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
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
The case report presented in this edition by Mu et al.The report presents a case of atrial septal defect(ASD)associated with electrocardiographic changes,noting that the crochetage sign resolved after Selective His Bu...The case report presented in this edition by Mu et al.The report presents a case of atrial septal defect(ASD)associated with electrocardiographic changes,noting that the crochetage sign resolved after Selective His Bundle Pacing(S-HBP)without requiring surgical closure.The mechanisms behind the appearance and resolution of the crochetage sign remain unclear.The authors observed the dis-appearance of the crochetage sign post-S-HBP,suggesting a possible correlation between these specific R waves and the cardiac conduction system.This editorial aims to explore various types of ASD and their relationship with the cardiac con-duction system,highlighting the diagnostic significance of the crochetage sign in ASD.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
Background:Atrial septal defect(ASD)is one of the common congenital heart diseases.The MYH6 gene has a critical role in cardiac development but the role of MYH6 promoter variants in patients with ASD has not been expl...Background:Atrial septal defect(ASD)is one of the common congenital heart diseases.The MYH6 gene has a critical role in cardiac development but the role of MYH6 promoter variants in patients with ASD has not been explored.Methods:In 613 subjects including 320 ASD patients,we investigated the MYH6 gene promoter variants and verified the effect on gene expression by using cellular functional experiments and bioinformatics analysis.Results:Eleven variants were identified in the MYH6 gene promoter,of which four variants were found only in ASD patients,and two variants(g.3434G>C and g.4524C>T)were identified for the first time.Cellular functional experiments indicated that all four variants reduced the transcriptional activity of the MYH6 gene promoter(p<0.05).Subsequent analysis through the JASPAR(A database of transcription factor binding profiles)suggests that these variants may alter transcription factor binding sites,which may in turn lead to changes in myocardin subunit expression and ASD formation.Conclusions:Our study for the first time focuses on variants in the promoter region of the MYH6 gene in Chinese patients with ASD and the discovered variants have functional significance.The study provides new insights in the role of the MYH6 gene promoter region to better understand the genetic basis of ASD formation and facilitates clinical diagnosis.展开更多
Stereoscopic three-dimensional echocardiography（S-3DE） is a novel displaying technol-ogy based on real-time 3-dimensional echocardiography （RT-3DE）. Our study was to evaluate the feasibility and efficiency of S-3D...Stereoscopic three-dimensional echocardiography（S-3DE） is a novel displaying technol-ogy based on real-time 3-dimensional echocardiography （RT-3DE）. Our study was to evaluate the feasibility and efficiency of S-3DE in the diagnosis of atrial septal defect （ASD） and its use in the guidance for transcatheter ASD occlusion. Twelve patients with secundum ASD underwent RT-3DE examination and 9 of the 12 were subjected to transcatheter closure of ASD. Stereoscopic vision was generated with a high-performance volume renderer with red-green stereoscopic glasses. S-3DE was compared with standard RT-3D display for the assessment of the shape, size, and the surrounding tis-sues of ASD and for the guidance of ASD occlusion. The appearance rate of coronary sinus and the mean formation time of the IVC, SVC were compared. Our results showed that S-3DE could measure the diameter of ASD accurately and there was no significant difference in the measurements between S-3DE and standard 3D display （2.89±0.73 cm vs 2.85±0.72 cm, P〉0.05; r=0.96, P〈0.05）. The appearance of coronary sinus for S-3DE was higher as compared with the standard 3D display （93.3% vs 100%）. The mean time of the IVC, SVC for S-3DE monitor was slightly shorter than that of the standard 3D display （11.0±3.8 s vs 10.3±3.6 s, P〉0.05）. The mean completion time of interven-tional procedure was shortened with S-3DE display as compared with standard 3D display （17.3±3.1 min vs 23.0±3.9 min, P〈0.05）. Stereoscopic three-dimensional echocardiography could improve the visualization of three-dimensional echocardiography, facilitate the identification of the adjacent structures, decrease the time required for interventional manipulation. It may be a feasible, safe, and efficient tool for guiding transcatheter septal occlusion or the surgical interventions.展开更多
