. RT 3DE was performed on the 27 normal controls and 28 patients with ASD. Based on the three-dimensional data workstations, the area of ASD was measured at P wave vertex, R wave vertex, T wave starting point, and T wave terminal point and in the T-P section. The right atrial volume in the same time phase of the cardiac cycle and the motion displacement distance of the tricuspid annulus in the corresponding period were measured. The measured value of the area of ASD was analyzed. The changes in the right atrial volume and the motion displacement distance of the tricuspid annulus in the normal control group and the ASD group were compared. The right ventricular ejection fractions in the normal control group and the ASD group were compared using the RT 3DE long-axis eight-plane（LA 8-plane） method. Real-time three-dimensional volume imaging was performed in the normal control group and ASD group（n=30）. The right ventricular inflow tract, outflow tract, cardiac apex muscular trabecula dilatation, end-systolic volume, overall dilatation, end-systolic volume, and appropriate local and overall ejection fractions in both two groups were measured with the four-dimensional right ventricular quantitative analysis method（4D RVQ） and compared. The overall right ventricular volume and the ejection fraction measured by the LA 8-plane method and 4D RVQ were subjected to a related analysis. Dynamic changes occurred to the area of ASD in the cardiac cycle. The rules for dynamic changes in the area of ASD and the rules for changes in the right atrial volume in the cardiac cycle were consistent. The maximum value of the changes in the right atrial volume occurred in the end-systolic period when the peak of the curve appeared. The minimum value of the changes occurred in the end-systolic period and was located at the lowest point of the volume variation curve. The area variation curve for ASD and the motion variation curve for the tricuspid annulus in the cardiac cycle were the same. The displacement of the tricuspid annulus exhibited directionality. The measured values of the area of ASD at P wave vertex, R wave vertex, T wave starting point, T wave terminal point and in the T-P section were properly correlated with the right atrial volume（P〈0.001）. The area of ASD and the motion displacement distance of the tricuspid annulus were negatively correlated（P〈0.05）. The right atrial volumes in the ASD group in the cardiac cycle in various time phases increased significantly as compared with those in the normal control group（P=0.0001）. The motion displacement distance of the tricuspid annulus decreased significantly in the ASD group as compared with that in the normal control group（P=0.043）. The right ventricular ejection fraction in the ASD group was lower than that in the normal control group（P=0.032）. The ejection fraction of the cardiac apex trabecula of the ASD patients was significantly lower than the ejection fractions of the right ventricular outflow tract and inflow tract and overall ejection fraction. The difference was statistically significant（P=0.005）. The right ventricular local and overall dilatation and end-systolic volumes in the ASD group increased significantly as compared with those in the normal control group（P=0.031）. The a RVEF and the overall ejection fraction decreased in the ASD group as compared with those in the normal control group（P=0.0005）. The dynamic changes in the area of ASD and the motion curves for the right atrial volume and tricuspid annulus have the same dynamic characteristics. RT 3DE can be used to accurately evaluate the local and overall volume and functions of the right ventricle. The local and overall volume loads of the right ventricle in the ASD patients increase significantly as compared with those of the normal people. The right ventricular cardiac apex and the overall systolic function decrease.展开更多
BACKGROUND Transcatheter device closure of atrial septal defect(ASD) guided by fluoroscopy and/or transesophageal echocardiography is a mature technology. Little study has focused on whether the technology can be guid...BACKGROUND Transcatheter device closure of atrial septal defect(ASD) guided by fluoroscopy and/or transesophageal echocardiography is a mature technology. Little study has focused on whether the technology can be guided totally by transthoracic echocardiography(TTE),even in pregnant women with ASD.AIM To evaluate the safety and efficacy of totally TTE guided transcatheter device closure of ASD in pregnant women.METHODS Six pregnant women(gestational age 20-26 wk) with ASD underwent transcatheter device closure totally guided by TTE at our cardiac center from January 2015 to August 2017. A routine transcatheter procedure without fluoroscopy or intubation and a domestic occluder were used in this study.RESULTS