Initial experience with the new Pul-Stent in treating postoperative branch pulmonary artery stenosis / 中华儿科杂志

<p><b>OBJECTIVE</b>The Pul-stent is a new cobalt alloys stent, specially licensed for pulmonary artery stenosis. The aim of this study was to investigate the value of the stent implantation as the treatment of postoperative pulmonary artery stenosis.</p><p><b>METHOD</b>Clinical practice was carried out to evaluate effectiveness, safety and maneuverability of Pul-stent in the defined clinical setting. Transthoracic echocardiography, chest roentgenography and electrocardiography were carried out as follow-up studies at 1 and 3 months after procedures.</p><p><b>RESULT</b>Ten patients (7 males and 3 females) received Pul-stent implantation in left or right pulmonary arteries (9 stents in left and 1 stent in right). For 9 cases transcatheter stent implantation was performed and in I case hybrid procedure. The median age was 7. 9 years (range 3. 4 - 13. 7 years). The median weight was 22. 3 kg (range 13 - 32 kg). Among them 6 cases were post surgical repair of tetralogy of Fallot, 2 cases were after Fontan procedures, 1 patient was post surgical repair of pulmonary atresia with ventricular septal defect, and 1 patient had stenosis at Glenn pathway. The pressure gradient at the stenosis decreased from (31. 6 ± 10. 2) mmHg(1 mmHg =0. 133 kPa) to (7. 3 ± 10. 3) mmHg, and the diameter of the narrowest segment increased from (4. 0 ± 2. 3) mm to (9. 6 ± 2. 7) mm, the right ventricle to aortic pressure ratio decreased from 0. 54 to 0. 36, all of these improvements were statistically significant (t = 3. 9, -9. 7, 4. 5; P =0. 008, 0. 000, 0. 004). The total procedure time ranged from 55 to 220 min (median 117 min) , and the fluoroscopy time ranged from 9 to 67 min (median 26 min). There were 2 cases of post-stenting pneumorrhagia. No stent fracture, stent malposition and other severe complications were observed. Initial follow-up of 1 and 3-months showed good results with maintenance of improved caliber of the stented vessel, and the gradient across the stenosis area measured by echocardiography was (32. 0 ± 14. 6) mmHg after 3 months. Compared with before stentifng ((40.6 ± 15. 2) mmHg) and 1 month later ((30. 6 ± 13. 6) mmHg), the difference was not statistically significant (t =2. 2,1. 76; P =0. 07, 0. 10).</p><p><b>CONCLUSION</b>Pul-Stent tracking and delivery was excellent, the initial experience has shown that Pul-stent implantation was effective and safe in treating post-operative branch pulmonary artery stenosis. Further follow-up study should be conducted to make sure whether those good results would be kept constant.</p>