Objective ：To study the gene mutations of homeobox transcription factor （CSX/NKX2.5） associated with a Chinese family with secundum atrial septal defect （ASD）. Methods ：Polymerase chain reaction and DNA sequenci...Objective ：To study the gene mutations of homeobox transcription factor （CSX/NKX2.5） associated with a Chinese family with secundum atrial septal defect （ASD）. Methods ：Polymerase chain reaction and DNA sequencing were used to check all the members in the family with ASD, and single strand conformation polymorphism analysis （SSCP） was used to check 126 normal control people for detecting the mutations of CSX/NKX2.5 gene. Results： Three mutations, G270A（Glu32Lys ）, G378A （Glu68Lys）andG390A （Glu72Lys）were identified in CSX/NKX2.5 gene of ASD patients. However, the other members in the family with ASD and the control did not have such gene mutations. Conclusion：These mutations of CSX/NKX2.5 gene, which were identified in a Chinese family, may be one of the secundum ASD etiologic causes .展开更多
A 66-year-old woman with lower limb edema and exertional dyspnea presented to the emergency department.Posteroanterior chest X-ray revealed a Fleischner’s sign in both lungs(Figure 1A)suggesting a pulmonary hypertens...A 66-year-old woman with lower limb edema and exertional dyspnea presented to the emergency department.Posteroanterior chest X-ray revealed a Fleischner’s sign in both lungs(Figure 1A)suggesting a pulmonary hypertension.A subsequent transthoracic echocardiogram revealed a 24 mm diameter secundum atrial septal defect(ASD)(Figure 1B)with a dilated right heart and a mean pulmonary pressure of 68 mmHg.Fleischner’s sign refers to a prominent central pulmonary artery that can be commonly caused either by pulmonary hypertension or acute pulmonary embolism.This radiological finding is very rare in patients with secundum ASD unless the defect remains undiagnosed till the elderly.Chest X-ray remains fundamental in making diagnosis of cardiovascular disease.展开更多
Objective To evaluate the safety and feasibility of transcatheter closure of large secundum atrial septal defects(ASDs)with Amplatzer~ septal occluder(ASO).Methods A total of 26 patients(age 16 to 67 years,median 43...Objective To evaluate the safety and feasibility of transcatheter closure of large secundum atrial septal defects(ASDs)with Amplatzer~ septal occluder(ASO).Methods A total of 26 patients(age 16 to 67 years,median 43 years;body weight 52 to 102 kg,median 67 kg)with large ASDs underwent an attempted transcatheter closure using ASO.Large ASD was defined as those with a balloon-stretched diameter of ≥30 mm.Another 81 patients with small-to-moderate ASD during same period who underwent closure served as controls.Results In patients with large ASDs,the ASD dimension means were(22.1±3.2)mm(range from 16 to 30 mm)and(23.8±2.6)mm(range from 18 to 31mm)assessed by transesophageal echocardiography(TEE)and transthoracic echocardiography(TTE),respectively.The mean balloon-stretched diameter of the ASD was(31.9±2.1)mm(range from 30 to 37mm).The size of device was(32.0±1.9)mm(range from 30 to 36mm).The transcatheter procedure was successful in all patients(100%).Seventeen deployments were performed using the conventional left atrium approach,and remaining 9 patients required the right upper pulmonary vein approach.Immediately after deployment,TEE revealed that complete closure rate was 73%.Procedure-related complications were recorded in 3 patients(12%),including device embolization in one patient,pericardial effusion in one patient,and large hematoma at puncture site in one patient.During follow-up,the complete closure rate increased to 88% at 24h after procedure and 100% at 6 months.The procedural success rates,immediate TEE results and TTE results at 24h and 6 months after procedure,were not significantly different between patients with large ASDs and those with small-to-moderate ASDs.Conclusion Transcatheter closure of large ASDs using ASO is technical feasible and relatively safe.Proper care selection and specific technique modification such as the right upper pulmonary vein approach is vital for the implantation success.展开更多
