ABSTRACT
Objective To analyse the failure reason in transcatheter closure of ventricular septal defect(VSD) ,in order to improve the succeeding rate of occlusive operation on screening VSD patients with echocardiography. Methods Echocardiographic datas were summarized in 50 cases who were failed in VSD occlusion. Results Atrio-ventricular block was occurred in 14 patients,residual shunt was visualized in 13 cases,transcatheter occlusive track could not be set up in 19 cases,arotic valve regurgitation in two cases were screened obviously after occlusive device was released into the intracristal VSD. One case was suffered from cononary heart disease(CAD) and another one was suffered from acute myocardial infarction with ventricular septal perforation. All these patients did not succeed in closure procedure. Conclusions The defect sizes of left and right sides of ventricular septal, structure close to defect must be considered in selecting patients before operation by echocardiography. Occlusion operation should be strictly chosen in cases who were children,or suffered from complex VSD,or senior patients with CAD.
ABSTRACT
Objective To evaluate clinical application of transthoraeic real time three-dimensional echocardiography(RT-3DE) on selecting oecluder of the atrial septal defect(ASD). Methods ASD size and its rim of thirty patients with ASD were measured by transthoracic two-dimensional echoeardiography(2DE) on various views before occlusion. ASD was reconstructed by transthoracic RT-3DE and color RT-3DE. The images were studied in multiple orientations and cross sections, including the morphology, area, longest diameter,and cycloidal dimension of substitution (CDS) was calculated. The waist size of occluder was measured after releasing oecluder. Results Among 30 eases of ASD, there were 22 cases(73.3 %) with non-round like defects. In various morphous of ASD,the waist morphology of occluder still was round-like after releasing oeeluder. There was no significant difference between waist area of occluder and measured area of ASD by RT-3DE and color RT-3DE. All ASD diameters measured by 2DE were smaller than the dimension of waist after releasing, ASD longest diameters measured by RT-3DE and color RT-3DE were larger than the dimension of waist after releasing,but were no significant differences with CDS. Significant correlation was existed between the CDS of ASD measured by RT-3DE and the size of selected occluder (Y = 0.29 + 1.132 X , r = 0.93, P<0.0001), and the waist size of released occluder(Y = - 0.160 + 1.063 X , r = 0.98, P 0.0001). Oceluder was firmly fixed without falling off in all patients. Conclusions Transthoracic RT-3DE has certain value on selection of ASD occluder.
ABSTRACT
Objective To observe the effect of inferior vena cava filter (IVCF) on prevention of bone cement implantation syndrome (BCIS). Methods Ten sheep were divided into 2 even groups, BCIS and LVCF intervention ones. First IVCF was implanted into the inferior vena cava through cervical vena-right atrium pathway under fluoroscopic monitoring to observe the influence of IVCF on BCIS. Then BCIS was es-tablished in the same sheep by compressing 10 mL of bone cement into a sheep medullary canal after mutilation of the left femur. Arterial blood pressure, heart rate, central venous pressure (CVP) and blood gas were monitored, while an ultrasonic device was utilized to monitor fat embolisms in the right atriums of the sheep. Oil red staining was performed to detect fat embolisms in pulmonary arteries after the sheep were executed. Results In BCIS group, dotted uneven resonances were found in the right atrium and right ventricle when the medullary canal pressure was increased to 120 mm Hg, indicating embolisms in the right chambers. The dotted resonances were increased to ponderous, snowflake-like ones as the medullary canal pressure climbed up. At the same time, blood pressure and Pa02 dropped significantly, the systolic blood pressure dropped to (80±11) mm Hg and PaO<.2> to the minimum 25 minutes after cone cement implantation. The heart rate and CVP increased continuously. The blood gas assay indicated respiratory and metabolic acidosis. The oil red staining showed bulk fat embolus in pulmonary arteries. But in IVCF group, the similar resonances were not observed throughout the surgery and the medullary canal pressure climbed to 400 mm Hg, reaching the maximum of our pressure gage range. The blood pressure, PaO2, heart rate and CVP did not change much compared to those before implantation. The blood gas and pulmonary oil red staining showed few changes either. Conclusion IVCF implantation can prevent the genesis of BCIS.