Current status and thought of transcatheter mitral edge-to-edge repair in the treatment of hypertrophy cardiomyopathy / 中华外科杂志

Septal reduction therapies, which include septal myectomy and alcohol septal ablation and so on, are the current treatment strategies for patients with obstructive hypertrophic cardiomyopathy and drug-refractory symptoms. With the deepening of theoretical understanding and the rapid development of interventional therapies, some researchers have tried to perform transcatheter mitral valve edge-to-edge repair to treat high-risk patients with hypertrophic cardiomyopathy, including obstructive and non-obstructive. The reported results are relatively satisfactory, but many urgent problems need to be solved, such as the lack of data on animal experiments and large cohort studies, and the unknown medium- and long-term outcomes. However, transcatheter mitral valve edge-to-edge repair brings new ideas for the diagnosis and treatment of patients with hypertrophic cardiomyopathy. On one hand, it can be used as a monotherapy, on the other hand, it can be combined with novel molecular targeted drug therapy or emerging minimally invasive surgical procedures targeting hypertrophic ventricular septum, which deserves our further attention and exploratory research.

Feasibility and Effectiveness of Percutaneous Balloon Mitral Valvuloplasty Under Echocardiographic Guidance Only / 中国循环杂志

Objectives: The present first-in-human study aimed to assess the feasibility of percutaneous balloon mitral valvuloplasty (PBMV) for the treatment of isolated mitral stenosis (MS) under echocardiography guidance only. Methods: Data were obtained from 24 consecutive patients with severe MS, who underwent PBMV from October 2016 to October 2017 under the guidance of echocardiography only. Outpatient follow-up including chest radiography, electrocardiography, and transthoracic echocardiography was conducted at 1, 3, 6 and 12 months post procedure. Results: PBMV was successful in all 24 patients under echocardiography guidance without radiation and contrast agent. Mitral transvalvular pressure gradient derived invasive catheterization measurement dropped from(15.0±5.1) mmHg to (6.7±2.9) mmHg (P<0.01). Mitral valve area increased from (0.8±0.1) cm2at pre-PBMV to (1.7±0.1) cm2post-PBMV (P<0.01). Mean balloon diameter was (26.7±1.2) mm. Mild mitral regurgitation developed in 8 patients. Mean follow-up duration was (7.4±3.1) months. At the last follow-up, mitral valve area remained high (1.6±0.1) cm2and mean transmitral pressure gradient remained low (9.0±4.3) mmHg. No pericardial effusion or peripheral vascular complications occurred. Conclusions: In this patient cohort, PBMV could be successfully performed with echocardiography as the single imaging guidance modality, this procedure is safe and effective and avoids the radiation exposure and contrast agent use.

Application of Pulmonary Vein Deployment Technique for Percutaneous Closure of Atrial Septal Defect Solely Under Echocardiography Guidance / 中国循环杂志

Objective: To investigate the safety and efficacy of pulmonary vein deployment technique for percutaneous closure of atrial septal defects (ASD) solely under echocardiography guidance. Methods: A total of 38 ASD patients received pulmonary vein deployment in our hospital from 2012-10 to 2016-09 since the conventional method could not deliver the occluder to correct place. The patients were with the mean age at (16.0±15.6) years, body weight at (37.2±22.9) kg and ASD diameter at (17.1±4.2) mm. Operative effect was assessed by echocardiography. Follow-up study was conducted at 1, 3, 6, 12 months post-operation and at each year thereafter. Results: 37 patients were successfully finished pulmonary vein deployment for percutaneous closure of ASD solely under echocardiography guidance. One patient was successfully treated by a controlled steerable sheath. The mean operative time was (25.2±5.1) min and mean diameter of ASD occluder was (22.9±5.6) mm. 2 patients had trivial residual shunt at the early post-operative stage. No peripheral vascular injury, pulmonary vein and cardiac perforation occurred. All 38 patients were recovered and discharged. The average in-hospital time was (2.9±0.7) days. The patients were followed-up for (23.9±15.4) months, without complications of residual shunt, pericardial effusion, aortic regurgitation and pulmonary vein stenosis. Conclusion: Pulmonary vein deployment technique for percutaneous closure of ASD solely under echocardiography guidance was safe and effective; it can avoid radiation damage and provided a simple and practical method for ASD patients who failed to conventional method under echocardiography guidance.

