ABSTRACT
OBJECTIVE:To investigate the feasibility,safety and efficacy of domestic small waist big edge-type occluder for patients with multiple outlets sac-type membranous ventricular septal defection (VSD),and summarize its technical problems and the choice of treatment strategies.METHODS:A total of 20 patients with sac-type membranous VSD,underwent left ventricular angiography at left anterior oblique 45°-60° plus CAOD 20°-25°;the left ventricular entrance diameters were 7-21 (10.9±5.2) mm,more than 2 outlets in the right ventricular surfaces,and the largest outlet diameters were 3-10 (4.8±2.9) mm.According to the result from transthoracic echocardiography (TTE) and angiography,the sac-bag size,shape,location,extent of tissue adhesion,and stability were determined.Different types of small waist big edge-type occluder were implanted,and the occluder diameter was 5-14 (4.6±2.8) mm.Following 15 minutes of blocking,the immediate effects of occlusion were observed through repeating left ventricuiar angiography and TTE.All patients rechecked ultrasonic cardiography and electrocardiogram at 5-7 days of hospital stay,and 1,3,6 and 12 months following surgery.All patients took aspirin tablets for 6 months.RESULTS:Of 20 patients,17 cases underwent domestic small waist big edge occluder,blocked successfully through left ventricular entrance,2 cases were successful using symmetry block,and 1 case was failed.Intraoperative occlusion did not affect the aortic valve and tricuspid valve function.There were 1 case with left bundle branch block and 1 case with right bundle branch block during the operation,and all recovered within a week by using hormone therapy.After 6 months,the cardiac sizes were reduced to different degrees.CONCLUSION:It is safe and effective to treat multiple outlets sac-shaped membranous VSD with domestic small waist big edge-type occluder.The key technology,according to the sac size,shape,firmness,outlet orientation,import size,and the size of aortic stump,is to determine the block site and to select a suitable occluder.
ABSTRACT
BACKGROUND: Conventional endovascular stent-graft exclusion for Debakey Ⅲ type aortic dissection is complicated and the complication rates are relatively high. Moreover, their operating techniques have increased the risk of rupture of laminated break. OBJECTIVE: To evaluate the efficacy and safety of improved endovascular stent-graft exclusion for Debakey Ⅲ type aortic dissection by the innovative methods of interventional therapy. DESIGN, TIME AND SETTING: A retrospective case analysis. Cases were selected from Department of Cardiology, Affiliated Hospital of Gannan Medical College between October 2006 and March 2009. PARTICIPANTS: A total of 30 male patients with Debakey Ⅲ type aortic dissection were selected from Department of Cardiology, Affiliated Hospital of Gannan Medical College, aged 43-70(53.5±12.8) years. The time of onset was 5-45 days. METHODS: All patients underwent improved endovascular stent-graft exclusion for Debakey Ⅲ type aortic dissection by the innovative methods of intervsntional therapy. Fine wire bundled endovascular stent-graft were implanted by the innovative transmission and delivery methods in all patients, of which branch stent were implanted when the distance from the break of descending aorta to left subclavian artery was less than 10 mm. MAIN OUTCOME MEASURES: After the success of operation, aortic angiography was performed to detect stent-graft position, shape, break closure, internal leakage, and patency of the aortic arch branches. The situation of post-operative complications were observed. All cases were followed up by MRI to understand the complications such as aneurysm rupture, internal leakage and stent migration. RESULTS: A total of 33 fine wire bundled endovascular stent-graft were successfully implanted in 30 patients, including 4 branch stents. After the operation, 5 patients were verified endoleak, 3 of them were resolved by repeated stent distension and 2 were treated by implantation of another stent. Three months after the operation, 1 patient showed new rupture at the distal stent and then was successfully implanted a new stent. Three cases showed numbness of right lower extremity and 1 case showed intermittent claudication. In follow-up of 3-32 months, MRI scanning showed the reduction of the false cavity with the formation of intraluminal thrombus, the enlargement of true cavity, and no complications such as tumor rupture, internal leakage or stent displacement were found. CONCLUSION: Fine wire bundled endovascular stent-graft and the innovative methods of interventional therapy for endovascular thoracic aorta repair is an effective, less invasive and safe surgery with fast postoperative recovery, high success rate and few complications for patients with Debakey Ⅲ type aortic dissection, especially for high-risk patients.