All patients had successful closure with good clinical results,and the overall immediate complete closure rate was 100%. The size of the occluder deployed ranged from 20 to 32 mm(26.7 ± 4.3 mm),the procedure time ranged from 30 to50 min(41.7 ± 7.5 min),and the length of hospital stay was 2-3 d(mean 2.2 ± 0.4 d). There were no serious cardiovascular related complications,and transient arrhythmias occurred in one patient during the procedure. During the follow-up period(3 mo to 2 years),no occluder dislodgement,residual fistulas,or thromboses occurred. All of the patients underwent vaginal delivery between 36 and 38 wk of gestation.CONCLUSION Totally TTE guided transcatheter device closure of ASD in pregnant women may be safe and effective.展开更多
文摘Percutaneous mitral valve repair has shown to be a less-invasive treatment option for patients with symptomatic severe mitral regurgitation (MR) with multiple comorbidities. We describe a case of improved mitral regurgitation due to improved atrial fibrillation secondary to left atrial pressure relief after the inter-atrial defect created during an unsuccessful mitraclip placement attempt. Transthoracic Echocardiogram that was performed on admission showed severe mitral valve regurgitation. She was not a surgical candidate due to multiple co-morbidities. Patient was then medically optimized and a percutaneous MitraClip placement (PMCP) was attempted but was unsuccessful due to excessive trans-mitral gradient and the procedure was aborted. However, left atrial pressure decreased, likely secondary to inter-atrial septal defect created by the procedure. Transesophageal echocardiogram performed post-op showed moderate and improved mitral regurgitation and sinus rhythm. Attempts to convert atrial fibrillation to sinus rhythm to improve mitral regurgitation had to be made before continuing with a mitral clip placement procedure in our case. In our case, the procedure itself did not help patient’s symptoms, but the resulting acute atrial pressure relief improved mitral regurgitation overall due to left to right shunt from iASD, which also helped the rhythm.
基金supported by the National Natural Science Foundation of China(82271725).
文摘Congenital atrial septal defect(ASD)with severe scoliosis is a rare compound malformation inchildren.Severe sco liosis should be corrected as soon as possible.The growth rod is suitable for patients withearly scoliosis and obvious scoliosis under 10 years old.However,the fluoroscopic radiopaque of titaniumalloy plate will inevitably partly make the operative field of interventional occlusion blind.We presenta7-year-old Chinese girl with ASD and scoliosis who underwent spinal correction with a dual-growthrod.In this case,we performed transcatheter closure of ASD solely under the guidance of transthoracicechocardiography.Transthoracic echocardiography(TTE)has been reported as efficacious and safe forassessment and guidance of ASD occlusion.For patients with visual field occlusion under fluoroscopy,theapplication of TTE is efficacious and safe for assessmnent and guidance of ASD occlusion.
文摘BACKGROUND The Food and Drug Administration has approved percutaneous atrial septal defect(ASD)and patent foramen ovale(PFO)closure devices for hemodynamically significant interatrial shunts,paradoxical emboli including stroke,and decompression sickness.We aimed to study the trends in utilization and reimbursements of transcatheter ASD/PFO closure devices.AIM To analyze trends in utilization and Medicare reimbursements for transcatheter ASD/PFO closure procedures from 2013 to 2022.METHODS A query of administrative data on United States Medicare beneficiaries undergoing transcatheter ASD/PFO was conducted from 2013 to 2022 using the Centers for Medicare and Medicaid Services Part B National Summary Data File.Inflation adjustments were made using the 2023 Consumer Price Index.Trend analysis was quantified using growth rate and simple linear regression calculations.All analyses were performed using Microsoft Excel 16.77.1(2023).RESULTS The annual number of transcatheter ASD/PFO closure procedures increased by 81%since 2013,with an average yearly growth rate of 44%cases per year(P<0.001).Annual Medicare reimbursements for transcatheter ASD/PFO therapies mirrored the annual procedure trends.The per-case reimbursements decreased by 18%,i.e.,$1128.80 in 2013 and$770.21 in 2022(P<0.001).There was a significant drop in the number of procedures in the year 2020,which correlates to the onset of the coronavirus disease 2019 pandemic,followed by a sharp uptick in the number of cases in 2021 and 2022.CONCLUSION Medicare utilization of transcatheter ASD/PFO closure therapies has grown significantly in procedural volume from 2013 to 2022.However,this has been accompanied by a decrease in per-case reimbursements.
