Retiro de dispositivo de oclusión septal transcateterismo en una paciente con comunicación interventricular / Removal of Transcatheter Septal Occlusion Device in a Patient with Ventricular Septal Defect

Introducción: Las complicaciones asociadas al procedimiento de colocación de un dispositivo de oclusión septal se presentan en menos del 10 por ciento de los casos. La embolización requiere de cirugía cardíaca, por lo que se incrementa el riesgo de la mortalidad. Objetivo: Presentar el caso en una paciente con comunicación interventricular e hipertensión pulmonar severa que se le retiró el dispositivo de oclusión septal transcateterismo. Presentación de caso: Se presentó una mujer de 24 años de edad con comunicación interventricular, insuficiencia cardíaca (New York Heart Association) clase IV e hipertensión pulmonar tipo 2, que se programó para la colocación de dispositivo de oclusión septal, sin embargo, presentó fallo en la colocación del dispositivo y defecto residual de 7 mm, por lo que se realizó el retiro de este 48 h después sin presentar complicaciones. Conclusiones: Aunque el cierre transcateterismo de la comunicación interventricular es una alternativa segura y efectiva a la cirugía, no está exento de complicaciones. En caso de translocación del dispositivo de oclusión septal este debe ser retirado durante el mismo procedimiento, ya que el riesgo de embolización es elevado y en caso de presentarse, el riesgo de muerte se incrementa(AU)

Introduction: Complications associated with the placement procedure of a septal occlusion device occur in less than 10percent of cases. Embolization requires cardiac surgery, which increases the risk of mortality. Objective: To report the case of a patient with ventricular septal defect and severe pulmonary hypertension who had the transcatheter septal occlusion device removed. Case report: We report the case report of a 24-year-old woman with ventricular septal defect, heart failure (New York Heart Association) class IV and type 2 pulmonary hypertension. She was scheduled for placement of a septal occlusion device, however, the placement of the device failed and had a residual defect of 7 mm, so the placement was removed 48 hours later without complications. Conclusions: Although transcatheter closure of the ventricular septal defect is a safe and effective alternative to surgery, it is not free of complications. In case of translocation of the septal occlusion device, it must be removed during the same procedure, since the risk of embolization is high and if it occurs, the risk of death increases(AU)

Embolic stroke of undetermined source: potential etiology and secondary prevention / 国际脑血管病杂志

The source of the emboli of embolic stroke of undetermined source (ESUS) is still unclear, and the effect of antithrombotic therapy is also different. The recurrence rate of stroke in patients with ESUS is higher, and antiplatelet therapy is still a commonly used secondary prevention scheme. This article reviews the potential causes, pathogenesis and secondary prevention of ESUS.

Echocardiography-guided transcatheter closure of atrial septal defects for three pregnant women / 中华围产医学杂志

Objective:To investigate the feasibility of echocardiography-guided transcatheter closure of atrial septal defect (ASD) during pregnancy and summarize the multidisciplinary treatment experience for such women.Methods:A retrospective analysis was performed on three women receiving echocardiography-guided secondum ASD closure during pregnancy in Guangdong Provincial People's Hospital from January 2018 to October 2021. Perioperative and perinatal multidisciplinary treatment and prognosis were described.Results:All three patients underwent cardiac ultrasonography due to abnormal electrocardiogram during routine prenatal examination and were diagnosed with secondum ASD. Progressive cardiac dysfunction was found during close follow-ups and all cases met the criteria for ASD closure during pregnancy after multidisciplinary evaluation. Echocardiography-guided ASD closure was successfully performed in all patients. Pulmonary arterial pressure was significantly reduced and the cardiac function was stable after the operation. All patients delivered vaginally at term without complications such as miscarriage, premature birth, postpartum hemorrhage or fetal growth restriction and had their cardiac function recovered during postpartum follow-up.Conclusions:Echocardiography-guided ASD closure during pregnancy is technically feasible. Good maternal and fetal outcomes can be obtained through multidisciplinary and close monitoring and treatment during perioperative and perinatal periods.

