ABSTRACT
With the rapid and in-depth development of interventional treatment of structural heart disease, the instrument treatment of heart failure (heart failure) will become the main way of heart failure treatment in the future. There are a large number of patients with heart failure. Due to different etiology, pathogenesis, course of disease and individual differences, it is sometimes difficult to achieve satisfactory results in medical treatment. The treatment of heart failure based on instruments or equipment provides the dawn of survival for patients who are ineffective in medical treatment. In recent years, the research and development and clinical application of various heart failure devices have mushroomed, but their effectiveness, safety and practicality still need to be verified by strict clinical trials and evidence-based medical evidence. This article briefly reviews the main progress and development prospects of instrument therapy for heart failure in recent years.
ABSTRACT
@#Pulmonary arterial hypertension (PAH) is a severe, progressive disease leading to right ventricular failure and finally death. Lung transplantation is recommended for PAH patients who do not respond to targeted drug combination therapy or World Health Organization functional class (WHO FC) Ⅲ or Ⅳ. However, only 3% of PAH patients can recieve the lung transplantation. A novel implantable interatrial shunt device (ISD) can create a relatively fixed right-to-left shunt established by balloon atrial septostomy (BAS). The device may decompress the right sided chambers, facilitate left heart filling, improve organ perfusion and reduce the likelihood of syncope, acute pulmonary hypertensive crisis and death. The systemic oxygen transport improves despite hypoxemia. Implantation is simple, feasible and safe, and the X-ray time and operation time are short. There is no severe complication or thrombosis during the mid-term follow-up of the clinical studies and the device remained patent. The syncope symptoms, six-minute walk distance, cardiac index and systemic oxygen transport improve significantly in the patients. ISD may be currently the last alternative treatment to improve symptoms and prolong survival in currently drug-resistant patients with severe PAH.
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Objective To study on the evaluation of haemodynamics in the normal and pulmonary hypertensive mouse hearts using pressure volume loops measured by electric catheter.Methods Compared the difference in haemodynamics between mice exposed to chronic hypoxia for 10 days,which causes hypoxia-induced pulmonary hypertension (experimental group,n =8),and mice raised under normal atmospheric pressure (control group,n =8).The right carotid artery was cannulated with a 1.2 F catheter and advanced into the ascending aorta,then punctured towards the right ventricular apex.A 1.2 F admittance pressure-volume catheter was introduced using a 20-gauge needle to obtain the pressure-volume measurements and calculate hemodynamic parameters.Results There were no significant differences in average by weight,ratio of right atrial weight to body weight,left atrial weight/body weight,left ventricular free wall and septum weight/body weight between the 2 groups(all P ＞ 0.05).The ratio of right rentricle/left rentricle and septum weight as well as right rentricular weight/body weight was increased in the experimental group and of significant difference when compared to the control.The mice in in the experimental group had a 61％ mean decrease in cardiac output,a 55％ decrease in ejection fraction,and a 63％ decrease in ventricular compliance(P ＜0.05).The increase in dP/dtmax-EDVand PRSWfound in the experimental group reflected significant increase in myocardial contractility.Increase in Ees was observed but without significant difference as compared to the control.Ea significantly increased in the experimental group resulting in significant decrease in Ees/Ea from (0.71 ±0.27) to (0.35 ±0.17) (P＜ 0.005).Conclusion This study demonstrates the feasibility of obtaining RV pressure-volume measurements in mice using electric catheter.These measurements provide insight into right ventricular-pulmonary artery interactions in healthy and diseased conditions.
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Objective To study pulmonary wedge angiography ( PWA ) with hemodynamic the evaluation of children with congenital heart disease and pulmonary artery hypertension ( PAH) . Methods Hemodynamic measurement and pulmonary wedge angiography were performed in 50 children with congenital heart disease. Comparison and analysis were made from the data obtained from PWA and catheterization. Results After PWA, the patients were categorized into 3 groups according to the measured hemodynamics parameters:group A [ n=15, patients with normal mean pulmonary artery pressure ( mPAP≤25 mmHg) and normal pulmonary vessel resistance (PVR﹤300 dyne?s?cm5)], group B [n=24, patients with PAH (mPAP﹥25 mmHg) but normal PVR] and group C (n=11, patients with PAH and elevated PVR (PVR≥300 dyne?s?cm5). Rote of tapering (ROT) was significant lower in group C than in group A and B (F=42. 559,P﹤0. 05). Pulmonary circulation time (PCT) was higher in group C than in group A and B (F=6. 037,P﹤0. 05). ROT correlated negatively with PVR (r = -0. 606, P ﹤0. 05). PCT index correlated positively with PVR (r=0. 783,P=0. 01). There was no significant correlation between PCT and mean pulmonary artery hypertension (mPAP). Conclusions PWA may help to make quantitative analysis of the pulmonary vascular status in patients with congenital heart disease.
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Objective To investigate the feasibility of the simultaneous measurement of right ventricular pressure-volume loops by cardiac catheterization and 2D electrocardiogram. Methods Patients referred for pulmonary hypertension underwent right heart catheterization in our hospital between June 1st, 2015 and June 1st, 2017 are to be enrolled in this study. The right ventricular volume was measured simultaneously by catheter and electrocardiogram. The pressure-volume loops were constructed by the parameters of the pressure and volume in the same cardiac cycle. Results The study completed in four cases and their pressure-volume loops were drawn. The obtained images were irregular and there was no relationship among them. As a result, the construction was a failure. Conclusions The construction of the right ventricular pressure-volume loops of pulmonary hypertension patients by simultaneous catheterization and 2D electrocardiogram is difficult to overcome the technology defects.