Background Transcatheter closure and surgical closure of secundum atrial septal defects(SASDs)are common treatment methods.It is not clear which method has a more obvious technical advantage.Objective To summarise dat...Background Transcatheter closure and surgical closure of secundum atrial septal defects(SASDs)are common treatment methods.It is not clear which method has a more obvious technical advantage.Objective To summarise data from studies comparing transcatheter closure versus surgical closure of SASDs.Methods Databases including Pub Med,EMbase,Web of science,Cochrane Library,CBM,CNKI and Wanfang databases were searched to enroll randomized controlled trials and cohort study trials comparing the two treatment methods(transcatheter closure versus surgical closure).The literature was screened according to the inclusive and exclusive criteria by two reviewers independently.The quality of the trials was evaluated.The data were extracted and meta-analysis was performed using Rev Man 5.3 software.Results 29 original studies(14,941 patients)were included.All studies were non-random.Transcatheter closure was found to be superior to surgical closure in the following outcomes:all-cause mortality(OR 0.36,95%CI 0.21~0.59,P<0.0001),total complications(OR 0.37,95%CI 0.25~0.55,P<0.00001),and hospital stay length(WMD-3.77,95%CI-4.36~-3.18,P<0.00001).Residual shunts incidence and retreatment incidence were more common in the transcatheter closure group than those in the surgical closure group[(OR 3.55,95%CI 1.79~7.05,P=0.0003)and(OR 2.19,95%CI 1.31~3.65,P=0.003),respectively].Conclusions Both approaches are effective for closure SASDs.Transcatheter is associated with lower mortality,complications and hospital stay length,while surgical closure has incidence of residual shunting and retreatment.展开更多
To evaluate the feasibility and short term results of transcatheter closure of secundum atrial septal defects (TCSASDs) using Amplatzer occluder device A new self centering device, the Amplatzer atrial septal occlu...To evaluate the feasibility and short term results of transcatheter closure of secundum atrial septal defects (TCSASDs) using Amplatzer occluder device A new self centering device, the Amplatzer atrial septal occluder, has recently been evaluated in an animal model with excellent results This paper reports our clinical research with this device Methods 30 patients underwent an attempt at TCSASDs at an average age of 35 6±15 9?y (range, 5-62?y) and average weight of 63 6±14 5?kg (range, 17-78?kg) using the Amplatzer atrial septal occluder The average ASD diameter measured by transesophageal echocardiography (TEE) was 23 6±4 0?mm (range, 16-31?mm), and the average atrial septal defects (ASD) balloon stretched diameter was 25 2±5 8?mm (range, 9-34?mm) All patients had right atrial and ventricular volume overload with a Qp/Qs of 3 4±1 2 (1 4-5 2) A F8 12 catheter was used for delivery of the device in all patients Results The device was placed correctly in all patients There was immediate and complete closure in 30 patients The average device waist size used to close the defect was 25 6±5 9?mm (range, 9-34?mm) There was no episode of device embolization or any other complication Follow up was performed using transthoracic echocardiography (TTE) 1 day, 1 month, 3 months, 6 months and 1 year after the procedure The first day after operation; there was complete closure of the ASD in all patients; there have been no episodes of endocarditis, thromboembolism, or wire fracture Conclusion TCSASDs using the Amplatzer occluder device was an efficient nonsurgical method which had a very high technical success rate and satisfactoy short term and follow up results展开更多
Background In China, transthoracic echocardiography （TTE） is popularly used for pre-intervention examination for atrial septal defect （ASD） and for guiding ASD closure. However, the ability to determine ASD size a...Background In China, transthoracic echocardiography （TTE） is popularly used for pre-intervention examination for atrial septal defect （ASD） and for guiding ASD closure. However, the ability to determine ASD size and the safety and efficacy of l-rE for guiding ASD closure still has not been widely accepted. This study aimed to evaluate the efficacy and safety of l-rE used before, during and after transcatheter ASD closure with Amplatzer septal occluders （ASO）. Methods Sixty-eight subjects （15 men and 53 women; mean age （33.7±17.3） years） were enrolled. TTE was used to measure the diameters and guide transcatheter closure of ASD. The ASD was examined by long-axis view, basal short-axis view, apical four-chamber view and the subcostal view to observe position, diameter and relation with neighbouring structures. The largest diameter was selected as the reference diameter. Patients were divided into 3 groups according to the ASD reference diameter： 22 subjects with ASD diameter 4-14 mm （group A）; 21 subjects with ASD diameter 15-20 mm （group