ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
<p><b>OBJECTIVES</b>To investigate the effect of chitosan biodegradable external stent (CES) on the early changes of rabbit vein graft (VG).</p><p><b>METHODS</b>Rabbit vein grafting models were divided into S group (with perivenous CES) and NS group (without perivenous CES). The VG were harvested in 1 week, 2 weeks, 4 weeks after operation, respectively. The expression of proliferating cell nuclear antigen (PCNA) was used for evaluating the proliferation of the smooth muscle cell (SMC). The thickness, area of neointima and media of the VG were calculated by computer imaging analysis system.</p><p><b>RESULTS</b>CES began to degrade in 2 weeks after operation. The thickness, area of both neointima and media of the VG in S group, increased mildly in 1 week after operation, and kept steady in 1 or 2 weeks after grafting, which was significantly less than NS group (both P < 0.01), then increased mildly in 4 weeks after grafting but still less than NS group (P < 0.05). The expression of PCNA of SMC decreased significantly in comparison with NS group though increasing mildly in four weeks after operation. Both neointimal formation and cell proliferation in the graft wall were significantly reduced by external stenting as compared to the results with unstented grafts.</p><p><b>CONCLUSIONS</b>CES may reduce early intimal and medial hyperplasia, and may be beneficial in improving the long term patency of the VG. The biodegradable characteristics of the CES may influence its effect.</p>