Feasibility of three-dimensional CT axial sequence assisted volumetric measurement for atrial septal defect evaluation / 中华放射学杂志

Objective:To explore the feasibility of three-dimensional CT axial sequence assisted volumetric measurement (CTAS) in evaluating atrial septal defect (ASD).Methods:The patients with single secundum ASD who successfully underwent interventional therapy in Fuwai Hospital from January 2016 to December 2019 were retrospectively collected. The patients underwent coronary CT angiography (CTA) before and on the second day after closures, and DSA examinations during operation. A total of 52 cases met the inclusion conditions, among them, there were 37 patients with large defects which had deficient inferior rims ≤3 mm, and 15 patients with severe pulmonary arterial hypertension that occluded with fenestrated ASD occluder. The CT data of patients before and after operation were reconstructed by CTAS. Then the anatomical structure of ASD before the operation was evaluated, including the long diameter and short diameter of ASD, and the CT three-dimensional volume diameter of ASD was calculated by using the equivalent circle conversion formula of ellipse. The waist diameter of occluder and rims of the ASD were measured after occlusion on postoperative CT three-dimensional volume reconstruction images. Meanwhile, the deployed occluder waist dimension was measured in DSA examination during the operation by simulating the balloon measurement of ASD. Lastly, paired t-test and consistency analysis were carried out among the values of parameters. Results:Before operation, the equivalent circle diameter of ASD was (32.3±5.4) mm measured by CTAS. After ASD occlusion, the size of the waist dimension measured by DSA and CTAS were (32.5±4.9) mm and (32.6±4.9) mm. There were no significant differences between them ( P>0.05). There were also no significant differences for each rims of the ASD pre and post operation on CTAS except for the inferior rims and the total length of atrial septum in superior-inferior direction ( P>0.05). Conclusion:As an alternative to balloon sizing, CTAS can be used as a reference standard to conduct ASD interventional treatment.

Feasibility of transesophageal echocardiography-guided transthoracic micro-incisions for the treatment of aortic dissection / 中国基层医药

Objective:To investigate the feasibility of transesophageal echocardiography (TEE)-guided transthoracic micro-incisions for the treatment of aortic dissection.Methods:Ten patients with aortic dissection who received TEE before surgery between March 2017 and March 2019 in Zhejiang Provincial Hospital of Chinese Medicine, China were included in this study. They were divided into group A (involving the aorta, n = 5) and group B (aortic arch ulcer, n = 5). Diagnosis before and after surgery was analyzed in each group. Whether guide sheath tube and guide wire rapidly entered the interlayer during the surgery was assessed. In addition, the stability and position of the occluder device and its effect on local blood flow were assessed. Results:TEE findings revealed that occlusion treatment was effective and TEE-guided transthoracic micro-incisions successfully occluded the breaks of the aortic dissection. In group A, the occluded breaks of the aortic dissection disappeared, and thrombi formed in the false lumen. Blood flow velocity decreased from 230 cm/s to 120 cm/s. In group B, aortic wall was tightly bounded to the occluder device and the breaks disappeared. The velocity of the blood flow in the arch of the aorta was 120 cm/s. The occluder device was stable before and after occlusion. It had no effect on the velocity of local blood flow. At 40 days after surgery, the position of the occluder was not deviated.Conclusion:TEE before surgery for aortic dissection can effectively assess the injury degree and avoid missed diagnosis. TEE can guide the placement of the occluder device during the surgery. TEE can also help accurately assess the surgical outcomes.

Endocarditis tardía en un portador de un Amplatzer: Manejo conservador en un paciente pediátrico / Late onset endocarditis in Amplatzer carrier: Conservative management in a pediatric patient

Desde su aparición, las técnicas percutáneas han ido sustituyendo la cirugía convencional como tratamiento de primera línea en los defectos septales interauriculares. Los dispositivos Amplatzer fueron los primeros aprobados por la Food and Drug Administration, y su colocación se ha convertido en un procedimiento habitual en cardiología pediátrica. La aparición de endocarditis bacteriana sobre este tipo de dispositivos es muy infrecuente. Se presenta el caso de una endocarditis bacteriana en un paciente pediátrico portador de un dispositivo Amplatzer, que se manejó de forma conservadora con antibioterapia intravenosa, con evolución satisfactoria.

Since their introduction, percutaneous techniques have been replacing conventional surgery as a first-line treatment for septal defects. Amplatzer devices were the first to be approved by the Food and Drug Administration, and their placement has become a standard procedure in pediatric cardiology. Bacterial endocarditis of intracardiac devices such as the Amplatzer septal occluder is very infrequent. We report a case of bacterial endocarditis in a pediatric patient with an Amplatzer device, who developed an infectious endocarditis six years after its placement and received conservative management with intravenous antibiotics, with satisfactory evolution.