B）; and 25 subjects with ASD diameter 21-33 mm （group C）. Results ASD was occluded successfully in groups A and B. In group C, occlusion failed in 2 cases; 1 case remained with a 3-mm residual shunt sustained until 6-month follow-up. However, at 6-month follow-up, no case of thromboembolism, ASO dislocation or death occurred in the three groups. The diameter of ASD measured by l-rE could accurately predict the ASO size that could successfully occlude the ASD, especially in patients with ASD 〈20 mm. The ASD diameter measured by l-rE correlated well with ASO size （r= 0.925, P〈0.001 ; r=0.976, P〈0.001 ; r=0.929, P〈0.001 respectively）. Conclusions ASD diameter measured by l-rE can accurately estimate the size of the ASO needed for successful closure of ASD. The larger the ASD, the much larger the ASO needed. l-rE is a satisfactory guiding imaging tool for ASD closure.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: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
Objectives To investigate the causes, theraputic and preventive methods of com- plications associated with transcatheter occlusion of at- rial septal defect ( ASD) using the Amplatzer septal oc- cluder (ASO) in childr...Objectives To investigate the causes, theraputic and preventive methods of com- plications associated with transcatheter occlusion of at- rial septal defect ( ASD) using the Amplatzer septal oc- cluder (ASO) in children. Methods 289 cases un- derwent transcatheter closure of ASD with ASO. Com- plications occurred in 9 cases. The complications in procedure included systemic circulatory systemic air embolism in 2, pulmonary air embolism in 1, pericar- dial tamponade in 1, ASO malposition requiring emer- gency surgical removal in 1, transient atrial extrasysto- les in 1 and sizing balloon rupture in 1 case. 2 cases with postoperative complications were found in the fol- low-up studies. These included perforation of mitral valve and ASO partially dislodged. In this study, 5 children with intraoperative complication received e- mergency therapy including surgical intervention, and others needed only follow-up, as the complications were transient or asymptomatic. Results There were no children death in this study. The 5 cases who re- ceived treatment were completely healing, and the oth- ers with intra - procedure complications were also had no sequela existed. Cases with mitral valve and ASO partially dislodged were still in follow-up studies, as the 2 patients having no symptoms. Conclutions Air embolism were occurred easily in atrial septal defect cases who received ASO therapy. Complications mainly caused by inappropriate operative procedure and some complications needed emergency treatments. Follow-up studies were important to cases with transcatheter oc- clusion therapy.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
BACKGROUND Unroofed coronary sinus syndrome(UCSS)is a rare congenital heart disease,which has variable morphologic features and is strongly associated with persistent left superior vena cava(PLSVC).However,it is often...BACKGROUND Unroofed coronary sinus syndrome(UCSS)is a rare congenital heart disease,which has variable morphologic features and is strongly associated with persistent left superior vena cava(PLSVC).However,it is often difficult to visualize the left-to-right shunt pathway through the CS by transthoracic echocardiography(TTE).CASE SUMMARY A 37-year-old female was admitted to the hepatological surgery department of a hospital with complaint of subxiphoid pain that had started 1 wk prior.Physical examination revealed a grade 3/6 systolic murmur at the left margin of the sternum,between the 2nd and 3rd intercostal cartilage.The patient underwent echocardiography and was diagnosed with ostium primum atrial septal defect(ASD);thus,she was subsequently transferred to the cardiovascular surgery department.A second TTE evaluation before surgery showed type IV UCSS with secundum ASD.Right-heart contrast echocardiography(RHCE)showed that the right atrium and right ventricle were immediately filled with microbubbles,but no microbubble was observed in the CS.Meanwhile,negative filling was observed at the right atrium orifice of the CS and right atrium side of the secundum atrial septal.RHCE identified UCSS combined with secundum ASD but without PLSVC in this patient.CONCLUSION This rare case of UCSS highlights the value of TTE combined with RHCE in confirming UCSS with ASD or PLSVC.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
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
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.