Stent implantation for relief of pulmonary artery branch stenosis / 中华儿科杂志

<p><b>OBJECTIVE</b>Branch pulmonary artery stenosis is one of the common congenital heart disease. Stent implantation to relieve branch pulmonary artery stenosis (BPAS) is an alternative to failed surgical or balloon angioplasty. The aim of this study was to explore the indication, methods and complications of using balloon expandable stent placement to treat branch pulmonary artery stenosis, and evaluate the results of stent implantation in the treatment of branch pulmonary artery stenosis.</p><p><b>METHOD</b>From August 2005 to December 2012, 19 patients underwent an attempt at stent implantation. The median age of those patients was 9.1 years (range 4.0-15.0 years). The median weight was 31.7 kg (range 17.0-60.5 kg); 14/19 patients underwent post surgical repair of tetralogy of Fallot, one patient received post surgical repair of pulmonary atresia with ventricular septal defect, one patient underwent post surgical repair of pulmonary atresia with intact septum, one with native left BPAS, and one was after surgical repair of aortopulmonary window and the other truncus arteriosus. CP stent and NuMED Balloon-in-Balloon catheter were selected according to digital subtracted angiography measurements. After checking for correct position by angiography, the inner balloon and outer balloon was inflated successively to expand the stent to desired diameter. Statistical analysis was performed with the unpaired Student t test.</p><p><b>RESULT</b>A total of 26 stents were implanted successfully in 19 patients. The systolic gradient across the stenosis fell from a median of (36.0 ± 18.3) to (3.8 ± 3.4) mmHg (P < 0.01, 1 mmHg = 0.133 kPa) and the diameter of the narrowest segment improved from (6.0 ± 1.9) to (11.6 ± 3.1) mm (P < 0.01). The right ventricle to aortic pressure ratio fell from 0.68 to 0.49 (P < 0.01). Complications included the following: two stents were malpositioned in the right ventricular outflow tract and one balloon ruptured when dilated the hole of the stent. No other complications occurred. All patients were followed up for 6 months to 6.0 (2.5 ± 1.8) years. One patient underwent stent re-dilation in order to accommodate somatic growth two years later.</p><p><b>CONCLUSION</b>Balloon expandable stents are safe and effective in relieving BPAS. Stent implantation should be considered the treatment of choice for most patients with BPAS. Stents placed into growing children will require further dilation to keep up with normal somatic growth. Intermediate and long-term follow up studies have shown excellent results after further dilation over time.</p>

Cardiac troponin I in children with left-to-right shunt congenital heart disease / 临床儿科杂志

Objective To analyze the level of cardiac troponin I (cTnI) in children with left-to-right shunt congenital heart disease (CHD). Methods In this study, 146 children with secundum atrial septal (ASD) defect, 132 children with ventricular septal defect (VSD) and 300 healthy children were recruited. The levels of cTnI and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured and their correlation with clinical data was analyzed. Results The serum cTnI and NT-proBNP levels in both ASD and VSD patients were signiifcantly higher than those in normal children (H=3.89 and 5.27, P<0.01). The serum cTnI and NT-proBNP levels in VSD patients were signiifcantly higher than those in ASD patients (P<0.05). The ratio of pulmonary to systemic arterial pressure (Pp/Ps), pulmonary vascular resistance index (PVRI) and standardized left ventricular end diastolic volume in VSD patients were signiifcantly higher than those in ASD patients (P<0.05). Multiple regression analysis showed that Pp/Ps was signiifcantly correlated with cTnI in VSD patients. (β=0.81, SE=0.03, P=0.000). Conclusions Signiifcant volume and pressure overload due to a left-to-right shunt induce myocardial injury and could lead to irreversible myocardial remodeling in children with CHD. The serum cTnI level is a sensitive biomarker for myocardial damage in VSD patients.

Etiology and mechanism of colonic transit dysfunction / 国际外科学杂志

Sicknesses caused by colonic transit dysfunction are commonly seen in clinical practice.The transit dysfunction of the colon has been studied in recent decades on the primary abnormalitie,the secondary damage of the colon enteric nervous system,the distribution of Cajal interstitial cells with the c-kit protein expression of its surface,the damage of smooth muscle by autoimmune,the absorption of water by colon,viral infections and the genetic aspects.

Ultrasonic study on the evaluation of regional right ventricular function by strain rate imaging after surgical repair of conotruncal defects / 中华超声影像学杂志

Objective To evaluate regional right ventricular function by ultrasonic strain rate imaging in postoperative children with conotruncal defects(CTD). Methods All 27 postoperative CTD children had magnetic resonance imaging evaluation of right ventricular end-diastolic volume and end-systolic volume to calculate right ventricular ejection fraction (RVEF). The ultrasonic parameters of peak systolic strain rate (SRs), peak early diastolic strain rate (SRe), peak late diastolic strain rate(SRa) and strain (S) were obtained at the basal,middle and apical segment in curve of right ventricular anterior wall in 27 postoperative CTD children and 27 normal children. The correlation between SRs,S and RVEF were evaluated. Results Compared with healthy children,SRs,S,SRe,SRa were significantly reduced in postoperative CTD children (P ＜ 0.01 ), there were different distribution rules between postoperative CTD children and normal children,and all indexes had no statistical descrepancy among the basal, middle and apical segment ( P ＞0.05). SRs in basal segment of the right ventricular anterior wall correlated well with RVEF ( r = 0.89,P ＜ 0. 01 ). Conclusions Regional right ventricular function still was reduced in postoperative CTD children, and could be accurately evaluated by ultrasonic strain rate imaging.