Endovascular closure of patent foramen ovale: a critical appraisal of published trials / Fechamento endovascular do forame oval patente: análise crítica dos estudos publicados

ABSTRACT The treatment of cryptogenic stroke patients with a patent foramen ovale (PFO) is controversial. A critical review of these studies is presented. Methods A description of all trials comparing medical and endovascular treatment with closing devices is given. Additional pertinent studies are discussed to help construct a rational basis for treatment decisions. Results Initial negative trials evaluating PFO closure were followed by positive studies published in 2017 and 2018. All trials evaluated young patients (up to 60 years). Methodological problems are present in all trials including their open label construction. Most positive trials developed strategies to increase the percentage of patients with interatrial septal aneurysms or hypermobility and large right-to-left shunts. Even in these positive trials, large numbers of patients need to be treated to avoid one stroke. Atrial fibrillation occurred in 2-6% and other adverse effects related to the procedure and to the devices occurred in a substantial number of patients. Incomplete occlusion of the PFO is also frequent. Anticoagulant treatment has not been adequately studied as a therapeutic option. Conclusion Young patients with cryptogenic strokes seem to benefit from endovascular closure of a PFO in the presence of a large right-to-left shunt or an associated atrial septum aneurysm. For most other patients, a highly-individualized decision must be made, taking into account the low risk of recurrence in patients with a cryptogenic stroke attributable to a PFO, the high numbers needed to treat and the risks related to the procedure.

RESUMO O tratamento de pacientes com infarto cerebral criptogênico e forame oval patente (FOP) é controverso. Uma revisão crítica destes estudos é apresentada. Métodos São descritos em detalhes os estudos comparando tratamento médico com o uso de próteses de oclusão do FOP após infarto cerebral. Discutem-se outros estudos pertinentes para ajudar na tomada racional de decisões terapêuticas individualizadas. Resultados Estudos iniciais avaliando fechamento endovascular com próteses foram negativos, porém seguidos de outros estudos com resultados positivos em 2017 e 2018. Somente pacientes até 60 anos foram estudados. Os estudos apresentam vários problemas metodológicos, incluindo sua natureza aberta. A maioria dos estudos positivos desenvolveu estratégias para aumentar o percentual de pacientes com risco aumentado de recorrência, especificamente grandes shunts direita-esquerda e aneurismas/hipermobilidade do septo interatrial. Mesmo estes estudos positivos revelaram um alto NNT (número de pacientes tratados para evitar um evento de desfecho). Fibrilação atrial ocorreu em 2-6 % dos pacientes tratados. Outras complicações relacionadas ao procedimento e às endopróteses e ainda fechamento incompleto do FOP foram também frequentes. Anticoagulantes poderiam constituir estratégia alternativa de tratamento clínico, mas não foram adequadamente estudados. Conclusão Pacientes jovens com infartos criptogênicos parecem beneficiar-se de oclusão endovascular do FOP na presença de grandes shunts e principalmente aneurismas ou hipermobilidade de septo interatrial. Para a maioria dos outros pacientes, uma decisão altamente individualizada deve ser tomada, considerando o baixo risco de recorrência dos infartos atribuíveis ao FOP, o ato NNT e os riscos inerentes ao procedimento.

Foramen oval permeable e ictus criptogénico

El foramen oval permeable es un defecto estructural cardíaco frecuente en la población general. Su importancia clínica radica principalmente en su asociación con el ictus criptogénico, que ha sido descrita en varios estudios. La evidencia es controvertida y para definir el mejor tratamiento en cada caso es necesario individualizar su rol en el ictus criptogénico y el riesgo de recurrencia del mismo.

Summary: The patent foramen ovale is a common structural heart defect in the general population. Its clinical magnitude lies in its association with cryptogenic stroke, which has been described in several studies. The evidence is controversial and to define the best treatment choice in each case, it is necessary to identify its role in the cryptogenic stroke and the risk of its recurrence.

O forame oval patente é um defeito cardíaco estrutural comum na população geral. A magnitude clínica deste achado reside na sua associação com o acidente vascular cerebral criptogênico, que tem sido descrito em vários estudos. A evidência é controversa e para definir a melhor escolha de tratamento em cada caso, é necessário identificar o seu papel no acidente vascular cerebral criptogênico e o risco de sua recorrência.