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 Guangzhou Municipal Science and Technology Bureau's 2024 Basic and Applied Basic Research Topic,China,No.2024A04J4491,and No.2024A04J4254the Scientific Research Project of Guangdong Provincial Bureau of Traditional Chinese Medicine,China,No.2022ZYYJ01the Soft Science Research Program of Luohu District,Shenzhen,China,No.LX202402016.
文摘The case report presented in this edition by Mu et al.The report presents a case of atrial septal defect(ASD)associated with electrocardiographic changes,noting that the crochetage sign resolved after Selective His Bundle Pacing(S-HBP)without requiring surgical closure.The mechanisms behind the appearance and resolution of the crochetage sign remain unclear.The authors observed the dis-appearance of the crochetage sign post-S-HBP,suggesting a possible correlation between these specific R waves and the cardiac conduction system.This editorial aims to explore various types of ASD and their relationship with the cardiac con-duction system,highlighting the diagnostic significance of the crochetage sign in ASD.
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This study involving human participants was reviewed and approved by the ethics committee of TEDA International Cardiovascular Hospital,China(No.0715-4,2021,02 August 2021)the National Natural Science Foundation of China[82170353&81870288]+4 种基金the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences[2020-PT310-007]Tianjin Municipal and Binhai New Area Health Commissions[KJ20071&2019BWKY010]Tianjin Science and Technology Project[18PTZWHZ00060]TEDA International Cardiovascular Hospital[2021-TD-006&2021-ZX-002&2019-TD-013]Tianjin Key Medical Discipline(Specialty)Construction Project[TJYXZDXK-019A].
文摘Background:Atrial septal defect(ASD)is one of the common congenital heart diseases.The MYH6 gene has a critical role in cardiac development but the role of MYH6 promoter variants in patients with ASD has not been explored.Methods:In 613 subjects including 320 ASD patients,we investigated the MYH6 gene promoter variants and verified the effect on gene expression by using cellular functional experiments and bioinformatics analysis.Results:Eleven variants were identified in the MYH6 gene promoter,of which four variants were found only in ASD patients,and two variants(g.3434G>C and g.4524C>T)were identified for the first time.Cellular functional experiments indicated that all four variants reduced the transcriptional activity of the MYH6 gene promoter(p<0.05).Subsequent analysis through the JASPAR(A database of transcription factor binding profiles)suggests that these variants may alter transcription factor binding sites,which may in turn lead to changes in myocardin subunit expression and ASD formation.Conclusions:Our study for the first time focuses on variants in the promoter region of the MYH6 gene in Chinese patients with ASD and the discovered variants have functional significance.The study provides new insights in the role of the MYH6 gene promoter region to better understand the genetic basis of ASD formation and facilitates clinical diagnosis.
