Transcatheter closure of patent ductus arteriosus with the new Amplatzer Duct OccluderII / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the indications, methodology and results of the transcatheter closure of patent ductus arteriosus (PDA) with the new Amplatzer Duct Occluder II (ADO-II).</p><p><b>METHOD</b>Totally 51 patients underwent transcatheter closure of PDA with the new ADO-II. The devices were delivered by 4F or 5F sheath through arterial or venous side respectively. The descending aorta angiography and transthoracic echocardiography was performed to evaluate the device position, residual shunt and complications caused by the device during and after implantation.</p><p><b>RESULT</b>Forty-nine patients had successful transcatheter closure of the PDA without significant residual shunts and artery obstruction during the short-term follow-up. One patient received the ADO-II dislodgment and first generation ADO re-implantation for the obvious descending aortal obstruction caused by ADO-II. Another patient had the ADO-II dislodgment and left pulmonary artery shaping surgery, because the ADO-II implantation led to obstruction of the left pulmonary artery. Both the obstructions in these two patients were ameliorated afterwards.</p><p><b>CONCLUSION</b>The transcatheter closure using the ADO-II is safe and effective for the non-window type PDA with a small size.</p>

Efficacy of the transcatheter closure of perimembranous and muscular ventricular septal defects with the Amplatzer duct occluder II / 中华心血管病杂志

<p><b>OBJECTIVES</b>To evaluate the feasibility and efficacy of transcatheter closure of perimembranous ventricular septal defects (pmVSD) with aneurysmatic formation and muscular ventricular septal defects (mVSD) with Amplatzer duct occluder II.</p><p><b>METHODS</b>This retrospective analysis included 48 cases received transcatheter closure of pmVSD aneurysmatic formation or mVSD from February 2011 to March 2012 in our hospital (42 pmVSD with aneurysmatic formation and 6 mVSD). Median age was 5.2 years (range: 1.8 - 15 years), and median weight was 20.2 kg (range: 12 - 44 kg). Amplatzer duct occluder II was selected depending on the condition of ventricular septal defect. The device was implanted by antegrade or retrograde approach. Complications such as residual shunt, valvular regurgitation and arrhythmia were evaluated by echocardiography or angiography. Median follow-up was 9.5 months (range: 1 - 13 months).</p><p><b>RESULTS</b>The mean ratio of pulmonary (Qp) to systemic (Qs) blood flow was 1.35 ± 0.15 before transcatheter closure. The diameter of exit hole of ventricular septal defects was (2.46 ± 0.53) mm measured by transthoracic echocardiography, and (2.35 ± 0.40) mm by angiography. Successful implantation of the device was achieved in 46 patients (96%) and unsuccessful in two cases due to acute aortic insufficiency. Forty-two (92%) patients were closed successfully, and trivial residual leak was evidenced in four patients and remained unchanged during follow-up. One patient with mVSD still had trivial residual shunt at 6 months post procedure. New trivial tricuspid insufficiency was observed in 1 patient (2.1%) during follow-up. Two patients developed procedural related left anterior fascicular block and remained unchanged during follow-up.</p><p><b>CONCLUSIONS</b>pmVSD with aneurysm and mVSD could be successfully treated with Amplatzer duct occluder II. However, the long waist and large disc of the device could interfere with tricuspid valve function and cause tricuspid insufficiency.</p>

Therapeutic effect of Cheatham-Platinum stent implantation for vessel stenosis associated with congenital heart disease in children and adolescents / 中华儿科杂志

