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Resumen Se presenta un caso de aneurisma del seno de Valsalva derecho roto a la aurícula derecha, que en el transcurso de tres meses desarrolló insuficiencia cardiaca global y fue resuelto del todo por medio de intervencionismo, colocando un dispositivo oclusor en el sitio de la fístula. Se discute su etología, así como las pautas para el diagnóstico clínico y el tratamiento.
Abstract We present a case of a ruptured right sinus of Valsalva aneurysm to the right atrium that developed global heart failure over the course of three months, and which was completely resolved through cardiac catheterism, placing an occlusive device at the site of the fistula. Its ethology is discussed, as well as the guidelines for clinical diagnosis and treatment.
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Objetivo: Comparar la efectividad del tratamiento de atropina versus oclusión ocular en pacientes con ambliopía refractiva moderada unilateral. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de una serie de casos que acudieron a la consulta de Oftalmología Pediátrica del Instituto Cubano de Oftalmología Ramón Pando Ferrer durante el período comprendido de septiembre del 2019 a septiembre de 2021. La muestra quedó conformada por 44 pacientes, los cuales se dividieron de forma aleatoria en dos grupos de estudio, 22 casos al grupo de oclusiones e igual número al grupo de atropina, que cumplían los criterios de inclusión. Se analizaron las variables edad, sexo, defecto refractivo, agudeza visual mejor corregida, sensibilidad al contraste y estereopsis. Resultados: Predominó el astigmatismo hipermetrópico en ambos grupos de estudio. La media de la agudeza visual mejor corregida inicial en ambos grupos fue de 0,4 LogMAR y mejoró a 0,1 LogMAR al finalizar el tratamiento. La media de la sensibilidad al contraste inicial fue de 1,48 (±19,75) para el grupo de oclusiones y de 1,47 (±20,5) para el grupo atropina, al finalizar alcanzaron 1,59 (±10,1) y 1,57 (±10,0) por orden de mención. La estereopsis inicial fue subnormal en ambos grupos, al finalizar el tratamiento fue normal en el 77,3 % grupo oclusión y el 68,2 % grupo atropina. Conclusiones: La efectividad del tratamiento en pacientes con ambliopía refractiva moderada unilateral con atropina es similar a la que se alcanza con la aplicación de la oclusión ocular.
Objective: To compare the effectiveness of atropine treatment versus ocular occlusion in patients with unilateral moderate refractive amblyopia. Methods: A descriptive, longitudinal and prospective study of a series of cases that attended the Pediatric Ophthalmology office of the Ramón Pando Ferrer Cuban Institute of Ophthalmology during the period from September 2019 to September 2021 was carried out. The sample consisted of 44 patients, who were randomly divided into two study groups, 22 cases to the occlusion group and the same number to the atropine group, who met the inclusion criteria. The variables age, gender, refractive defect, best corrected visual acuity, contrast sensitivity and stereopsis were analyzed. Results: Hypermetropic astigmatism predominated in both study groups. Average initial best-corrected visual acuity in both groups was 0.4 LogMAR and improved to 0.1 LogMAR at the end of treatment. Average initial contrast sensitivity was 1.48 (±19.75) for the occlusion group and 1.47 (±20.5) for the atropine group, at completion reaching 1.59 (±10.1) and 1.57 (±10.0) in order of mention. Initial stereopsis was subnormal in both groups, at the end of treatment it was normal in 77.3 % occlusion group and 68.2 % atropine group. Conclusions: The effectiveness of treatment in patients with unilateral moderate refractive amblyopia with atropine is similar to that achieved with the application of ocular occlusion.
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Objective To analyze influences of the braiding angle and material on performance of ventricular septal defect (VSD) occluders, so as to provide theoretical basis and guidance for their design. Methods The finite element models of occluders with different braiding angles (30°, 45° and 60°) were developed respectively. The radial supporting and axial bending performances of nickel titanium (NiTi) occlude and poly-p-dioxanone (PPDO) occlude were then compared. Results Under 5 kPa radial loading, radial stiffness of the 30°, 45° and 60° NiTi occluder waists were 8.60, 1.51 and 0.99 mN/mm3,respectively, while that of 45° PPDO occluder waist was 7.35 mN/mm3. Under axial bending of 0.5 rad, the maximum radial deformation of the 30°, 45°, 60° NiTi occluder waists were 1.17, 1.24 and 0.22 mm, while that of the 45° PPDO was 0.54 mm. Conclusions Under the condition of using the same material, occluders with braiding angle of 60° show the lowest radial stiffness, indicating they have the best radial supporting ability. Furthermore, they also show the smallest maximum radial deformation, indicating they have the best axial bending ability and the compliance. On the other hand, under the condition of using the same braiding angle, NiTi occluders show lower radial stiffness, indicating they have better radial supporting ability. However, PPDO occluders show lower maximum radial deformation, indicating they have better axial bending ability and compliance.