Influence of interventional closure on heart rate in patients with atrial septal defect ／ / 心血管康复医学杂志

To explore influence of interventional closure on heart rate in patients with atrial septal defect . Methods : A total of 63 patients with atrial septal defect undergoing percutaneous interventional closure in our hospi‐tal were selected. Heart rate was compared before and after surgery ,and correlation among heart rate ,age ,occlude size and preoperative pulmonary artery pressure was analyzed .Results : Compared with before surgery ,there was significant reduction in heart rate [(75.22 ± 8.23) beats／min vs. (64.87 ± 10. 65) beats／min] after percutaneous in‐terventional closure of atrial septal defect , P＝0.001 ;Pearson correlation analysis indicated that postoperative heart rate change was not correlated with age ,occluder size and pulmonary artery systolic pressure (PASP ) ( r＝0.017－0.182 , P＞0.05 all) . Compared with patients without preoperative pulmonary artery hypertension ,there was sig‐nificant rise in postoperative reduction amplitude of heart rate [ (2.28 ± 9.81) beats／min vs. (11. 35 ± 10.73) beats／min] in those with preoperative elevated pulmonary systolic pressure (≥25mmHg) , P＝0.038 .Conclusion : After percutaneous interventional closure ,heart rate significantly decreases in patients with atrial septal defect .Presence of preoperative pulmonary artery hypertension can be regarded as a risk predictor for postoperative heart rate reduction .

Transcatheter device closure for perimembranous ventricular septal defects with aortic valve prolapse:Effect and prognosis / 中国实用儿科杂志

OBJECTIVE: To evaluate the the effect and prognosis of transcatheter device closure for perimembranous ventricular septal defects(PmVSDs)with aortic valve prolapse(AVP). METHODS: The clinical data of 1108 patients who underwent percutaneous closure from January 2011 to January 2017 were collected to conduct this retrospective study,mainly including transthoracic echocardiography,digital subtraction angiography data,occluder type and sociodemographic information(age,weight and gender). T-test and Mann-Whitney U test were used to compare group measurement data. Wilcoxon signed rank test was used for the nonnormal distribution of paired design data. Fisher exact test was used for the four fold table. Monte Carlo approximation exact probability method was used for the R×C table.Multiple Logistic-regression analysis was used to estimate the risk factors of AR. RESULTS: Compared with 10(0.9%)of1053 patients without AVP,8(14.5%)of the 55 children with preoperative AVP presented aggravated postoperative aortic regulation(AR)and AR usually occurred in the long-term follow-up(>1 year). None of the AR progressed to moderate or severe. There were no significant changes in left ventricular ejection fraction,left ventricular shortening rate or AR before and after interventional operation in PmVSDs with AVP. CONCLUSION: Percutaneous closure for ventricular septal defect combined with AVP is an effective alternative to surgery when using appropriate occluders,meeting related standards and operated in an experienced cardiovascular center.

Early to Mid-Term Follow-Up Outcomes of Percutaneous Closure of Atrial Septal Defects Using Recent Generation Devices: a Single-Center Experience

BACKGROUND AND OBJECTIVES: This study aimed to describe our early to mid-term experience with transcatheter atrial septal defect (ASD) closure using the Occlutech Figulla® Flex II device (FSO), Gore® Cardioform septal occluder (GSO), and Amplatzer® septal occluder (ASO) after they were first approved in Korea in 2014, and to compare the three aforementioned kinds of ASD closure devices. METHODS: Between September 2014 and August 2016, 267 patients underwent transcatheter ASD closure in our institution. Baseline characteristics, hemodynamic features, comorbidities, and procedural success and complication rates were analyzed retrospectively. The unpaired Student t-test or variance analysis was used in the statistical analysis. RESULTS: The FSO was most commonly used (n=152, 56.9%), followed by the ASO (n=98, 36.7%) and GSO (n=17, 6.4%). Baseline characteristics and hemodynamic features were similar between the devices, except that the defect size and pulmonary flow-to-systemic flow ratio were lower in the GSO group than in the other groups. Overall, the procedural success rate remained at 100%, and major complication rate was < 1%. No late complication occurred during the follow-up. CONCLUSIONS: The FSO and GSO are feasible, safe options for use in transcatheter ASD closure, and they are comparable to the ASO.