基金This research was funded by the Natural Science Foundation of Guangdong Province(2023A1515012501)Guangzhou Municipal Science and Technology Planning Project(2023B03J1254)Congenital Heart Disease Medical Talent Cultivation and Education Fund(2023QT0009).
文摘Background:Totally thoracoscopic surgery(TTS)and right lateral thoracotomy(RLT)are both extensively utilized in the surgical repair for atrial septal defect(ASD).However,RLT is generally considered in low-weight pediatric patients as a result of restricted surgical exposure.This study aims to introduce an RLT approach for ASD repair in adults and compare its clinical outcomes with TTS.Methods:We conducted a retrospective analysis of the clinical data of 23 adult patients who underwent ASD repair at Guangdong Provincial People’s Hospital between June and October 2024.Patients were divided into two groups based on the surgical approach they adopted:group totally thoracoscopic surgery(TTS,n=12)and group right lateral thoracotomy(RLT,n=11).All individuals finished a follow-up three months after surgery.Operative parameters,postoperative courses,echocardiographic measurements and laboratory investigations were compared between the two groups.Results:The total surgical duration was significantly longer in group RLT compared with group TTS[(234.00±47.93)min vs.(175.17±52.36)min,p=0.011].Group RLT exhibited a significantly higher respiratory index(RI)at<6 h postoperatively(1.00±0.58 vs.0.30±0.37,p=0.01)and significantly lower levels of soluble suppression of tumorigenicity 2(sST2)[(136.61±43.12)ng/mL vs.(199.08±33.56)ng/mL,p=0.037]and cardiac troponin(cTnT)[(277.04±89.85)pg/mL vs.(343.30±482.40)pg/mL,p=0.047]at 12-24 h postoperatively.Echocardiographic measurements showed no significant differences between two groups,except for a more pronounced reduction in left atrial(LA)size at discharge in group TTS[(5.00±3.64)mm vs.(0.09±4.44)mm,p=0.008].Conversely,group RLT demonstrated a less significant decrease in glutamyl transpeptidase(GGT)[(1.00±6.00)U/L vs.(5.25±3.86)U/L,p=0.026]but a more significant decrease in blood urea nitrogen(BUN)[(1.81±1.10)mg/dL vs.(0.81±1.07)mg/dL,p=0.038].Conclusions:RLT for ASD repair in adults demonstrated comparable clinical outcomes to TTS in terms of postoperative recovery and cardiac function and also produced fewer scars than TTS.Our study proved the feasibility,safety and cosmetic effects of uniport RLT for ASD repair in adults when compared with TTS.
文摘Residual atrioventricular valve regurgitation after correction of complete atrioventricular septal defect(cAVSD)is still not ideal.As a modification of the double-patch method,our technique comprises a suture-bite-wide strip of a third patch that is incorporated to the upper margin of the left side of the ventricular septal defect(VSD)patch.This third patch counteracts not only the valvular tissue loss caused by the suture bites but also the rightward displacement of the VSD patch in a bulged fashion that occurs with increased left ventricular pressure after weaning from cardiopulmonary bypass.This unfavorable outcome was addressed with the current technique through augmentation of the left-sided bridging leaflets serving to prevent the separation of them from their corresponding mural leaflets.The concept was applied in two cases with Down syndrome aged 5 months and 6 months,respectively,as a rescue procedure in the same session just after a failed cAVSD repair.Since the immediate-and short-term outcomes of the atrioventricular valves in regard to regurgitation are satisfying,we believe that the technique proposed herein holds promise for the future in terms of tackling residual atrioventricular valve regurgitation.
