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Objective: To explore the methodology and efifcacy of transcatheter induced closure in patients with small patent ductus arteriosus (PDA). Methods: A total of 717 PDA patients treated in our hospital from 2005-11 to 2014-08 were summarized and there were 8 patients with small PDA were treated by transcatheter induced closure method including 3 male and 5 female from (1-6) years of age at the mean of (3.9±1.4) years with the body weight of (10-21) kg at the mean of (15.2±3.7) kg. The procedures were performed under local or general anesthesia with right cardiac catheterization and descending aortic arch angiography to observe PDA morphology and to measure PDA diameter at aortic and pulmonary aterial lateral and ductus length. Right catheter along the guide wear was pushed to the narrowest part of PDA and the motion was repeated for several times to stimulate the local area and then, the catheter was kept at PDA aortic lateral about 20 minutes thereafter. Results: Descending aortic arch angiography indicated that no residual shunt at 20 min after catheter partial blockage in all 8 patients, the immediate closure rate was 100%. No patient suffering from re-canalization by 1 year follow-up examination. Conclusion: Transcatheter induced closure of small PDA has minor trauma, no foreign material implantation, with low cost and good effect. It provides a new method for treating such particular type of PDA patients in clinical practice.
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Objective: To explore the relationship between plasma levels of calcitonin gene related peptide (CGRP) and cardiac function in ventricular septal defect (VSD) children before and after the interventional therapy. Methods: Our research included 2 groups:VSD group, n=90 containing 43 male and 47 female at the age of (3-12) years and treated in our hospital from 2011-09 to 2012-09, Control group, n=50 healthy children with matched age and gender. The levels CGRP were measured at before and 24 hours, 3 days, 5 days, 3 months after the therapy. The cardiac function as left ventricle end-diastolic diameter (LVEDD), left ventricle end systolic diameter (LVESD), left ventricle end diastolic volume (LVEDV), left ventricle end systolic volume (LVESV) and ejection fraction (EF) were examined by echocardiography at before and after the procedure. Results: Before interventional procedure, the level of CGRP in VSD group was lower than Control group (35.28 ± 7.25) pg/ml vs (50.90 ± 8.60) pg/ml, t=11.42, P Conclusion: Plasma levels of CGRP closely related to ventricular cavity diameter, which was important for evaluating the cardiac function in VSD children after the interventional therapy.
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BACKGROUND: It is difficult to cover aneurysm-like ventricular septal defect (VSD) of large inlet and multiple outlets completely with symmetrical type occluders or eccentric type occluders. OBJECTIVE: To investigate the feasibility of A4B2 occluder devices for covering aneurysm-like VSD, and to observe the effects of proper occhiders selected according to pseudoaneurysm size on coveting aneurysm-like VSD. DESIGN: Case analysis.SETTING: the First Hospital of Hebei Medical University. PARTICIPANTS: From August 2004 to May 2006, 226 patients with the pseudoaneurysm of petimembranous VSD, who underwent interventional therapy in the First Hospital of Hehei Medical University, were recruited in the study. According to the results of the left ventricular angiography, 36 patients of pseudoaneurysm of petimembranous VSD with large inlet and multiple outlets were closured with A4B2 occluder devices. According to the results of the left ventricular angiography, the mean diameter of the left inlet of VSD was (10.6+8.7) mm (ranged from 8 to 21 mm), the mean diameter of the right outlet of VSD was (3.1 ± 2.9) mm (ranged from 2 to 8 ram). Main materials: Occluder device and delivery mechanism were offered by Shanghai Shape Memory Alloy Materials Company and Beijing Starway Medical Technology Inc. They were processed into double disks using nickel-titanium shape memory alloy wires by a special technology to close VSD by a transcatheter approach. The size of the occluder was denoted with the diameter of the waist, and the Size ranged from 4 to 16 mm in the present study. METHODS: All the occluders were transferred by a 7-10 F transferring sheath from right heart system, and the mean diameter of the occluders was (6.364-2.48) nun (ranged from 4 to 16 ram). Fifteen minutes after the procedure, left ventricular angiography and transthoracic echocardiography (TIE) were performed again to evaluate the efficacy. After the procedure, electrocardiogram (ECG) monitoring lasted for 5 successive days in all patients, and ECG and TIE were performed 1, 3, 6 and 12 months later. MAIN OUTCOME MEASURES: Residual shunt, arrhythmia and valve function as well as blood compatibility. RESULTS: Sixteen cases were closured by placing the occhiders into left inlet of VSD, 16 cases were closured by placing the occluders into the pseudoaneurysm completely, and 4 cases were closured at the outlet of the defects. The results of the left ventricular angiography and TTE that performed fifteen minutes after the procedure demonstrated that 32 cases were completely closured and slightly residual shunts (< 3 mm) was found in other 4 patients. And confirmed by TIE, the residual shunts completely disappeared in 2 of the 3 patients 24 hours later while in the other one in 1 month after the procedure. Temporary left bundle branch block was found in 3 cases while temporary right bundle branch block was found in 2 cases, and all of them recovered within one week. Without severe complications, all of the 36 patients were treated successfully with A4B2 (thin waist shape) occluder devices made in China. Critical appraisal in blood compatibility of the implantation materials used in this research had been performed. The hemolysis ratio was less than 5%, the platelet adhesion was less, and the blood coagulation function ,the immune system response( immunoglobulin and complement)and the re-endothelialization of material surface were all normal. CONCLUSION: Transcatheter interventional therapy with domestic A4B2 occluder devices for VSD with pseudoaneurysm is safe, effective, promising, and has fewer complications. The key to the procedure is to select suitable occluders and suitable positions where to plant them according to the size, morphologic characteristics, position, and maturity of the pseudoaneurysm.
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Objective To investigate the relationship between serum homocysteine(Hcy)level and endothelial function in patients with coronary heart disease(CHD).Methods A total of 209 patients having undertaken coronary angiography were enrolled in this study.The serum concentrations of homocysteine were investigated for all subjects using fluorescence polarization immunoassay.B-mode ultrasound was used to scan brachial arteries for all subjects at rest and during reactive hyperemia,and then the rates of endothelium-dependent and independent flow-mediated vasodilatation(FMD% and NTG%)of the brachial artery were calculated.Results The values of Hcy in the CHD group were higher than that in the control group(P