Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension in adults: immediate and two-year follow-up results / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Transcatheter closure of patent ductus arteriosus (PDA) is a well established procedure and an accepted treatment modality for small to moderate-sized PDA. This study aimed to evaluate the immediate and follow-up results of transcatheter closure of large PDAs with severe pulmonary arterial hypertension (PAH) in adults.</p><p><b>METHODS</b>After a complete hemodynamic evaluation differentiating from the reversibility of severe PAH, transcatheter closure of PDA was performed. Patients were followed up clinically and echocardiographically at 24 hours, 1 month, 3 months, 6 months, 12 months and 24 months after occlusion.</p><p><b>RESULTS</b>Twenty-nine patients had successful occlusion, pulmonary artery pressure (PAP), left ventricular ejection fraction (LVEF) and fractional shortening (FS) significantly decreased immediately after occlusion ((106 ± 25) mmHg vs. (50 ± 14) mmHg, P < 0.01; (63.7 ± 7.2)% vs. (51.4 ± 10.1)%, P < 0.01 and (36.9 ± 8.2)% vs. (28.9 ± 8.6)%, P < 0.05, respectively). At 1 month after PDA closure, the signs and symptoms improved markedly in all 29 patients, and PDAs were completely closed and remained closed during the follow-up. Eighteen patients having different degrees of dyspnea were treated with angiotensin converting enzyme inhibitor (ACEI) and/or digoxin after occlusion. Nine patients whose pulmonary vascular resistence (PVR) > 6 Wood units accepted targeted PAH therapy. After 1 to 3 months of peroral drug therapy, their exercise tolerance improved from New York Heart Association (NYHA) class III-IV to NYHA class I. During follow-up, no latent arrhythmias were found, the left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular mass index (LVMI) and pulmonary artery systolic pressure (PASP) decreased significantly (P < 0.05), and FS and LVEF recovered compared to the immediate postclosure state. However, FS and LVEF remained low compared to the preclosure state.</p><p><b>CONCLUSIONS</b>Transcatheter closure of large PDA with severe PAH is feasible, effective, and safe in adults. Significant left ventricular systolic changes may occur after closure of large PDA, and left ventricular function usually recovers within a few months.</p>

Immediately effects of inhaled aerosolised iloprost in adult patients with severe pulmonary hypertension secondary to congenital heart diseases / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the immediately effects of inhaled aerosolized iloprost in adult patients with severe pulmonary arterial hypertension (PAH) secondary to congenital heart diseases (CHD).</p><p><b>METHODS</b>Adult patients with severe PAH secondary to CHD (n = 165) were included in this study. Right heart catheterization was performed, Pulmonary and systemic blood flow, the oxygen consumption VO(2) (ml/min) were calculated using Fick's principle. Pulmonary vascular resistances (PVR) were calculated with standard formulas and indexed to body surface area. Hemodynamic parameters were measured before and after iloprost inhalation (20 µg).</p><p><b>RESULTS</b>Post iloprost inhalation, heart rate, mean aortic pressure, pulmonary systolic pressure to aortic systolic pressure ratio all remained un changed (P > 0.05), while pulmonary artery pressure (PAP) were significantly reduced and Qp significantly increased from (7.2 ± 4.8) L/min to (9.9 ± 7.2) L/min (P < 0.01), PVR was also significantly reduced from (13.4 ± 8.7) Wood units to (9.5 ± 6.6) Wood units (P < 0.01), and left-to-right shunt volume increased from (3.2 ± 4.4) L/min to (5.5 ± 7.0) L/min (P < 0.01) and right-to-left shunt volume decreased from (1.0 ± 1.0) L/min to (0.7 ± 0.7) L/min (P < 0.01). Subgroup analysis showed that adult patients with patent ductus arteriosus and/or ventricular septal defects are more likely to develop severe pulmonary arterial hypertension or Eisenmenger syndrome than patients with atrial septal defects.</p><p><b>CONCLUSIONS</b>Inhaled Aerosolised iloprost use is effective and safe for adult patients with severe pulmonary arterial hypertension secondary to congenital heart diseases.</p>

Acute left ventricular failure after transcatheter closure of a secundum atrial septal defect in a patient with hypertrophic cardiomyopathy / 中华医学杂志(英文版)