文摘Objective: To evaluate of the role of transesophageal echocardiography (TEE)in percutaneous closure of atrial septal defects (ASD) with the Amplatzer septal occluder. Methods:Sixty- two patients (10 to 55 years of age) were selected for percutaneous closure of ASD bytrans-esophageal echocardiography, which was also used to monitor the procedure, to select theappropriate size of the Amplatzer device, to verify its position, and to access the immediateresults of the procedure. During the follow-up, transthoracic echocardiography (TTE) or TEE was usedto evaluate the presence and magnitude of residual shunt (RS), device position, and right cardiacchamber diameters. Results: The mean ASD diameter by TTE ([19. 1 +- 5. 8] mm) was significantlysmaller (P< 0. 001) than the stretched diameter of the ASD (25. 1 +- 6. 4) mm. There are nosignificant differences between the TEE -measured value (23. 5+_6. 2) mm and the stretched diameterof the ASD (P > 0. 05). Due to proper patient selection all procedures were successful. There wasimmediate and complete closure in 61/62 patients, only one patients had trivial residual shunt.Follow- up was performed using TTE or TEE right after operation, 1 d, 1 month, 3 months, 6 monthsand yearly thereafter. Ail, patients remain asymptomatic without any clinical or technical problems.Conclusion: With the aid of TEE, percutaneous closure of ASD can be performed successfully, safely,and effectively.
文摘Objective: To evaluate the therapeutic effect, safety and complications oftranscathetering Amplatzer device in the closure of patent ductus arteriosus (PDA) and atrial septaldefects (ASD) in children. Methods: Patients with PDA (n = 25) and ASD ( n = 16), confirmed byechocardiography, were treated by transcatheterization. Amplatzer occluder device was placed by thetranscatheterization with the image support of X-ray and transthoracic echocardiography ( TTE) . TheTTE, ECG and X-ray examination were engaged to evaluate the therapeutic results on the time pointsof 24 h , 1, 3 , 6, 12 months after the operation, and all these cases were engaged to the follow-upexamination. Results: The cardioangiographic diameter was 13.0-28.0 mm ([19.3+-4.9] mm) in ASD and2.0-7.7 mm ([3.9+-1.5] mm) in PDA . The diameter of the Amplatzer occluder selected were 13.0-30.0mm ( [20.6+-5.1] mm) in ASD and 4.0-12.0 mm ([6.6+-1.9] mm) in PDA , respectively. All the Amplatzeroccluders were placed successfully. There were no complications during and after the operation.Very small residual shunt was still found soon after the operation in 10 cases , and there were noresidual or recanalization after three months of the operation. The pulmonary artery pressure andheart size were significantly decreased in follow-up examination . Conclusion: Transcatheteringclosure with Amplatzer device is an effective, simple and safe technique in the treatment of ASD andPDA in children.
基金supported by National Nature Science Foundation of China(NO.81260052)Science and Technology Planning Project of Hainan Province of China(NO.812147)
文摘Objective:To evaluate the feasibility,safety and efficacy of transcathcter closure of ventricular septal defect(VSD)in patients with aortic valve prolapse(AVP)and mild aortic regurgitation(AR).Methods:Between January 2008 and July 2014,transcatheter closure of VSD was attempted in 65 patients.Results:The total intermediate closure successful rate in all subjects was 96.9%.During the perioperative period,no death,major bleeding,pericardial tamponade,occluder dislodgement,residual shunt or hemolysis occurred.Two procedures had been forced to suspend due to significant aggregation of device related aortic regurgitation,three cases of transient complete left bundle branch block occurred but did not sustain.At 1-year followup,no patients had residual shunts and complications.Furthermore,grade of residual AR were relieved in 61.9%(39/63)cases and degree of AVP were ameliorated in 36.5%(23/63)patients;Conclusions:Transcatheter closure VSD in selected patients with AVP and mild AR is technically feasible and highly effective.Long term safety and efficacy needs to be assessed.
文摘An atrial septal defect (ASD) may cause right heart dysfunction, pulmonary hypertension and atrial fibrillation (AF), and atrial septal defect occlusion (ASDO) is the first choice for treating secundum defects when the morphology permits. ASD and AF frequently coexist, and the risk of AF and stroke persists after ASDO.[1] In recent years, left atrial appendage occlusion (LAAO) has been recognized as an effective treatment for stroke prevention in nonvalvular AF patients with a high risk of stroke, systemic embolism and bleeding who are unwilling to take oral anticoagulants or cannot tolerate them.