Catherization in congenital heart diseased patients with stage operation / 介入放射学杂志

Objective To explore the indications and clinical assessment for catherization in congenital heart diseased patients with stage operation. Methods Sixty five patients were selected from Apr. 1999 to Dec. 2002 undergoing second catherization. 47 male, 18 females with age ranging from 5 months to 22 years old on average of 6.8 years. EKG, chest X-ray, ECHO, cardiovascular pressure and blood oxygen saturation were taken in all patients during the procedure. Results According to the physiologic data recorded during the procedure of catherization, 39 cases needed one more surgery, 9 cases for intervention, 4 cases would be placed with endovascular stent 9 cases should be follow-up and 4 cases couldn t be operated again. Conclusions Catherization is not only offering the accurate physiologic data, but also revealing the details about anatomy with important information to the diagnosis and treatment for the congenital heart disease, especially for the srage-operation.

It is insulin resistance rather than hyperinsulinemia that relates to hypertension / 中华内分泌代谢杂志

Objective To investigate the relationship of insulin resistance (IR) and hypertension. Methods Eight hundred seventy two participants were divided into 6 groups by systolic blood pressure (SBP) or diastolic blood pressure (DBP). SBP1:

Study on correlation between HCMV DNA and T cell subsets as well as islet function in type 1 diabetic patients / 中国糖尿病杂志

Objective To study the correlation between serum human cytomegalovirus (HCMV) DNA and peripheral T cell subsets as well as islet function in type 1 diabetic patients.Methods HCMV DNA levels in sera from 20 type 1 diabetic patients and 40 controls were measured by quantitative polymerase chain reaction (PCR),then the comparison and correlation analysis were made between HCMV DNA and T cell subsets,blood glucose (BG),insulin (Ins) and C peptide (C P).Results The positive rate and levels of HCMV DNA in type 1 diabetic patients were significantly higher than those of controls respectively.The percentage of CD 8 and the levels of fasting BG and BG 2 hours after meal in type 1 diabetic patients with positive HCMV DNA were by far higher than those in controls,while the percentage of CD 4,the ratio of CD 4/CD 8,the levels of fasting Ins,Ins and C P 2 hours after meal were significantly lower than those of controls.There existed the linear positive correlation between HCMV DNA and CD 8 or fasting BG,negative correlation between HCMV DNA and CD 4/CD 8,fasting Ins or fasting C P.Differences were not so significant between type 1 diabetic patients with negative HCMV DNA and controls compared with those between patients with positive HCMV DNA and controls.Conclusion HCMV infection is associated with dysfunction of islet and T cell mediated immunity in type 1 diabetic patients.

Transcatheter closure of coronary artery fistula / 介入放射学杂志

Objective To explore the indication and the methodology of transcatheter closure of coronary artery fistula.Methods Altogether 17 cases for intervention,included 13 using the Cook corp coil(2 detachable and another 11 un-detachable);1 with the Pfm corp detachable coil;3 with the AGA corp Amplatzer-Duct.The other 26 cases underwent surgery. Results Intervention group,showed 3 failure cases because of selecting too small and un-detachable coil in early stage with final displacement.Fourteen cases were successful.Follow-up 3 years showed no residue shunt and other complications.All patients were successful with surgery.Conclusions Transcatheter closure of the coronary artery fistula is mild invasive,short hospitalization,safe,and effective under proper indications.