We report a case of acute left ventricular failure at one hour after transcatheter closure of a secundum atrial septal defect (ASD) in a 28-year-old man with hypertrophic cardiomyopathy. Afforded noninvasive mechanical ventilation and the administration of intravenous morphine and high doses of furosemide, the patient exhibited improvement of his clinical condition, reduction of pulmonary congestion at chest X-ray, and satisfactory blood gas analyses in twelve hours. Twenty-four hours later, the patient received oral administration of furosemide and metoprolol. After 7 days the patient was discharged in good clinical condition. At follow-up at 12 months, the patient had remained symptomatically improved from NYHA Class III symptoms before the procedure to Class II symptoms. There was no latent arrhythmia at the follow-up examination. Follow-up transthoracic echocardiography estimated an improvement of the left ventricular function. So, transcatheter closure of a secundum ASD in a patient with hypertrophic cardiomyopathy is feasible, and a thorough understanding of the hemodynamic condition of ASD and hypertrophic cardiomyopathy will reduce the complication of ASD closure.

Correlation of angiotensin-converting enzyme 2 gene polymorphisms to essential hypertension and ischemic stroke / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the relationship between angiotensin-converting enzyme 2 (ACE2) gene polymorphisms and the risk factor for essential hypertension (EH) with concurrent ischemic stroke in southern Chinese population.</p><p><b>METHODS</b>The G9570A polymorphism in ACE2 gene were detected in 139 patients with EH and stroke using polymerase chain reaction-restriction fragment length polymorphism. Detailed clinical and biochemistrical data of the patients, including the pulse pressure, high sensitivity C-reactive protein (hsCRP), intima-media thickness (IMT), high-density lipoprotein cholesterol (HDL-C) and uric acid levels, were collected to study the relationship between ACE2 gene and the risk factor of EH and stroke.</p><p><b>RESULTS</b>The levels of hsCRP (OR=1.022), uric acid (OR=1.224), IMT and pulse pressure was positively correlated to the incidence of EH and stroke. The pulse pressure, hsCRP, IMT, and HDL-C levels in male stroke patients carrying A allele was significantly higher than those in patients carrying G allele (P<0.05). In female stroke patients, the pulse pressure, hsCRP, IMT, and HDL-C levels were also significantly different with regard to the genotype of ACE2 gene (P<0.05).</p><p><b>CONCLUSIONS</b>The patients with EH and ischemic stroke carrying the A/AA allele of ACE2 gene have higher risks than those carrying other allele, and can be also more vulnerable to stroke recurrence.</p>

Quantitative assessment of pulmonary blood flow by echocardiography in patients with congenital heart defect / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the possibility and reliability of echocardiography in quantitative evaluation of pulmonary blood flow in patients with congenital heart disease (CHD).</p><p><b>METHODS</b>Sixty-four patients with left to right shunt congenital atrial septal defect (ASD) underwent echocardiographic examinations of the right upper and lower pulmonary vein blood flow spectrum in the four-chamber face, and the right upper pulmonary vein flow velocity time integral (VTIrupv) and right inferior pulmonary venous flow velocity time integral (VTIrlpv) were calculated according to the heart rate. The VTIrupv and VTIrlpv were compared with the pulmonary blood flow (Qp) calculated by Fick method with right heart catheterization.</p><p><b>RESULTS</b>There was a high correlation between the right lung vein flow velocity time integral measured by the catheter of transthoracic echocardiography and Qp.</p><p><b>CONCLUSION</b>The pulmonary venous flow spectrum measured by echocardiography can be informative of the pulmonary blood flow in patients with CHD. Echocardiography may serve as a potential noninvasive technique to evaluate pulmonary blood flow in these patients.</p>

Transcatheter closure of patent foramen ovale with the Spider patent foramen ovale occluder: a prospective, single-center trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Transcatheter closure of patent foramen ovale (PFO) is a promising alternative to surgical closure or anticoagulation therapy to prevent paradoxical embolic events in patients with PFO. Several different devices have been used for transcatheter PFO closure. The aim of the present study was to evaluate the safety and feasibility for closure of PFO with a new PFO occluder, the Spider PFO occluder.</p><p><b>METHODS</b>The device was implanted in the PFO patients under fluoroscopy and transthoracic echocardiography (TTE) using a 10 French delivery sheath employing a femoral vein approach. Aspirin was administered at 100 mg/d for six months after occlusion. The clinical and echocardiographic follow-up of patients were performed at the 24th hour, 1st month, 3rd month, 6th month, and 12th month after occlusion, and yearly thereafter.</p><p><b>RESULTS</b>The device was implanted successfully in all 55 patients. No major complications occurred during the perioperative period, such as thromboembolism, occluder dislodgement, infection or myocardial infarction. No residual shunt of the atrial level was shown by transesophageal echocardiography, and no latent arrhythmia or cerebral vessel events occurred in any cases during follow-up ((35 +/- 9) months, range 6 - 51 months).</p><p><b>CONCLUSION</b>Transcatheter closure of a PFO with the Spider PFO occluder is a safe and effective therapeutic option for the secondary prevention of presumed paradoxical embolism. However, randomized trials comparing this device with other devices and therapies have to be performed.</p>