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Objective To design and prepare a glass-shaped transthoracic left atrial appendage (LAA) reverse occluder and delivery system, and to evaluate the feasibility of transthoracic left atrial appendage reverse occlusion by in vitro reverse occlusion experiment. Methods We used fresh canine heart specimens and measured the anatomical parameters, including the long diameter, short diameter and perimeter of atrial appendage opening, the thickness of upper 1/3 left atrial appendage, the shortest distances from the edge of the opening of the atrial appendage to the left superior pulmonary vein, the left inferior pulmonary vein, and the mitral valve. A new glass-shaped left atrial appendage occluder was designed using nitinol wire, and the appendage occluder opening disk diameter and waist height were designed according to the average diameter of the opening of the atrial appendage and the thickness of upper 1/3 left atrial appendage. The delivery system comprised 9F delivery sheath, expansion sheath, preload sheath and a pushing cable. Delivery sheath was scaled which can be used to control the depth into the left atrial appendage, and expansion sheath head end had smooth transition shape which exposed only about 0.8 cm when inserted into the delivery sheath to prevent damage internal of tissue of heart. Ten isolated dog hearts were punctured at the center of the upper 1/3 axis of left atrial appendage outside under direct vision, and 9F sheath with scale was used to complete in vitro experiment of occlusion. The location and effect of the occluder were observed. Results Nine of the 10 heart specimens successfully underwent the occluding tests in vitro. It was showed that the occluder was well located, with the disc of the opening of left atrial appendage porting into the opening a little and the opening in an overdistraction state, and there was no influence on blood flow of pulmonary vein or function of the mitral valve. The ideal point of puncture was at the upper 1/3 long axis of left atrial appendage outside, and the purse-string suture should focus on this point. The puncture points located at the center of the left atrial appendage opening after removing the occluder postoperatively. Only 1 case failed because of low puncture point and unsuitable location of the occluder. Conclusion The glass-shaped transthoracic reverse occluder is well-designed and matched the anatomy of left the atrial appendage in experimental canine. The occluding effects are exact and meet the requirements of animal experiments in vivo.
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Objective To evaluate clinical effectiveness of transcatheter closure of atrial septal defects ( ASD) with severe pulmonary arterial hyperyension ( sPAH) by fenestrated Amplatzer septal occluders ( ASO) . Methods From September 2002 to April 2013, 17 patients of ASD with sPAH received transcatheter ASD closure using fenestrated occluders. Aged from 18 - 72 years, the diameters of ASDs were 18 - 33 mm. The systolic pulmonary arterial hypertension measured by transthoracic echocardiogram were 80 - 112 (96. 9 ± 8. 9) mmHg. The follow-up study included electrocardiography, chest radiography and echocardiography. All the patients were followed up for 1. 5 - 12 ( mean 6. 4 ± 0. 7) years. Results Systolic pulmonary arterial pressure (sPAP) of 60 - 108 (88. 7 ± 11. 7) mmHg and mean pulmonary artery pressure ( mPAP) of 29. 3 - 60 (51. 0 ± 8. 1) mmHg were measured by cardiac catheterization before ASD closure. Qp/ Qs was 1. 50 - 2. 44 (1. 8 ± 0. 31) and the pulmonary vascular resistance was 3. 1 - 9. 7 (5. 6 ± 1. 5) wood units (wu) . Immediately after the implantation of fenestrated occluders, sPAP decreased to 56 - 99 (70 ± 11. 5) mmHg and mPAP to 27 - 51. 7 (41. 1 ± 7. 1) mmHg. On the 3 d, 3 m and 6 m follow-up exam, RVEDd decreased ( P ﹤ 0. 05), while LVEDd, LVEDV and LVEF increased significantly (P ﹤ 0. 05) . sPAP decreased significantly after transcatheter closure at 3 m and 6 m as compared to pre-closure levels (both P ﹤ 0. 05) . The mean sPAP in long term follow up was (60. 2 ± 13. 3) mmHg which had significant decrease compared to pre-closure level ( P ﹤ 0. 01), but no significant difference found when compared to 6 m follow up (P ﹥ 0. 05). Conclusions ASD closure with fenestrated ASO is a satisfactory approach for ASD with severe PAH.