Pulmonary inhalation-perfusion scintigraphy in the evaluation of bronchoscopic treatment of bronchopleural fistula / Cintilografia pulmonar inalatória na avaliação do tratamento broncoscópico de fístula broncopleural

Abstract Objective: To evaluate the use of pulmonary inhalation-perfusion scintigraphy as an alternative method of investigation and follow-up in patients with bronchopleural fistula (BPF). Materials and Methods: Nine patients with BPFs were treated through the off-label use of a transcatheter atrial septal defect occluder, placed endoscopically, and were followed with pulmonary inhalation-perfusion scintigraphy, involving inhalation, via a nebulizer, of 900-1300 MBq (25-35 mCi) of technetium-99m-labeled diethylenetriaminepentaacetic acid and single-photon emission computed tomography with a dual-head gamma camera. Results: In two cases, there was a residual air leak that was not identified by bronchoscopy or the methylene blue test but was detected only by pulmonary inhalation-perfusion scintigraphy. Those results correlated with the evolution of the patients, both of whom showed late signs of air leak, which confirmed the scintigraphy findings. In the patients with complete resolution of symptoms and fistula closure seen on bronchoscopy, the scintigraphy was completely negative. In cases of failure to close the BPF, the scintigraphy confirmed the persistence of the air leak. In two patients, scintigraphy was the only method to show residual BPF, the fistula no longer being seen on bronchoscopy. Conclusion: We found pulmonary inhalation-perfusion scintigraphy to be a useful tool for identifying a residual BPF, as well as being an alternative method of investigating BPFs and of monitoring the affected patients.

Resumo Objetivo: Avaliar a cintilografia por inalação-perfusão pulmonar como método alternativo de investigação e acompanhamento em pacientes com fístula broncopleural (FBP). Materiais e Métodos: Nove pacientes com FBPs foram tratados de forma endoscópica com o uso off label de um oclusor transcateter de defeito do septo interatrial e foram seguidos com cintilografia de inalação-perfusão pulmonar usando tomografia computadorizada por emissão de fóton único com câmera de cintilação de duas cabeças e inalação com 900-1300 MBq (25-35 mCi) de ácido dietilenotriaminopentacético marcado com tecnécio-99m, inserido num nebulizador. Resultados: Broncoscopia e teste de azul de metileno não foram capazes de detectar dois casos de vazamento residual, detectados apenas por cintilografia por inalação-perfusão pulmonar. Esses resultados foram correlacionados com a evolução desses pacientes que tardiamente apresentaram sinais de vazamento de ar confirmando os achados da cintilografia. Pacientes com resolução completa dos sintomas e com aspecto broncoscópico do fechamento da fístula apresentaram cintilografia negativa completa. Em casos de falha no fechamento da FBP, a cintilografia por inalação-perfusão confirmou a persistência da fuga de ar. Em dois pacientes, a cintilografia foi o único método a mostrar FBP residual, apesar da ausência da fístula por avaliação broncoscópica. Conclusão: Neste estudo, a cintilografia de inalação-perfusão pulmonar mostrou ser um instrumento útil para identificar FBP residual e como método alternativo de investigação e seguimento de pacientes com FBPs.

Tricuspid stenosis: A rare and potential complication of ventricular septal occluder device

Asymmetrical septal occluder device (ASOD) has made percutaneous closure of ventricular septal defect an easy and effective management option. Although there are reports of aortic and tricuspid valvular regurgitation after deployment of ASOD, only few cases of tricuspid stenosis (TS) has been reported so far in the literature. We report a case of malaligned ASOD that occurred after successful device closure resulting in TS along with mild tricuspid and aortic regurgitation requiring surgical retrieval. Transesophageal echocardiography played crucial role in detecting the cause of tricuspid valve dysfunction besides providing continuous monitoring during the procedure. We intend to emphasize the need of echocardiographic evaluation of the tricuspid valvular apparatus and aortic valve during and after the device deployment even after the successful device closure to prevent this rare complication.

The role of heart team approach in penetrating cardiac trauma: case report and review of the literature

Abstract Penetrating cardiac trauma has been increasing in clinical experience and is joined to important morbidity and mortality. A case of a 38-year-old female with history of postpartum depression was reported, admitted to our department for cardiac tamponade due to penetrating self-inflicted multiple stab wound of the chest complicated by rupture of anterior left ventricular wall and traumatic ventricular septal defect. Following the unstable hemodynamic instability, a combined therapeutic strategy was chosen: surgery and transcatheter implantation to correct free wall ventricle damage and traumatic ventricular septal defect, respectively.