<p><b>OBJECTIVE</b>Although NuMED Cheatham-Platinum (CP) stent was specifically designed to treat vascular obstructions associated with congenital heart disease (CHD), its application in pediatric patients is relatively uncommon, especially in the pulmonary artery stenosis. The aim of this study was to evaluate the immediate-, early- and intermediate-term results of CP stent implantation in the treatment of vessel stenosis associated with CHD in children and adolescents.</p><p><b>METHODS</b>From August 2005 to May 2007, 5 consecutive patients (3 boys and 2 girls) diagnosed as vascular stenosis associated with CHD underwent CP stent implantation in our institution. One patient had native coarctation of the aorta (CoA) and four patients had pulmonary artery stenosis. The median age and weight of patients were 12 years (range 4 - 15 years) and 24 kg (range 20 - 51 kg), respectively. The CP stent and NuMED Balloon-in-Balloon catheter were selected according to digital subtracted angiography measurements. After checking for correct position by angiography, the inner balloon and outer balloon inflated successively to expand the stent to desired diameter.</p><p><b>RESULTS</b>Totally 6 stent placement procedures were performed and 8 CP stents (8-zig, 22 - 39 mm in length) were implanted in these 5 patients. All stents but one in a case of right pulmonary artery stenosis were immediately successfully placed in the target lesions without displacement during the procedures. For this case, a repeat procedure was performed and a second CP stent was reimplanted successfully 11 months later. After the procedure, the systolic pressure gradient across the stenosis decreased from (43.43 +/- 25.61) mm Hg (1 mm Hg = 0.133 kPa) to (3.29 +/- 3.09) mm Hg (t = 4.320, P < 0.01) and the narrowest diameter of the stenotic vessels increased from (6.86 +/- 2.04) mm to (13.44 +/- 4.02) mm (t = -4.508, P < 0.01). The percentage of pulmonary artery flow to the ipsilateral lung increased from 11.0% and 13.0% to 47.5% and 52.2% after the procedure in 2 cases of unilateral pulmonary artery branch stenosis, respectively. The ratio of right ventricular to aortic systolic pressure decreased from 62.3% and 72.2% to 27.0% and 33.3% in 2 cases of bilateral branch pulmonary artery stenosis, respectively. Upper limb blood pressure of one case of native CoA dropped greatly from 206/133 mm Hg to 156/95 mm Hg. During a median follow-up of 20 months (range 13 - 34 months), the results have been stable without complications except 2 stents which developed intrastent restenosis 6 months after the procedure.</p><p><b>CONCLUSION</b>Our experience suggests that the CP stent implantation is safe and feasible for the treatment of vessel stenosis associated with CHD in children and adolescents. The immediate-, early- and interim results are encouraging, but long-term results remain to be further evaluated and demand many more cases to be studied.</p>

Postoperative follow up of patients with complete atrioventricular septal defect / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the operative efficacy of patients with complete atrioventricular septal defect (CAVSD).</p><p><b>METHODS</b>From January 2003 to June 2006, CAVSD patients underwent operative closure were included in this study. Color Doppler with apical four-chamber view was used to evaluate the degree of valve insufficiency before surgery and 2 days, 1 month, 6 months and 1 year after the surgery. Cardiac catheterization was performed to evaluate pulmonary artery pressure and pulmonary arteriolar resistance (PAR) before surgery in patients whose age were over 6 months. The time of staying at ICU, ventilation time after surgery and the occurrence of pulmonary artery hypertension crisis were recorded.</p><p><b>RESULTS</b>105 CAVSD patients underwent operative closure were enrolled in this study. The mean staying time at ICU was (4.7 +/- 2.4) days, and the mean ventilation time was (1.7 +/- 1.0)days, 9 patients (8.5%) developed pulmonary artery hypertension crisis after surgery. Patients with PAR > 8 Wood unit were older, staying time at ICU and ventilation time were longer compared patients with PAR < 8 Wood unit (all P < 0.05). The incidence of pulmonary artery hypertension crisis after surgery was also significantly higher in patients with PAR > 8 Wood unit compared patients with PAR < 8 Wood unit (P < 0.05). Hospital mortality was 3.8% (4/105). Three out of 4 hospital-dead patients had severe hypoplasia of the atrioventricular valve. Compared with preoperative, degree of valve insufficiency in both sides were relieved after surgery (P < 0.05). The valve insufficiency remained unchanged in 81 patients (77.1%), worsened in 14 patients (13.3%) and improved in 10 patients (9.6%) after surgery.</p><p><b>CONCLUSIONS</b>Our results suggested that early surgical repair for CAVSD was safe and beneficial. Preoperative PAR > 8 Wood unit was associated with increased risk of pulmonary artery hypertension crisis after surgery in patients with CAVSD.</p>

Anomalous origin of the left coronary artery from the pulmonary artery: report on 10 cases / 中国当代儿科杂志