基金Project supported by the National Natural Science Foundation of China （Nos. 81370204, 81300072, and 81101475） Electronic supplementary materials： The online version of this article （htlp：//dx.doi.org/10.1631/jzus.B1400062） contains supplementary materials, which are available to authorized users
文摘Congenital heart disease （CHD） is the leading cause of birth defects, and its etiology is not completely understood. Atrial septal defect （ASD） is one of the most common defects of CHD. Previous studies have demonstrated that mutations in the transcription factor T-box 20 （TBX20） contribute to congenital ASD. Whole-exome sequencing in combination with a CHD-related gene filter was used to detect a family of three generations with ASD. A novel TBX20 mutation, c.526G〉A （p.D176N）, was identified and co-segregated in all affected members in this family. This mutation was predicted to be deleterious by bioinformatics programs （SIFT, Polyphen2, and MutationTaster）. This mutation was also not presented in the current Single Nucleotide Polymorphism Database （dbSNP） or National Heart, Lung, and Blood Institute （NHLBI） Exome Sequencing Project （ESP）. In conclusion, our finding expands the spectrum of TBX20 mutations and provides additional support that TBX20 plays important roles in cardiac development. Our study also provided a new and cost-effective analysis strategy for the genetic study in small CHD pedigree.
文摘Objective To evaluate the efficacy of minimally invasive perventricular device closure of ventricular septal defect(VSD). Methods Between September 2011 and February 2013, we collected 40 patients who underwent perventricular closure via a small lower sternal incision(minimally invasive group), aged 15.5±3.5 years(12 months to 32 years) with a body weight of 24.2±7.5 kg(10.8-58.0 kg). The mean size of VSD was 5.6±0.5 mm(2-14 mm). Another 40 patients were included as the surgical group, receiving the conventional surgical repair of VSD. The device of the minimally invasive group was released under the guidance of transesophageal echocardiography. Success rate, cardiac indicators, and clinical outcomes of the 2 groups were compared. Results The patients in the surgical group and those in the minimally invasive group showed similar results in success rate(both 97.5%). The procedure time, intensive care unit stay, hospital stay, and postoperative recovery time in the minimally invasive group were significantly shorter than those in the surgical group(58±21 minutes versus 145±26 minutes, 2±1 days versus 8±3 days, 5±1 days versus 16±6 days, 3±1 days versus 90±20 days, all P<0.05). The minimally invasive group had a higher incidence of conduction anomalies(17.5% versus 2.5%, P<0.05). In the follow-up period of 3-12 months, there was no new residual shunt, noticeable aortic regurgitation, significant arrhythmias, or device failure except for new complications in the surgical group. Conclusions The success rate of minimally invasive perventricular device closure of VSD under transesophageal echocardiography guidance is similar to that of conventional surgical repair, but the short-term outcomes of the minimally invasive approach is much better. Long-term follow-up is necessary to confirm the effectiveness of this technique.
基金supported by the National Science Foundation of China(Grant number 81470443)
文摘Background: Perimembranous ventricular septal defect combined with right coronary cusp bulge generally should be treated with surgical thoracotomy, owing to the potential aortic regurgitation. However, the minimally invasive method of transcatheter closure has always attracted the attention of cardiologists and patients. The present study aimed to apply transcatheter occlusion in treating ventricular septal defect with right coronary cusp bulge and further evaluate the clinical effect through follow-up. Materials and methods: A total of 40 children diagnosed as having a ventricular septal defect with right coronary cusp bulge, examined using transthoracic echocardiography and cardiovascular angiography, were enrolled in this study. The ventricular septal defects were closed by placing occluders through transcatheter occlusion treatment. During the operation process, the children underwent angiography and transthoracic echocardiography examinations to check the position of the occlude and the extent of aortic regurgitation. The influence of occlusion on the conduction system was evaluated using a surface electrocardiogram. The children were followed up after their procedures. Results: All 40 patients were immediately and successfully occluded. Three patients with filament residual shunts were observed during the operations. No major surgical complications occurred during the perioperative period. During the follow-up period, the positions of all the occluders were good, the residual shunts in the three patients disappeared, and no new or aggravated aortic regurgitation occurred. Electrocardiogram did not reveal any atrioventricular blocks. Only one patient suffered from an incomplete right bundle branch block. Conclusions: Children diagnosed with ventricular septal defect combined with right coronary cusp bulge could be considered for transcatheter occlusion. With appropriate indications and methods, the effect may be favorable.