Safety and efficacy of percutaneous intervention for children with combined congenital heart abnormality solely guided by transthoracic echocardiography / 中华心血管病杂志

Objective@#To investigate the safety and efficacy of percutaneous intervention of children with combined congenital heart abnormality solely guided by transthoracic echocardiography (TTE) .@*Methods@#From September 2015 to June 2017, 21 children with combined congenital heart abnormality undergoing percutaneous interventional guided by TTE in Fuwai hospital were enrolled in our study, and the clinical data were retrospective analyzed. The atrial septal defect(ASD) closure, ventricular septal defect(VSD) closure, patent ductus arteriosus(PDA) closure or balloon pulmonary valvuloplasty were performed under the guidance of TTE. The procedural effect was evaluated by TTE after operation. The patients were followed up after discharged from the hospital.@*Results@#The age was (37.3±11.6) months, and there were 9 male and 12 female patients. There were 4 cases with ASD and VSD, 6 cases with VSD and PDA, 6 cases with ASD and PDA, 2 cases with VSD and pulmonary stenosis, 3 cases with ASD and pulmonary stenosis. The operations were successfully performed in all patients. No one required extra X ray guidance or open heart surgery. The operation time was (44.6±7.5)min. All patients did not require blood transfusion, inotropic support, and analgesia. There were no complications such as peripheral vascular injury and pericardialeffusion after the operation. The length of hospital stay time was (3.5±0.6) days. All patients were recovered well. The follow-up was (17.6±5.2) months, and post-procedural conduction disturbances, residual shunts, occlude fall off, thrombosis, and new onset of valvular regurgitation were not observed in these patients.@*Conclusion@#Percutaneous interventional of children with combined congenital heart abnormality solely guided by TTE is safe and effective, and the procedure can avoid the potential injuries of X ray and contrast agent.

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.

Clinical analysis of transcatheter closure of patent foramen ovale in migraine / 中华神经科杂志

Objective To investigate the effect of the transcatheter closure of patent foramen ovale (PFO) on the treatment of migraine.Methods This prospective clinical trial enrolled 43 consecutive migraine patients with PFO from Department of Neurology,Beijing Anzhen Hospital from March 2014 to March 2015,in which PFO was diagnosed by transesophageal echocardiography (TEE) and contrast-enhanced transcranial Doppler (c-TCD).We grouped subjects according to their selection or refusal of PFO closure.Nine patients were allocated to treatment with PFO closure.Thirty-four patients were given with medical treatment and were assigned to control group.Basal clinical data,frequency of migraine,duration of migraine and scores of Headache Impact Test-6 (HIT-6) were collected.c-TCD was performed after procedure of PFO closure transthoracic echocardiography.Changes of HIT-6 scores were analyzed after closure of PFO in the follow-up period.Results Successful PFO procedure was achieved in all patients without any complications both in hospital and in follow-up period.Only one patient had residual Ⅱ-grade right-to-left shunt (RLS) tested by c-TCD.Mean scores of HIT-6 in the surgical group were reduced significantly (49.3 ± 3.6 vs 67.5 ± 4.9,t =15.129,P =0.000).There were statistically significant differences in mean reduction of HIT-6 scores in the following one year for the female (48.8 ± 3.1 vs 69.8 ± 2.6,t =15.674,P=0.002),constant RLS (47.8 ±2.1 vs 67.9 ±3.5,t =8.572,P=0.043),RLS Ⅲ (50.6±2.3 vs65.4±2.7,t=7.663,P=0.039)/RLS 1V(48.2 ±1.9 vs 68.5 ±3.9,t=8.924,P=0.028)as well as migraine with aura subgroup (47.9± 1.6 vs 68.3 ±3.8,t=13.532,P=0.001).Conclusion Our results suggest that transcatheter PFO closure is a safe and effective approach for the treatment of migraine,espeecially for female migraineur with aura and with constant serious RLS.

Clinics in diagnostic imaging (186). Atrial septal defect with pulmonary arterial hypertension

We report a case of a 61-year-old woman with a large atrial septal defect (ASD) that was detected incidentally on chest radiography and computed tomography when she presented with sepsis. Echocardiography confirmed a large secundum ASD with left-to-right shunt flow, right heart dilatation and severe pulmonary hypertension. The patient had a poor clinical outcome despite intensive care and eventually passed away. Haemodynamically significant ASDs have a known association with increased morbidity and mortality, and their early detection and closure cannot be understated. This article aimed to highlight the imaging features of ASD, with special emphasis on the routine chest radiograph. The pathophysiology and clinical manifestations of ASD are also briefly discussed.

