ABSTRACT
Objective To investigate the interventional treatment strategy for occluding the intercristal ventricular septal defect (VSD) in order to improve the surgical safety and success rate. Methods During the period from January 2012 to December 2013, a total of 31 patients with intercristal VSD were admitted to authors’ hospital to receive interventional catheter occlusion therapy. Preoperative color Doppler ultrasound echocardiography showed that on the short axis view of the aorta the VSD interrupted port was situated at 12:00 - 1:00 o’clock region. Left ventricular and above aortic valve angiography indicated that the VSD location, shape and size, the split vent size on the left ventricle side and its distance from the aortic valve could be correctly measured when the VSD shunt was visualized , which were very helpful in guiding the operator to select the suitable occluder as well as to adjust the release pattern of the occluder. Postoperative imaging findings of the left ventricular and above aortic valve angiography were compared with the preoperative ones. Results Successful occlusion of VSD was obtained in 22 patients , in 13 among them the left ventricular angiography showed that the direction of blood flow beam at the defect hole was from the left ventricle to the right ventricle in an obliquely upward direction. The basal width of the defect on the left ventricle side was (5.12 ± 1.38) mm, and(6 - 10) mm occluder was employed. In the remaining 9 patients the left ventricular angiography showed that the direction of blood flow beam at the defect hole was from the left ventricle to the right ventricle in a direction almost parallel to the aortic valve , and the basal width of the defect on the left ventricle side was (7.18 ± 1.26) mm, and (9 - 12) mm zero-bias occluder was adopted. Interventional occlusion of VSD was unsuccessful in 9 cases as the intercristal hole was rather larger, and two of them had coexisting aortic sinus aneurysm complicated by mid-to-severe degree aortic valve regurgitation. Conclusion Based on the precise analysis of angiographic images by experienced radiologists optimal treatment scheme can be worked out. If conditions permit, symmetrical occluder should be employed so far as possible in order to reduce the degree of operation difficulty and improve the surgical safety and the success rate as well.
ABSTRACT
OBJECTIVE: Interventional occlusion of intracristal ventricular septal defects (IVSD) is a node point. Reports concerning angiography features and successful occlusion of IVSD using domestic occluder are rare. The aim of this paper is to investigate the angiography features of IVSD and the experience of interventional occlusion with domestic occluder. METHODS: Totally 46 cases of IVSD were diagnosed by color Doppler echocardiography that they had interventional indications.According to the short axis view of aortic, they were divided into 4 groups: A (11:30-12:00), B (12:00-12:30), C (12:30-13:00) and D (13:00-13:30). Different groups were performed with adequate angle angiography to show ventricular septal defect, as well as to decide strategy, which to choose occluder and occluded methods.RESULTS: All 46 patients were occluded successful. Technical success rate was 100%, without related complications. A group included 10 cases, B group 13 cases, C group 16 cases and D group 7 cases. The left anterior oblique angle of IVSD left ventricular angiography was greater than other type of VSD, and increased gradually with the changes in the defect location (Group A to D). According to the defect size and different groups, the defects were successfully occluded with symmetric,decentered, zere-decentered type occluder. Modified pigtail catheter was good value in practice occlusion of IVSD.CONCLUSIONS: Left anterior oblique angle in IVSD left ventricular angiography should be bigger. Domestic occluder is safe,effective, with less complication and cost, which can be the first choose for patients with LVSD.
ABSTRACT
To understand the sero-epidemiological features of rickettesiosis of humans and domestic animals in Yunnan province, blood samples from 237 adults in different geographic area, including Xundian country,Yulong country and Simao country and 81 children aged from 4 to 6 years old were collected for serological testing. In addition, 90 blood samples from dogs, goats and ox in each investigated area were also collected. Antibodies against 8 rickettsiae, including R.typhi, R.heilongjiangii or R.sibirica, Orientia tsutsugamushi Karp or Kato, Ehrlichia chaffeensis, Anaplasma phagocytosis, Bartonella henselae, Coxiella burnetii and Hainan spotted fever group of rickettsia were examined by using immunofluorescence assays(IFA).It was found that the sero-epidemiologic rates of R.typhi, B.henselae and C.burnetii (16.46%、6.33% and 9.28%) of adults were higher than those of other rickerrsiae investigated. The positive rates of IgG antibody against R.typhi for children also shared the higher rate (12.35%). Similar sero-epidemiologic features were found for domestic animals. Among the 8 rickettsia tested in this study, the positive rate of IgG antibody against R.typhi appeared to be the highest(61.48%) without significant difference among these investigated sites. From this investigation, it is evident that the rickettsial infection of farm population and domestic animals are common in Yunnan province, and the active surveillance of rickettsiosis and differential diagnosis of unknown febrile patients in clinical practice should be enforced.