文摘BACKGROUND The off-label use of various devices has been reported for the transcatheter closure of perimembranous ventricular septal defects(PmVSD) because of serious complications, such as heart block and tricuspid regurgitation(TR),associated with conventional ventricular septal defect devices. However, whether certain defects such as PmVSD with abnormally attached tricuspid are fit for interventional treatment is still disputable.AIM To explore the feasibility and safety of transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae using an improved patent ductus arteriosus(PDA) occluder.METHODS We retrospectively analyzed 20 patients diagnosed with PmVSD with abnormally attached tricuspid chordae tendineae who underwent interventional treatment using an improved PDA occluder at our center from January 2012 to January 2016. Baseline characteristics and procedural and follow-up data were analyzed.RESULTS All 20 patients achieved procedure success. No heart block occurred during the operation. One patient had a transient complete right bundle branch block within48 h post-procedure and reverted to normal rhythm after intravenous injections of dexamethasone for 3 d. For all 20 patients, no residual shunt was observed by transthoracic echocardiography post-procedure. During the average follow-up period of 2.4 years, no severe TR was observed.CONCLUSION Using of the improved PDA occluder for the transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae is a safe and promising treatment option. However, long-term follow-up in a large group of patients is still warranted.
文摘AIM:To investigate long-term efficacy of two different devices more than five years after percutaneous atrial septal defect(ASD)closure in adults.METHODS:All patients who underwent percutaneous closure of an ASD in the St.Antonius Hospital,Nieuwegein,The Netherlands,between February 1998 and December 2006 were included.Percutaneous closure took place under general anaesthesia and transesophageal echocardiographic moni toring.Transthoracic echocardiography(TTE)was performed 24 h post-procedure to visualize the device position and to look for residual shunting using color Doppler.All complications were registered.All patients were invited for an outpatient visit and contrast TTE more than 5-years after closure.Efficacy was based on the presence of a residual right-to-left shunt(RLS),graded as minimal,moderate or severe.The presence of a residual left-to-right shunt(LRS)was diagnosed using color Doppler,and was not graded.Descriptive statistics were used for patients'characteristics.Univariate analysis was used to identify predictors for residual shunting.RESULTS:In total,104 patients(mean age 45.5±17.1 years)underwent percutaneous ASD closure using an Amplatzer device(ASO)in 76 patients and a Cardioseal/Starflex device(CS/SF)in 28 patients.The mean follow-up was 6.4±3.4 years.Device migration occurred in 4 patients of whom two cases occurred during the index hospitalization(1 ASO,1 CS/SF).The other 2 cases of device migration occurred during the first 6 mo of follow-up(2 CS/SF).The recurrent thrombo-embolic event rate was similar in both groups:0.4%per follow-up year.More than 12 mo post-ASD closure and latest follow-up,new-onset supraventricular tachyarrhythmia's occurred in 3.9%and 0%for the ASO and CS/SF group,respectively.The RLS rate at latest follow-up was 17.4%(minimal 10.9%,moderate 2.2%,severe 4.3%)and 45.5%(minimal 27.3%,moderate 18.2%,severe 0%)for the ASO-and CS/SF groups,respectively.There was no residual LRS in both groups.CONCLUSION:Percutaneous ASD closure has good long-term safety and efficacy profiles.The residual RLS rate seems to be high more than 5 years after closure,especially in the CS/SF.Residual LRS was not observed.
基金supported by the Ph.D. Launch Programs Foundation of Liaoning Province (2019-BS-266)
文摘Percutaneous left atrial appendage(LAA)occlusion evolved as an alternative treatment to the patients who are contraindicated or cannot tolerate oral anticoagulants with nonvalvular atrial fibrillation(AF)at risk of stroke or systemic embolism.[1]Abnormal hemodynamic changes in elder atrial septal defect(ASD)patients cause remodeling of the left atrium,which eventually leads to right heart failure.[2]As the ASDs elderly are associated with a higher incidence of AF,simultaneous transcatheter ASD and LAA closure has become a new effective therapeutic strategy.However,only a limited number of articles involving cardiac tamponade complications have been published in the literature.What’s more,previous studies involving early hemodynamically irrelevant pericardial effusion after the procedure attribute to multiple repositioning attempts of LAA occluder or delivery sheath injured the atrial wall.