<p><b>OBJECTIVE</b>The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary artery abnormality. This study aimed to investigate the clinical characteristics, diagnosis and treatment of the disorder.</p><p><b>METHODS</b>The medical data, including common clinical presentations, the findings of the digital subtraction angiogram (DSA), echocardiograms and the electrocardiograph (ECG), surgical records and the outcome, of 10 children with ALCAPA between June 2001 and February 2005 were retrospectively reviewed.</p><p><b>RESULTS</b>Diaphoresis, fantod, breathlessness and difficult feeding were commonly presented in the patients with ALCAPA. ECG, echocardiography and DSA examinations showed characteristic changes in these patients. The Takeuchi procedure was performed in 4 patients, direct aortic reimplantation in 4 cases and aortic reconstruction in 2 cases. After operation the symptoms of 8 patients were improved but 2 died.</p><p><b>CONCLUSIONS</b>ALCAPA patients have characteristic clinical manifestations and lab findings. This is helpful in making an early diagnosis of ALCAPA. Early surgical treatment can improve the patients' outcome.</p>

Congenital coronary artery fistula in children:The interventional management and outcome / 介入放射学杂志

Objective To assess the safety and efficacy of transcatheter closure of congenital coronary artery fistulas(CAFs).Methods Retrospective analysis was performed on 19 patients mean age of(5.5?4.1) years treated from February 1995 to December 2005 with transcatheter closure of CAFs using transcatheter spring coil embolization,Amplatzer PDA occluder or Amplatzer plug.One case had a residul fistula postoperatively associated with patent duetus arteriosus(PDA).Results The abnormal parameters included mean fistula diameter(3.7?1.6)mm(2.5-8.2 mm),pulmonary mean pressure(28.0?5.0)mmHg(25.0-67.0 mmHg)and pulmonary to systemic shunt(Qp/Qs)1,6?0.8(1.0-2.3).The sites of the fistulas were originated in right coronary artery 11,left anterior descending coronary artery or left circumflex coronary artery 8. Abnormal communication sites of these fistulas were to right ventricle in 14 and right atrium in 5.Various occlusion devices used to close these fistulas included one Giantureo coil in 10,2-4 Gianturco coils in 3, Duct-Occlud in 3,Amplatzer duct occluder in 2 and Amplatzer plug in 1.The post-operative residul fistula with PDA was treated successfully with PDA occlusion.The immediate,one month and one year complete occlusion rates were 55.6%(10/18),88.9%(16/18),100%(18/18),respectively.The coil slipped into the left pulmonary artery in 1 case and correction was obtained by retrieving with forceps.Follow-up studies at 3 months to 4.3 years showed complete abolition of shunt in all patients with no evidence of recanalization leading to recurrences of shunt.Conclusion Transcatheter closure of CAFs is a safe and effective alternative to surgical repair.

Risk factors for arrhythmia early after transcatheter closure of perimembranous ventricular septal defects / 中华儿科杂志