文摘Stereoscopic three-dimensional echocardiography（S-3DE） is a novel displaying technol-ogy based on real-time 3-dimensional echocardiography （RT-3DE）. Our study was to evaluate the feasibility and efficiency of S-3DE in the diagnosis of atrial septal defect （ASD） and its use in the guidance for transcatheter ASD occlusion. Twelve patients with secundum ASD underwent RT-3DE examination and 9 of the 12 were subjected to transcatheter closure of ASD. Stereoscopic vision was generated with a high-performance volume renderer with red-green stereoscopic glasses. S-3DE was compared with standard RT-3D display for the assessment of the shape, size, and the surrounding tis-sues of ASD and for the guidance of ASD occlusion. The appearance rate of coronary sinus and the mean formation time of the IVC, SVC were compared. Our results showed that S-3DE could measure the diameter of ASD accurately and there was no significant difference in the measurements between S-3DE and standard 3D display （2.89±0.73 cm vs 2.85±0.72 cm, P〉0.05; r=0.96, P〈0.05）. The appearance of coronary sinus for S-3DE was higher as compared with the standard 3D display （93.3% vs 100%）. The mean time of the IVC, SVC for S-3DE monitor was slightly shorter than that of the standard 3D display （11.0±3.8 s vs 10.3±3.6 s, P〉0.05）. The mean completion time of interven-tional procedure was shortened with S-3DE display as compared with standard 3D display （17.3±3.1 min vs 23.0±3.9 min, P〈0.05）. Stereoscopic three-dimensional echocardiography could improve the visualization of three-dimensional echocardiography, facilitate the identification of the adjacent structures, decrease the time required for interventional manipulation. It may be a feasible, safe, and efficient tool for guiding transcatheter septal occlusion or the surgical interventions.
文摘Objective ：To study the gene mutations of homeobox transcription factor （CSX/NKX2.5） associated with a Chinese family with secundum atrial septal defect （ASD）. Methods ：Polymerase chain reaction and DNA sequencing were used to check all the members in the family with ASD, and single strand conformation polymorphism analysis （SSCP） was used to check 126 normal control people for detecting the mutations of CSX/NKX2.5 gene. Results： Three mutations, G270A（Glu32Lys ）, G378A （Glu68Lys）andG390A （Glu72Lys）were identified in CSX/NKX2.5 gene of ASD patients. However, the other members in the family with ASD and the control did not have such gene mutations. Conclusion：These mutations of CSX/NKX2.5 gene, which were identified in a Chinese family, may be one of the secundum ASD etiologic causes .
文摘A 66-year-old woman with lower limb edema and exertional dyspnea presented to the emergency department.Posteroanterior chest X-ray revealed a Fleischner’s sign in both lungs(Figure 1A)suggesting a pulmonary hypertension.A subsequent transthoracic echocardiogram revealed a 24 mm diameter secundum atrial septal defect(ASD)(Figure 1B)with a dilated right heart and a mean pulmonary pressure of 68 mmHg.Fleischner’s sign refers to a prominent central pulmonary artery that can be commonly caused either by pulmonary hypertension or acute pulmonary embolism.This radiological finding is very rare in patients with secundum ASD unless the defect remains undiagnosed till the elderly.Chest X-ray remains fundamental in making diagnosis of cardiovascular disease.
文摘Objective To evaluate the safety and feasibility of transcatheter closure of large secundum atrial septal defects(ASDs)with Amplatzer~ septal occluder(ASO).Methods A total of 26 patients(age 16 to 67 years,median 43 years;body weight 52 to 102 kg,median 67 kg)with large ASDs underwent an attempted transcatheter closure using ASO.Large ASD was defined as those with a balloon-stretched diameter of ≥30 mm.Another 81 patients with small-to-moderate ASD during same period who underwent closure served as controls.Results In patients with large ASDs,the ASD dimension means were(22.1±3.2)mm(range from 16 to 30 mm)and(23.8±2.6)mm(range from 18 to 31mm)assessed by transesophageal echocardiography(TEE)and transthoracic echocardiography(TTE),respectively.The mean balloon-stretched diameter of the ASD was(31.9±2.1)mm(range from 30 to 37mm).The size of device was(32.0±1.9)mm(range from 30 to 36mm).The transcatheter procedure was successful in all patients(100%).Seventeen deployments were performed using the conventional left atrium approach,and remaining 9 patients required the right upper pulmonary vein approach.Immediately after deployment,TEE revealed that complete closure rate was 73%.Procedure-related complications were recorded in 3 patients(12%),including device embolization in one patient,pericardial effusion in one patient,and large hematoma at puncture site in one patient.During follow-up,the complete closure rate increased to 88% at 24h after procedure and 100% at 6 months.The procedural success rates,immediate TEE results and TTE results at 24h and 6 months after procedure,were not significantly different between patients with large ASDs and those with small-to-moderate ASDs.Conclusion Transcatheter closure of large ASDs using ASO is technical feasible and relatively safe.Proper care selection and specific technique modification such as the right upper pulmonary vein approach is vital for the implantation success.
