ABSTRACT
Objective To evaluate the safety aod efficacy of device closure of ventricular septal defect (VSD) through parasternal approach,and to compare the advantages and disadvantages of three approaches.Methods Between Jan 2012 and Jul 2015,209 cases(Group A) underwent per-ventricular device closure of VSD through a left parasternal approach,and 36 cases(Group B) underwent per-atrial device closure of VSD through a fight parasternal approach,and 49 cases(Group C) underwent per-ventricular device closure of VSD through a median sternotomy approach.In group A,a 1.0 to 2.0 cm left parasternal iucision was made in the fourth or third intercostal space.Press the right ventricular(RV) free wall to select the puncture point.After securing double purse-string suture around the optimal puncture site,the occluder was introduced via a sheath inserted directly into the RV and navigation and positioning of the device guided by transesophageal echocardiography(TEE).In group B,a 1.0 to 2.0 cm right parasternal incision was made in the fourth or third intercostal space.After securing double purse-string suture at the right atrium near the atrioventricular groove,a specially designed hollow probe was inserted into the right atrium and was passed through the tricuspid valve into the right ventricle.The tip of the probe was manipulated to aim at or cross VSD,and a spring guide-wire was inserted into the left veotricle(LV) through the channel of the probe under TEE guidance.Then the delivery sheath was positioned into LV passing over the wire,and the device was pushed into the sheath and was deployed to finish closure.In group C,after a 1.5 to 3.0 cm median sternal incision was made,the closure of VSD was finished as the same procedure as in group A.Results There was no significant differences at the age and weight between 3 groups,as well as the size of VSD and devices.But the position of VSD varied between 3 groups.The rate of successful closure in group A (98.1％,205/209) and B (97.2％,35/36) was similar to group C (97.9％,48/49).The mean intracardiac manipulating time was shorter in group A(10 ± 6) min and group C (7 ± 5) min than in group B(19 ± 11) min.The mean time of skin cut to suture was shorter in group A(40 ± 15) min and group B(43 ± 17) min than in group C(55 ±21) min.And the average hospitalization time in group A (5.9 ± 2.2) days and group B (5.5 ± 2.7) days was shorter than in group C (8.3 ± 3.6) days.During the follow-up period of 1 to 40 months,no obvious residual leakage,arrhythmia or valvular inadequacy were found in all cases,and no device dropped out.Conclusion Minimally invasive technique of device closure of VSD through parasternal approach appears to be safe and effective,further reducing trauma and recovering faster than median sternal approach.Accurate and all-round TEE evaluation is very important to case selection of VSD.Individually procedure approach should be performed according to the size,position,and path and flow direction of VSD.
ABSTRACT
BACKGROUND:It has been demonstrated to be effective for the improvement of heart function after acute myocardial infarction with intravenous or intramyocardial administration of bone marrow mesenchymal stromal cels. However, little is known regarding the effect of the combination of intravenous and intramyocardial administration of mesenchymal stromal cels on the heart function of a chronic myocardial infarction model. OBJECTIVE:To study the effect of intravenous and intramyocardial administration of bone marrow mesenchymal stromal cels on the heart function of a rat chronic myocardial infarction model and the relevant mechanism. METHODS:Bone marrow mesenchymal stromal cels isolated from Lewis rats were expandedex vivo. BrdU-labeled bone marrow mesenchymal stromal cels (3×106) were administeredvia the femoral vein and the myocardial surface respectively into rat models of chronic myocardial infarction in cel transplantation group. The equal volume of PBS was injected into the same place in control group. Four weeks after injection, echocardiography was performed to evaluate the heart function, and then the heart tissues were harvested for immunohistochemistry examination. The total blood vessel density in the scar area was evaluated. RESULTS AND CONCLUSION:At 4 weeks after cel implantation, the left ventricular function was not improved in the two groups. The immunohistochemistry staining showed that (1) the mesenchymal stromal cels in the myocardium did not differentiate to myocardial cels; (2) there was no significant difference in the total blood vessel density in the scar area between the cel transplantation and control groups. Taken together, the combined intravenous and intramyocardial administration of bone marrow mesenchymal stromal cels cannot improve heart function in a rat chronic myocardial infarction model.