<p><b>OBJECTIVE</b>Perimembranous ventricular septal defects (PMVSDs) is the most common type of congenital ventricular septal defects (VSD), which accounts for 70% approximately 80% of VSD. The structure of PMVSDs is very complex, it is close to tricuspid valve, mitral valve and aortic valve. The atrioventricular (AV) node is located in the posterior upper membranous ventricular septum and branches into left and right bundle in the posterior lower margin. This increases the risk of transcatheter closure of PMVSDs. Arrhythmias is the common complication after transcatheter closure of PMVSDs. The present study aimed to identify the risk factors resulting in arrhythmias after transcatheter closure of PMVSDs in patients under 18 years of age to decrease the incidence of arrhythmias after the interventional catheterization.</p><p><b>METHODS</b>A retrospective analysis was performed on the patients treated with transcatheter intervention from June 2002 to June 2004. Transcatheter closure of PMVSDs with Amplatzer membranous septal occluder and a domestic product was performed in 89 cases after obtaining consent themselves and/or their guardian or parents, 47 cases were males and 42 females. The age of the cases ranged from 3 to 18 years (mean 8.2 years) and the body weight ranged from 13 to 55 kg (mean 26.7 kg). They were all diagnosed as having PMVSDs with trans-thoracic echocardiography (TTE) before the interventional catheterization, the electrocardiographic (ECG) and chest X-ray (CXR) findings were recorded. A simultaneous care ECG and TTE were performed during operation in order to identify the effect of the transcatheter closure, the heart structure and functional changes and whether or not arrhythmias occurred, respectively. In 80 cases AGA Amplatzer membranous septal occluder was used and in 9 cases a domestic product was used. Follow-up was performed based on the echocardiography and ECG.</p><p><b>RESULTS</b>The devices were successfully implanted in 89 cases; 11 cases (12%) developed various block of heart conduction within 5 days, which included first degree AV block in 1 patient, third degree AV block in 1, left anterior bundle branch block in 5, partial right bundle branch block in 4, complete right bundle branch block in 3, and 3 patients had two kinds of heart block. Eight patients were treated with corticosteroids, 6 of them recovered within 14 days, 1 patient within 1 month and in 1 case the problem shifted from first degree block and left anterior bundle branch block to left anterior bundle branch block 5 days later and that persisted for 6 months. It was found that the distance from upper margin of defects to the aortic valve < 3 mm, the diameter of ventricular septal defect > or = 8 mm, the diameter of device > or = 10 mm, blood pH < 7.35 and arteriovenous track building time after the success of the Seldinger technique > or = 60 min were independent predictors of post-closure arrhythmias.</p><p><b>CONCLUSION</b>Arrhythmias remain the severe early complications after interventional catheterization for PMVSDs in patients under 18 years of age. Shortening of operation time, prevention of acidosis and strict selection of indications may be the most effective measures to prevent arrhythmias after transcatheter closure of PMVSDs in patients under 18 years of age.</p>

Transcatheter closure of secundum atrial septal defect in children / 中华儿科杂志

<p><b>OBJECTIVE</b>This study was undertaken to investigate the indication, methodology and complication of transcatheter closure of secundum atrial septal defect (ASD). ASD transcatheter occlusion techniques have become alternative to surgical procedures. A number of different devices are available for transcatheter ASD closure. The type and incidence of complications depend partially upon different devices.</p><p><b>METHODS</b>A retrospective analysis was performed on the patients treated from October 1998 to January 2003. Transcatheter closure of ASD with Amplatzer septal occluder (ASO) was performed in 119 patients, of whom 3 patients were multiple ASD, 3 associated with pulmonary stenosis (PS) and 3 patent ductus arteriosus (PDA). The age of the cases ranged from 0.8 to 17 years (mean 7.5 +/- 2.8 years) and the body weight ranged from 6.7 to 88 kg (mean 23.7 +/- 7.8 kg). They all met with criteria for transcatheter closure. The balloon-stretched diameter of ASD was determined with fluoroscopy, ultrasound and measuring plate. A choice of device size was identical to or 1 approximately 2 mm larger than the stretched diameter (SD). A simultaneous PDA closure with device or balloon dilation was done in six cases associated with PDA or PS, respectively. Follow-up was performed based on the echocardiographic and clinical findings.</p><p><b>RESULTS</b>In 119 cases examined with transesophageal echocardiography (TEE) or trans-thoracic echocardiography (TTE), ASD mean diameter was (12.9 +/- 5.6) mm (6.5 - 34.5 mm), pulmonary mean pressure was (29.0 +/- 5.0) mmHg (25.0 - 62.0 mmHg), and SD was (15.7 +/- 4.8) mm (8.0 - 38.0 mm). The diameters of these devices were (15.0 +/- 5.0) mm (8 - 38 mm). The devices were successfully implanted in 112 cases. Of them, 3 patients had multiple ASD with one device occlusion. 6 cases associated with PDA or PS were treated successfully with PDA occlusion or balloon dilatation, respectively. The immediate, one month and one year complete occlusion rates were 93.8% (105/112), 97.3% (109/112) and 98.2% (110/112), respectively. Residual shunt remained in 2 cases. No complication occurred except transient atrial premature beats and grade II type 1 A-V block in 5 cases (4.5%) and 1 cases (0.9%), respectively. The whole time period of the procedure ranged from 25 to 68 minutes. The total follow up period was from one month to 4.3 years. No unsatisfactory device position or embolization or clinical evidence of bacterial arteritis was found during the follow-up period.</p><p><b>CONCLUSION</b>Transcatheter closure of secundum ASD using the ASO is a safe and effective alternative to surgical repair. Transcatheter closure of secundum ASD associated with small anterior, inferior or posterior rim is feasible using ASO. ASO can be performed in infants and young children only if the diameter of disk is smaller than the diameter of atrial septum. Multiple ASD is not the contraindication for intervention. If the diameter of ASD is over 36 mm, the device choice should depend on the maximum diameter of ASD determined with echocardiography. TTE is suitable for the smaller ASD and TEE for the bigger ASD. It is very important to avoid air embolism and atrial perforation during the procedure.</p>