Safety and efficacy of percutaneous transcatheter closure of atrial septal defect under transesophageal echocardiography guidance in children / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess the safety and effectiveness of percutaneous transcatheter closure of atrial septal defect (ASD) under transesophageal echocardiography (TEE) guidance in children.</p><p><b>METHODS</b>The study included 20 cases of patients with ASD. The patients were (4.2 ± 1.2) years old and the mean body weights were (18.2 ± 4.2) kg. The diameter of ASD before closure was (13.4 ± 3.3) mm . All procedures were guided under TEE. Procedure success was evaluated by TEE immediately after procedure.</p><p><b>RESULTS</b>Closure devices were successfully implanted in all 20 patients under TEE guidance. The diameter of closure devices was 14-26 mm. There were no procedure related complications. The ventilation time was (2.9 ± 0.8)h and the hospitalization time was (3.2 ± 0.7) days.</p><p><b>CONCLUSION</b>TEE guided percutaneous transcatheter closure is safe and effective for patients with ASD and avoids the radiation damages.</p>

A modified Calgary syncope syndrome score in the differential diagnosis between cardiac syncope and vasovagal syncope / 中华儿科杂志

<p><b>OBJECTIVE</b>This study aimed at analyzing the usefulness of a modified Calgary Syncope Syndrome Score in the differential diagnosis between cardiac syncope (CS) and vasovagal syncope (VVS) in children through a large sample clinical study.</p><p><b>METHOD</b>Totally 189 children [112 males, 77 females, aged 2 - 18 yrs, mean age (12.4 ± 3.1) yrs] with CS and VVS who were at the syncope clinic or admitted to the Department of Pediatrics, Peking University First Hospital from August 2002 to April 2011 were included in the study. The diagnosis was analyzed by a modified Calgary Syncope Syndrome Score and receiver operating characteristic (ROC) curve was used to explore the predictive value of different Calgary Syncope Syndrome Scores in differential diagnosis between CS and VVS.</p><p><b>RESULT</b>There were significant differences in the score between CS [-5.00(-7, 1)] and VVS [1(-4, 6)] (P < 0.01). When the score was ≤ -2.5, the sensitivity and specificity of the differential diagnosis between CS and VVS were 95.4% and 67.7%, respectively. Since the modified Calgary Syncope Syndrome Score was integer number, CS should be considered when the score was less than -3.</p><p><b>CONCLUSION</b>The modified Calgary Syncope Syndrome Score might be used as an initial diagnostic method in differential diagnosis between CS and VVS, based on the history of the patients.</p>

A diagnosis-based health economic analysis of postural orthostatic tachycardia syndrome in Chinese children / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Postural orthostatic tachycardia syndrome (POTS) is a common clinical problem in children and adolescents. The previous diagnostic approach to POTS of children and adolescents is based on a series of tests to exclude all other causes, which is time and medical resource consuming. Recently, a new diagnostic approach has been developed. The present study was designed to statistically analyze the results of clinical investigation items and the cost for the diagnosis of POTS in children patients, and evaluate cost changes in the diagnosis of POTS.</p><p><b>METHODS</b>A total of 315 children patients were divided into two groups according to diagnosis period, including group I diagnosed in 2002 - 2006 (100 cases) and group II in 2007 - 2010 (215 cases) and the diagnostic item-based distribution of the cost was analyzed. The diagnostic costs were compared between two groups using SPSS17.0.</p><p><b>RESULTS</b>The per-capita cost of diagnosis in group I was (621.95 ± 21.10) Yuan, costs of diagnostic tests (head-up tilt test, standing test, etc) accounted for 8.68% and the exclusive tests for 91.32%. The per-capita cost of diagnosis in group II was (542.69 ± 23.14) Yuan, diagnostic tests accounted for 10.50% and exclusive tests for 89.50%. Comparison of the total cost of diagnostic tests between the two groups showed significant differences (P < 0.05).</p><p><b>CONCLUSION</b>The cost of POTS diagnosis has been declined in recent years, but the cost of exclusive diagnosis is still its major part.</p>