Efficacy of a domestic left-disk-coated atrial septal occluder on treating patent foramen Ovale in a miniswine model / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of domestic left-disk-coated atrial septal occluder on treating patent foramen ovale in a miniswine model.</p><p><b>METHODS</b>Foramen ovale was punctured in 12 Guangxi BA-MA miniswine and occluded by domestic left-disk-coated atrial septal occluder (Spider(TM) PFO closure system) under the guidance of fluoroscopy. After occlusion, miniswine were executed after transthoracic echocardiography examination with color Doppler at month 1, 2, 3 and 6 respectively for gross inspection and microscopic examinations.</p><p><b>RESULTS</b>There were no vegetation, thrombosis, broken stent, or erosion on the surface of all devices. The PFOs were completed occluded as evidenced by transthoracic echocardiography at 1 to 6 months after operation. The surface of the device was fully covered by collagen tissue and endothelial tissue at 1 month after operation and the thickened gradually thereafter.</p><p><b>CONCLUSIONS</b>The domestic left-disk-coated atrial septal occluder can efficiently occlude patent foramen ovale. Satisfactory biocompatibility, rapid and complete endothelium covering and low incidence of complication are also evidenced for this closure system in our experiment.</p>

Chronic outcome of percutaneous transcatheter patent foramen ovale closure with Left-disk-coated patent foramen ovale occluder / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the safety and efficacy of patent foramen ovale (PFO) closure with Left-disk-coated PFO occluder.</p><p><b>METHODS</b>The device was implanted in patients with PFO under the guidance of fluoroscopy and transthoracal echocardiography using a 10-12 French delivery sheath via femoral vein approach. Aspirin (100 mg/d for 6 months) was administered post procedure. Patients were followed clinically and echocardiographically at 24 hours, 1 month, 3 months, 6 months, and 12 months after device implantation and yearly thereafter.</p><p><b>RESULTS</b>Permanent device implantation failed in one patient (4%) and succeed in the remaining 24 patients (96%). There were no major in-hospital-adverse events or complications (thromboembolism, occluder dislodgement, infection or myocardial infarction). Seven patients developed transient atrial premature beats or atrial tachycardia during implantation and stopped without medication post procedure. Follow-up [(25 + or - 12) months] results showed that all occluders were in position and there were no residual shunt, arrhythmia and cerebral vessel events post procedure.</p><p><b>CONCLUSION</b>Left-disk-coated PFO occluder is safe and effective for PFO closure.</p>

Relationship Between the Angiotensin-Converting Enzyme 2 Genotype and Effect of Irbesartan on Left Ventricular Structure and Function in Hypertensive Patients / 中华高血压杂志

Background Experimental data have shown tnat polymorpnisms in tne angiotensm-converting en- zyme 2(ACE2)gene are related to echocardiographically determined parameters of left ventricular mass,structure or function in the general population whether ACE2 genotype influences the effect of angi0tensin Ⅱ receptor blocker which improve left ventricular remodeling and function is unknown.Objective To investigate the association be- tween ACE2 gene G9570A polymorphism and the effect of irbesartan on left ventricular structure and function in hy- pertensive patients.Methods Two hundred and five male patients and 190 female patients who were preliminaryly diagnosised with mild and moderate essential hypertension were treated with irbesartan for 48 weeks with initial dose of 150 mg/d and titrated to 300 mg/d to reach the targed BP.Gene polymorphisms of ACE2 G9570A were detected by PCR-RFLP methods.The association between changes in the SBP,DBP,parameters of left ventricular struc- ture and function and genotypes of the ACE2 gene locus were analyzed.Results Irbesartan reducted in blood pres- sure in all patients(P