Interventional therapy for complex congenital heart disease / 中华儿科杂志

<p><b>OBJECTIVE</b>The advances in interventional cardiac catheterization have changed the therapeutic strategy for many patients with congenital heart diseases. The aim of this study was to evaluate the role of therapeutic cardiac catheterization in the treatment of complex congenital heart diseases.</p><p><b>METHODS</b>Balloon atrial septostomy (BAS) was performed in 59 children using Rashkind balloon catheter. Static balloon dilatation of the atrial septum was performed in 2 children with hypoplastic right heart syndrome. One child with pulmonary artery stenosis at the suture lines after arterial switch was treated with balloon dilatation. Percutaneous balloon pulmonary valvuloplasty (PBPV) and balloon angioplasty were performed in 15 children with tetralogy of Fallot (TOF). Transcatheter coil embolization was performed in 18 children with systemic to pulmonary collateral vessels and 5 children with B-T shunts before surgical procedures. Transcatheter closure of fenestration with Amplatzer septal occluder device was performed in 1 child who had undergone Fontan procedure.</p><p><b>RESULTS</b>In 46 children with transposition of great arteries (TGA), the arterial oxygen saturation (SaO(2)) was increased from 0.57 +/- 0.17 to 0.76 +/- 0.13 (t = 14.58, P < 0.01) after BAS. The pressure gradients across left and right atrium were less than 2 mmHg. The created atrial septal defects were 5 - 20 mm in size. In 10 children with pulmonary atresia with intact ventricular septum (PA/IVS), the arterial oxygen saturation did not change after BAS (t = 1.57, P > 0.05), but the pressure gradients across left and right atrium were less than 2 mmHg. In children with TOF, the arterial oxygen saturation was increased by 15 percent after PBPV and pulmonary valvular stenosis was relieved. In 14 of 18 children with systemic to pulmonary collateral vessels and 5 children with B-T shunts, complete occlusion was accomplished and the procedures were successful. In the child who had undergone Fontan procedure, the fenestration was occluded successfully and no complication was observed.</p><p><b>CONCLUSION</b>In management of complex congenital heart diseases, combination of surgical procedure and interventional catheterization therapy could be suggested to have better outcome.</p>

Role of cytomegalovirus infection in the pathogenesis of type 2 diabetes mellitus / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To further study the role of human cytomegalovirus (HCMV) infection in the pathogenesis of the type 2 diabetes mellitus.</p><p><b>METHODS</b>HCMV DNA levels in sera from 29 type 2 diabetic patients and 23 controls were measured by quantitative polymerase chain reaction (PCR), and comparative analyses was made between HCMV DNA and T cell subsets, blood glucose (BG), insulin (Ins) and C peptide (C-P).</p><p><b>RESULTS</b>The levels of HCMV DNA were (1.81+/-1.67) x 10(8) copies/ml for type 2 diabetic patients, a level significantly higher than that (5.50+/-4.30) x 10(7) copies/ml of controls. The percentage of CD8 for type 2 diabetic patients with positive HCMV DNA was 29.53%+/-2.00%, being much higher than that for controls (27.13%+/-4.12%), while the ratio of CD4/CD8 1.24+/-0.05 was significantly lower than that 1.41+/-0.10 of controls. Fasting C-P of type 2 diabetic patients with positive HCMV DNA was far lower than that of those with negative HCMV DNA, but the differences of BG and Ins between the two groups were not significant.</p><p><b>CONCLUSION</b>Active HCMV infection of type 2 diabetic patients may suppress cellular immunity and its influence on the pathogenesis of the type 2 diabetes mellitus should be further studied.</p>