Therapies for postural tachycardia syndrome in children / 中华儿科杂志

<p><b>OBJECTIVE</b>This study was designed to compare the short-term and long-term effects of oral rehydration salts, oral rehydration salts plus metoprolol or oral rehydration salts plus midodrine hydrochloride on the treatment of postural tachycardia syndrome (POTS) in children.</p><p><b>METHOD</b>A total of 118 children with POTS were divided into oral rehydration salts group (n = 39), metoprolol group (oral rehydration salts plus metoprolol, n = 10) or midodrine hydrochloride group (oral rehydration salts plus midodrine hydrochloride, n = 69). The patients were followed up in clinics or over telephone for 3 - 18 months, with a mean of (11.7 ± 4.1) months. The symptom scores were recorded before treatment, after 3 months and at the end of the follow-up. Reduction of the score by 2 points or more was considered that the treatment was effective. The effective rate in 3 months was applied to evaluate short-term effects of 3 different therapies by chi-square test. Taking futility as events, Kaplan-Meier curves were drawn to compare long-term effects of the 3 different therapies in treating POTS in children.</p><p><b>RESULT</b>No significant differences among the 3 groups were found in sex, age, body height, weight, the symptom scores before treatment or hemodynamic variables. Oral rehydration salts, metoprolol and midodrine hydrochloride improved clinical symptoms after 3 months. The symptom scores of the 3 groups before treatment and after 3 months were 2.4 ± 3.2 vs. 5.5 ± 2.9, 2.2 ± 3.0 vs. 6.1 ± 3.0 and 1.9 ± 1.6 vs. 5.9 ± 2.7, respectively. The difference was significant (P < 0.05). Descending order of the short-term effective rate was 91.3% in midodrine hydrochloride group, 80.0% in metoprolol group and 74.4% in oral rehydration salts group. The difference was significant (χ(2) = 5.85, P < 0.05). All the 3 different therapies improved clinical symptoms at the end of follow-up. The symptom scores were 2.6 ± 3.2 vs. 5.6 ± 2.9, 2.5 ± 3.1 vs. 6.1 ± 3.0 and 2.2 ± 2.1 vs. 6.0 ± 2.7, respectively. (P < 0.05). The result of the Kaplan-Meier curves showed that the long-term effect of midodrine hydrochloride was significantly superior to metoprolol group and oral rehydration salts group (P < 0.05). There was no significant difference between the latter two groups.</p><p><b>CONCLUSION</b>Oral rehydration salts plus midodrine hydrochloride or plus metoprolol improved the efficacy of drugs in children with POTS. And the efficacy of midodrine hydrochloride was superior to that of metoprolol.</p>

Investigation of Tilt Angle of Head-Up Tilt Test on Children / 实用儿科临床杂志

0.05).The different tilt angles impacted patients' fear psychology(?2=8.038,P=0.018).The order of the extent of children's fear psychology represented from low to high at the angle of 60?,70? and 80?,respectively.The extent of the children's fear psychology had positive correlation with the tilt angle(r=0.669,P=0.002).Conclusions The tilt test angle does not affect the positive rate of HUTT and the hemodynamics in children undergoing HUTT with angles from 60? to 80?.The children at the tilt angle 60? had less fear than at the angle of 70? or 80?.The 60? tilt angle of HUTT in children is recommended in the clinical practice.

Clinical Significance of Measuring Exhaled Gaseous Signal Molecules / 实用儿科临床杂志

Exhaled gaseous signal molecules such as nitric oxide(NO),carbon monoxide(CO) and hydrogen sulfide(H2S) can be measured with a non-invasive technique.The fraction of NO level in exhaled gaseous of patients with airway inflammatory illness(such as bronchial asthma) significantly increases.No in exhaled gaseous is one of the markers in the diagnosis of asthma,and it is also a marker of anti-inflammatory response for patients with asthma.The fraction of CO level in exhaled gaseous of patients with bronchial asthma is also si-gnificantly elevated.Both NO and CO in exhaled gaseous in other airway inflammatory illness,such as chronic obstructive pulmonary disease,chronic bronchitis and cystic fibrosis are also evidently changed.Measuring exhaled gaseous signal molecules can provide important basis for the diagnosis and treatment of airway inflammatory illness.