基金supported by Hainan provincial health industry scientific research project (No.22A200277)。
文摘Background Transcatheter closure and surgical closure of secundum atrial septal defects(SASDs)are common treatment methods.It is not clear which method has a more obvious technical advantage.Objective To summarise data from studies comparing transcatheter closure versus surgical closure of SASDs.Methods Databases including Pub Med,EMbase,Web of science,Cochrane Library,CBM,CNKI and Wanfang databases were searched to enroll randomized controlled trials and cohort study trials comparing the two treatment methods(transcatheter closure versus surgical closure).The literature was screened according to the inclusive and exclusive criteria by two reviewers independently.The quality of the trials was evaluated.The data were extracted and meta-analysis was performed using Rev Man 5.3 software.Results 29 original studies(14,941 patients)were included.All studies were non-random.Transcatheter closure was found to be superior to surgical closure in the following outcomes:all-cause mortality(OR 0.36,95%CI 0.21~0.59,P<0.0001),total complications(OR 0.37,95%CI 0.25~0.55,P<0.00001),and hospital stay length(WMD-3.77,95%CI-4.36~-3.18,P<0.00001).Residual shunts incidence and retreatment incidence were more common in the transcatheter closure group than those in the surgical closure group[(OR 3.55,95%CI 1.79~7.05,P=0.0003)and(OR 2.19,95%CI 1.31~3.65,P=0.003),respectively].Conclusions Both approaches are effective for closure SASDs.Transcatheter is associated with lower mortality,complications and hospital stay length,while surgical closure has incidence of residual shunting and retreatment.
文摘To evaluate the feasibility and short term results of transcatheter closure of secundum atrial septal defects (TCSASDs) using Amplatzer occluder device A new self centering device, the Amplatzer atrial septal occluder, has recently been evaluated in an animal model with excellent results This paper reports our clinical research with this device Methods 30 patients underwent an attempt at TCSASDs at an average age of 35 6±15 9?y (range, 5-62?y) and average weight of 63 6±14 5?kg (range, 17-78?kg) using the Amplatzer atrial septal occluder The average ASD diameter measured by transesophageal echocardiography (TEE) was 23 6±4 0?mm (range, 16-31?mm), and the average atrial septal defects (ASD) balloon stretched diameter was 25 2±5 8?mm (range, 9-34?mm) All patients had right atrial and ventricular volume overload with a Qp/Qs of 3 4±1 2 (1 4-5 2) A F8 12 catheter was used for delivery of the device in all patients Results The device was placed correctly in all patients There was immediate and complete closure in 30 patients The average device waist size used to close the defect was 25 6±5 9?mm (range, 9-34?mm) There was no episode of device embolization or any other complication Follow up was performed using transthoracic echocardiography (TTE) 1 day, 1 month, 3 months, 6 months and 1 year after the procedure The first day after operation; there was complete closure of the ASD in all patients; there have been no episodes of endocarditis, thromboembolism, or wire fracture Conclusion TCSASDs using the Amplatzer occluder device was an efficient nonsurgical method which had a very high technical success rate and satisfactoy short term and follow up results
文摘Background In China, transthoracic echocardiography （TTE） is popularly used for pre-intervention examination for atrial septal defect （ASD） and for guiding ASD closure. However, the ability to determine ASD size and the safety and efficacy of l-rE for guiding ASD closure still has not been widely accepted. This study aimed to evaluate the efficacy and safety of l-rE used before, during and after transcatheter ASD closure with Amplatzer septal occluders （ASO）. Methods Sixty-eight subjects （15 men and 53 women; mean age （33.7±17.3） years） were enrolled. TTE was used to measure the diameters and guide transcatheter closure of ASD. The ASD was examined by long-axis view, basal short-axis view, apical four-chamber view and the subcostal view to observe position, diameter and relation with neighbouring structures. The largest diameter was selected as the reference diameter. Patients were divided into 