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@#Objective To evaluate the mid-term safety, efficacy and feasibility of perventricular device closure for subarterial ventricular septal defect. Methods Clinical data of 97 patients diagnosed with subarterial ventricular septal defect through echocardiography in West China Hospital from September 2013 to December 2015 were retrospectively analyzed. There were 66 males and 31 females aged 3 (1.8, 5.9) years. All the patients underwent perventricular device closure under the guidance of transesophageal echocardiography using eccentric occlusion device. Possible complications such as residual shunt, valvular regurgitation, atrioventricular conduction block and arrhythmias were recorded during the 1-year, 3-year and 5-year follow-up. Results All the patients received perventricular device closure successfully except that 1 patient underwent open surgical repair under cardiopulmonary bypass 3 months later because of the migration of device. So the rate of complete closure was 99.0%. No residual shunt, moderate or severe valvular regurgitation, atrioventricular conduction block or arrhythmias were observed 5 years later. Conclusion Treating subarterial ventricular septal defect through perventricular device closure exhibits remarkable mid-term efficacy, safety and feasibility with high success rate.
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Objective To evaluate the risk factors,diagnostic index of the restrictive right ventricle physiology(rRV) and the impact of the mid-term outcome of the patients.Methods Eighty patients(30 in rRV group and 50 in non-rRV group) undergoing TOF repair admitted in our department from Oct 2011 to May 2012 were studied.Perioperative clinical data were collected and echo data were recorded after operation.Mixed linear regression for repeated measures was used to compare the variables and analyze the correlations.Results Patients in rRV group were younger with longer cardiopulmonary bypass(CPB) time,aortic cross clamp time,ventilation time,intensive care unit and hospital stay compared with those in non-rRV group(P<0.01,respectively).The younger patients with longer CPB time had high risk of rRV by logistic regression analysis.Within 7 days post operation,the increase of saturation of venous oxygenation and decrease of oxygen extraction ration were slower in rRV group than those in non-rRV group(P<0.05,respectively).Lactate decreased in both groups,but was higher in rRV group throughout the 7 days(P=0.03).NT-proBNP was higher in rRV group throughout the 7 days than that in non-rRV group.NT-proBNP≥4750pg/ml often indicated the patients in the state of rRV.CRP slightly increased in 1-2 days post operation,and decreased thereafter,and the decrease was slower in rRV group(P=0.08).With regard to the mid-term outcome,there was no significant differences in the incidences of the obstruction of the right ventricle outflow and main pulmonary artery,the stenosis of the branch of pulmonary artery and the degree of the pulmonary valve regurgitation.Conclusion rRV is associated with significantly higher levels of NT-proBNP and CRP.The incidence of rRV correlates with age on operation and positively correlates with CPB time.NT-proBNP would be regarded as an indicator of the incidence of rRV.The study indicated the rRV would have impact on the early outcome of the patients but there was no significant effect on mid-term outcome.
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<p><b>OBJECTIVE</b>To retrospectively analyze the clinical data of 17 patients with bone cement leakage after percutaneous kyphoplasty and explore the leakage type and mid-term clinical effects.</p><p><b>METHODS</b>The clinical data of 17 patients with osteoporotic vertebral compression fractures occurred bone cement leakage after percutaneous kyphoplasty from October 2011 to October 2016 were collected. There were 7 males and 10 females, aged from 68 to 87 years old with an average of 78 years. All the patients had the history of low emergy trauma who had normal activity and full self-care for living before trauma, and complained with the lower back pain without signs and symptoms of nerve root injury after trauma. According to the anatomical location by images, the bone cement leakage pathways was confirmed, the preoperative and postoperative vertebral body height and Cobb angle were measured, the improvement of spinal stenosis were recorded. Preoperative and postoperative visual analogue scale (VAS) and Oswestry Disability Index(ODI) were used to evaluate pain and daily activities.</p><p><b>RESULTS</b>All the patients were followed up for 4 to 7 years with an average of 5.1 years. According to anatomical location by images, we found the bone cement leakage pathways of vertebral side type in 6 cases, intervertebral disc type in 3 cases, spinal canal type in 2 cases, vertebral pedicle type in 5 cases and mixed type in 1 case. Vertebral body height from preoperative(27.7±3.5)% restored to (56.4±2.5)% at final follow-up, and the kyphosis was corrected with Cobb angle from preoperative(45.3±4.2)° corrected to(18.3±3.1)° at final follow-up. VAS score decreased from preoperative 7.9±1.5 to 2.1±0.5 at final follow-up. ODI obviously restored from preoperative(49.1±7.5)% to (23.5±3.7)% at final follow-up. The nerve symptoms in lower limbs occurred in 2 cases, and the neurological symptom was disappeared after urgent symptomatic treatment and anaphase trophic nerve treating. Lower back pain occurred in 3 cases, including one case of unbearable pain, and the pain disappeared after symptomatic treatment.</p><p><b>CONCLUSIONS</b>Although the rate of bone cement leakage during percutaneous vertebral kyphoplasty is not low, the bone cement leakage has little influence on PKP surgery. Even if a little leakage occurred within the spinal canal during the surgery, spinal canal decompression will not be needed urgently. The significant clinical symptoms caused by leakage can basically disappear after treatment in mid-term follow-up.</p>
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Objective To study midterm curative effect of domestic drug eluting coronary stent in treatment of left main (LM) lesion.Method From April 2004 to September 2005,totally 32 patients with LM lesion received percutaneous coronary intervention (PCI) without protection.Thirty-nine coronary stents (Firebird, Microport,Shanghai) were implanted.One stent was used when the lesion only involved the opening or the middle portion of the LM branch.If the bifurcation was involved,the stenosis was treated considering the following factors: the diameter of left main,left anterior descending (LAD) and the left circumflex branch (LCX);whether there was stenosis of the opening of circumflex branch.Methods included"T"stent,stent pass though the opening of circumflex branch and kissing stents.All patients were followed at 1,6 and 12 months after discharge.Coronary angiography of patients was performd at 5 months after discharge.Central necrosis,restenosis,target vessel reconstructive rate (TVR) and target lesion reconstructive rate (TLR) were analyzed.Results Most LM lesion involved bifurcation (53.1%).Treatment for bifurcation included"T"stent in 47% patients,stent passing through the opening of LCX in 35.3 %.No restenosis occurred in lesion involving the opening or middle portion of the LM during follow-up.The 62.3% patients received coronary angiography.Angiography showed 5% of restenosis rate,5% TLR,10% TVR and 6.3% central necrosis rate.Conclusions Drug eluting stent implantation in low risk unprotective left main lesion may achieve satisfactory clinical results.