基金supported by a grant from the Youth Science Foundation of China (No.30600213)
文摘The present study evaluated the application of three dimensional echocardigraphy （3DE） in the diagnosis of atrial septal defect （ASD） and the measurement of its size by 3DE and compared the size with surgical findings. Two-dimensional and real-time three dimensional echocardiography （RT3DE） was performed in 26 patients with atrial septal defect, and the echocardiographic data were compared with the surgical findings. Significant correlation was found between defect diameter by RT3DE and that measured during surgery （r=0.77, P〈0.001）. The defect area changed significantly during cardiac cycle. Percentage change in defect size during cardiac cycle ranged from 6%-70%. Our study showed that the size and morphology of atrial septal defect obtained with RT3DE correlate well with surgical findings. Therefore, RT3DE is a feasible and accurate non-invasive imaging tool for assessment of atrial septal size and dynamic changes.
文摘We report the management of a patient with secundum atrial septal defect （ASD） and severe pulmonary hypertension. A 65-year-old male with recently diagnosed atrial septal defect was referred to our centre for decompensated right heart failure with rest and exercise induced dispnea and severe pulmonary hypertension. Right heart catheterization confirmed a mean pulmonary pressure of about 55 mmHg and a Qp/Qs of 2.7. An occlusion test with a compliant large balloon demonstrated partial fall of pulmonary arterial pressure. The implantation of a home-made fenestrated Amplatzer ASD Occluder （ASO） was planned in order to decrease left-to-right shunt and promote further decrease of pulmonary arterial pressure in the long-term. Thus, by means of mechanical intracardiac echocardiography study with a 9F 9 MHz Ultralce catheter （Boston Scientific Corp.）, we selected a 34 mm ASO for implantation. Four millimeter fenestration was made inflating a 4 mm non-compliant coronary balloon throughout the waist of the ASO, which was successfully implanted under intmcardiac echocardiography. After six months, a decrease of pulmonary arterial pressure to 24 mmHg and full compensated right heart failure was observed on transthoracic echocardiography and clinical examination. This case suggests that Wanscatheter closure with home-made fenestrated ASD in elderly patients with severe pulmonary hypertension is feasible.
文摘A 54-year-old female patient with congenital heart disease had a persistent complete left bundle branch block three months after closure by an Amplatzer ventricular septal defect occluder. Nine months later, the patient suffered from chest distress, palpitation, and sweating at daily activities, and her 6-min walk distance decreased significantly （155 m）. Her echocardiography showed increased left ventricular end-diastolic diameter with left ventricular ejection fraction of 37%. Her symptoms reduced significantly one week after received cardiac resynchronization therapy. She had no symptoms at daily activities, and her echo showed left ventricular ejection fraction of 46%and 53%. Moreover, left ventricular end-diastolic diameter decreased 6 and 10 months after cardiac resynchronization therapy, and 6-min walk dis-tance remarkably increased. This case demonstrated that persistent complete left bundle branch block for nine months after transcatheter closure with ventricular septal defect Amplatzer occluder could lead to left ventricular enlargement and a significant decrease in left ventricular systolic function. Cardiac resynchronization therapy decreased left ventricular end-diastolic diameter and increased left ventricular ejection fraction, thereby improving the patient’s heart functions.