3 groups according to the ASD reference diameter： 22 subjects with ASD diameter 4-14 mm （group A）; 21 subjects with ASD diameter 15-20 mm （group B）; and 25 subjects with ASD diameter 21-33 mm （group C）. Results ASD was occluded successfully in groups A and B. In group C, occlusion failed in 2 cases; 1 case remained with a 3-mm residual shunt sustained until 6-month follow-up. However, at 6-month follow-up, no case of thromboembolism, ASO dislocation or death occurred in the three groups. The diameter of ASD measured by l-rE could accurately predict the ASO size that could successfully occlude the ASD, especially in patients with ASD 〈20 mm. The ASD diameter measured by l-rE correlated well with ASO size （r= 0.925, P〈0.001 ; r=0.976, P〈0.001 ; r=0.929, P〈0.001 respectively）. Conclusions ASD diameter measured by l-rE can accurately estimate the size of the ASO needed for successful closure of ASD. The larger the ASD, the much larger the ASO needed. l-rE is a satisfactory guiding imaging tool for ASD closure.
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.
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Objectives To investigate the causes, theraputic and preventive methods of com- plications associated with transcatheter occlusion of at- rial septal defect ( ASD) using the Amplatzer septal oc- cluder (ASO) in children. Methods 289 cases un- derwent transcatheter closure of ASD with ASO. Com- plications occurred in 9 cases. The complications in procedure included systemic circulatory systemic air embolism in 2, pulmonary air embolism in 1, pericar- dial tamponade in 1, ASO malposition requiring emer- gency surgical removal in 1, transient atrial extrasysto- les in 1 and sizing balloon rupture in 1 case. 2 cases with postoperative complications were found in the fol- low-up studies. These included perforation of mitral valve and ASO partially dislodged. In this study, 5 children with intraoperative complication received e- mergency therapy including surgical intervention, and others needed only follow-up, as the complications were transient or asymptomatic. Results There were no children death in this study. The 5 cases who re- ceived treatment were completely healing, and the oth- ers with intra - procedure complications were also had no sequela existed. Cases with mitral valve and ASO partially dislodged were still in follow-up studies, as the 2 patients having no symptoms. Conclutions Air embolism were occurred easily in atrial septal defect cases who received ASO therapy. Complications mainly caused by inappropriate operative procedure and some complications needed emergency treatments. Follow-up studies were important to cases with transcatheter oc- clusion therapy.
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BACKGROUND Unroofed coronary sinus syndrome(UCSS)is a rare congenital heart disease,which has variable morphologic features and is strongly associated with persistent left superior vena cava(PLSVC).However,it is often difficult to visualize the left-to-right shunt pathway through the CS by transthoracic echocardiography(TTE).CASE SUMMARY A 37-year-old female was admitted to the hepatological surgery department of a hospital with complaint of subxiphoid pain that had started 1 wk prior.Physical examination revealed a grade 3/6 systolic murmur at the left margin of the sternum,between the 2nd and 3rd intercostal cartilage.The patient underwent echocardiography and was diagnosed with ostium primum atrial septal defect(ASD);thus,she was subsequently transferred to the cardiovascular surgery department.A second TTE evaluation before surgery showed type IV UCSS with secundum ASD.Right-heart contrast echocardiography(RHCE)showed that the right atrium and right ventricle were immediately filled with microbubbles,but no microbubble was observed in the CS.Meanwhile,negative filling was observed at the right atrium orifice of the CS and right atrium side of the secundum atrial septal.RHCE identified UCSS combined with secundum ASD but without PLSVC in this patient.CONCLUSION This rare case of UCSS highlights the value of TTE combined with RHCE in confirming UCSS with ASD or PLSVC.
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.
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.