Clinical study of transcervical occlusion of patent ductus arteriosus via femoral artery guided by ultrasound / 中国医师杂志

Objective To evaluate the efficacy and safety of transthoracic echocardiography (TTE) guided by transcatheter closure of patent ductus arteriosus (PDA) through the femoral artery.Methods From February 2016 to December 2017,53 patients with simple PDA were selected,the funnel type in 30 cases,cast type in 23 cases.All patients were guided by TTE and transcatheter closure of PDA through the femoral artery.The femoral artery was guided by TTE by establishing the orbit of the femoral artery-catheter-pulmonary artery to the right ventricle.The right ventricular septal defect was placed under the femoral artery approach,and the therapeutic effect was evaluated by echocardiography after occlusion.The outpatient visits were made at 1,3,and 6 months after operation.Results PDA closure was successfully completed under TTE guidance in 53 patients.In one adult PDA,the ultrasonic diagnosis of the inner diameter of the catheter was incorrect due to the image quality,which resulted in the replacement of the occluded device several times,but the occlusion was successful.The operative time was (30 ± 10)min.And the back diameter of the transcatheter closure device was (12 ± 6) mm and the murmur of the transmission sheath disappeared.There was no shunt between the main pulmonary artery and the main pulmonary artery,and the length of hospitalization was 3-4 days.No shunt signal was found at 1,3 and 6 months follow-up.Left atrial diameter (LAD) [(25.8 ± 6.1) mm vs (30.6 ± 8.4) mm] and left ventricular end diastolic diameter (LVEDD) [(38.5 ±9.1)mm vs (45.2 ± 11.5)mm],were decreased significantly (P ＜0.05).Conclusions It is safe and effective to block PDA by using femoral artery approach under the guidance of TTE,which avoids the damage of X-ray and contrast agent,and its prospect of clinical application is promising.

Clinical implication of real-time three-dimensional transesophageal echocardiography in percutaneous transcatheter left atrial appendage closure with Amplatzer Cardiac Plug(ACP) device for non-valvular atrial fibrillation patients / 中华超声影像学杂志

Objective To evaluate the application value of real-time three-dimensional echocardiography (RT-3D TEE) in nonvalvular atrial fibrillation patients after transcatheter left atrial appendage closure (LAAC) with the Amplatzer Cardiac Plug (ACP).Methods The two-dimensional transesophageal echocardiography (2D TEE) and RT-3D TEE were performed in selected patients to measure the diameter of left atrial appendage ostium and landing zone,to observe left atrial appendage morphology and lobular distribution.These were also performed to guide the whole process of transcatheter LAAC with ACP,which included the atrial septal puncture,sheathing canal cruise,occluder device implantation,and verifying the stability of occluder device and releasing the device.It involved observing ACP occluder morphology,location,stability,surrounding residual shunt,whether influencing the mitral valve and left superior pulmonary vein flow,and pericardial effusion.Results A total of 15 patients (100％) successfully underwent LAAC with the ACP.The maximum diameter of left atrial appendage ostium by 2D-TEE measurement during operation was (20.5 ± 2.9)mm,located at 135°.The diameter of left atrial appendage landing zone was (17.1 ± 2.8) mm,located at 45°;(18.0 ± 4.0) mm,located at 90°;(22.1 ± 4.7)mm,located at 135°,respectively.The left atrial appendage morphology:2 had one leaf and 13 had two leaves or more,including 2 cases of bifoliate short neck shape.In 15 patients,6 cases of cauliflower type,2 cases of wind sock type,3 cases of chicken wing type,2 cases of cactus type and 2 cases of complex type.The proximal left atrial appendage morphology:3 cases of boot type,2 cases of wide mouth type,6 cases of narrow mouth type,2 cases of straight tube type,and 2 cases of bifoliate short neck type.There was no obvious residual shunt in all the patients at immediately post-operation.Conclusions In the transcatheter LAAC with the ACP,RT-3D TEE has important application value in the preoperative selection of patients,the choice of appropriate occluder,guidance of full-process monitoring during operation,the postoperative effect evaluation and so on.