文摘The dynamic characteristics of the area of the atrial septal defect（ASD） were evaluated using the technique of real-time three-dimensional echocardiography（RT 3DE）, the potential factors responsible for the dynamic characteristics of the area of ASD were observed, and the overall and local volume and functions of the patients with ASD were measured. RT 3DE was performed on the 27 normal controls and 28 patients with ASD. Based on the three-dimensional data workstations, the area of ASD was measured at P wave vertex, R wave vertex, T wave starting point, and T wave terminal point and in the T-P section. The right atrial volume in the same time phase of the cardiac cycle and the motion displacement distance of the tricuspid annulus in the corresponding period were measured. The measured value of the area of ASD was analyzed. The changes in the right atrial volume and the motion displacement distance of the tricuspid annulus in the normal control group and the ASD group were compared. The right ventricular ejection fractions in the normal control group and the ASD group were compared using the RT 3DE long-axis eight-plane（LA 8-plane） method. Real-time three-dimensional volume imaging was performed in the normal control group and ASD group（n=30）. The right ventricular inflow tract, outflow tract, cardiac apex muscular trabecula dilatation, end-systolic volume, overall dilatation, end-systolic volume, and appropriate local and overall ejection fractions in both two groups were measured with the four-dimensional right ventricular quantitative analysis method（4D RVQ） and compared. The overall right ventricular volume and the ejection fraction measured by the LA 8-plane method and 4D RVQ were subjected to a related analysis. Dynamic changes occurred to the area of ASD in the cardiac cycle. The rules for dynamic changes in the area of ASD and the rules for changes in the right atrial volume in the cardiac cycle were consistent. The maximum value of the changes in the right atrial volume occurred in the end-systolic period when the peak of the curve appeared. The minimum value of the changes occurred in the end-systolic period and was located at the lowest point of the volume variation curve. The area variation curve for ASD and the motion variation curve for the tricuspid annulus in the cardiac cycle were the same. The displacement of the tricuspid annulus exhibited directionality. The measured values of the area of ASD at P wave vertex, R wave vertex, T wave starting point, T wave terminal point and in the T-P section were properly correlated with the right atrial volume（P〈0.001）. The area of ASD and the motion displacement distance of the tricuspid annulus were negatively correlated（P〈0.05）. The right atrial volumes in the ASD group in the cardiac cycle in various time phases increased significantly as compared with those in the normal control group（P=0.0001）. The motion displacement distance of the tricuspid annulus decreased significantly in the ASD group as compared with that in the normal control group（P=0.043）. The right ventricular ejection fraction in the ASD group was lower than that in the normal control group（P=0.032）. The ejection fraction of the cardiac apex trabecula of the ASD patients was significantly lower than the ejection fractions of the right ventricular outflow tract and inflow tract and overall ejection fraction. The difference was statistically significant（P=0.005）. The right ventricular local and overall dilatation and end-systolic volumes in the ASD group increased significantly as compared with those in the normal control group（P=0.031）. The a RVEF and the overall ejection fraction decreased in the ASD group as compared with those in the normal control group（P=0.0005）. The dynamic changes in the area of ASD and the motion curves for the right atrial volume and tricuspid annulus have the same dynamic characteristics. RT 3DE can be used to accurately evaluate the local and overall volume and functions of the right ventricle. The local and overall volume loads of the right ventricle in the ASD patients increase significantly as compared with those of the normal people. The right ventricular cardiac apex and the overall systolic function decrease.
基金Supported by Chinese National and Fujian Provincial Key Clinical Specialty Construction Programs
文摘BACKGROUND Transcatheter device closure of atrial septal defect(ASD) guided by fluoroscopy and/or transesophageal echocardiography is a mature technology. Little study has focused on whether the technology can be guided totally by transthoracic echocardiography(TTE),even in pregnant women with ASD.AIM To evaluate the safety and efficacy of totally TTE guided transcatheter device closure of ASD in pregnant women.METHODS Six pregnant women(gestational age 20-26 wk) with ASD underwent transcatheter device closure totally guided by TTE at our cardiac center from January 2015 to August 2017. A routine transcatheter procedure without fluoroscopy or intubation and a domestic occluder were used in this study.RESULTS All patients had successful closure with good clinical results,and the overall immediate complete closure rate was 100%. The size of the occluder deployed ranged from 20 to 32 mm(26.7 ± 4.3 mm),the procedure time ranged from 30 to50 min(41.7 ± 7.5 min),and the length of hospital stay was 2-3 d(mean 2.2 ± 0.4 d). There were no serious cardiovascular related complications,and transient arrhythmias occurred in one patient during the procedure. During the follow-up period(3 mo to 2 years),no occluder dislodgement,residual fistulas,or thromboses occurred. All of the patients underwent vaginal delivery between 36 and 38 wk of gestation.CONCLUSION Totally TTE guided transcatheter device closure of ASD in pregnant women may be safe and effective.
