Association between the morphology of the implanted atrial septal defect occluding umbrella and postoperative headache / 中华心血管病杂志

Objective: To explore whether the atrial septal defect(ASD) size, the type of occlusion umbrella selected, and the morphological changes after release of occlusion umbrella affect the headache symptoms of ASD patients after operation. Methods: A total of 567 ASD ptients, who underwent successful implantion with a single occlude from January 2014 to December 2017 in General Hospital of Northern Theater Command were enrolled. The patients were divided into symptomatic group and asymptomatic group according to the presence or absence of headache symptoms after occlusion. X-ray catheter calibration method was used to measure the diameter(d), thickness（L）, maximum diameter of the left umbrella surface after release(D2) and the value of i (i = D2/L). Risk factors related to headache were analyzed by multivariate logistic regression analysis. linear regression analysis was used to detect the relationship between the type of occluder umbrella and ASD diameter in asymptomatic group. Results: A total of 567 patients with one occluder umbrella were included, and 148(26.1%) cases were male. The age was (34.4±19.4) years old. The follow-up time was (12.7±2.8) months. There were 51 cases in the symptomatic group and 516 cases in the asymptomatic group. In 29 patients who were treated by extending the course or increasing the dose of aspirin, the symptoms disappeared or improved. There was no significant difference in the maximum ASD diameter (TTE measured) and the size of occluder between the symptomatic group and asymptomatic group(both P>0.05). The value of d ((19.80±6.67)mm vs.(17.40±7.28) mm, P=0.041) D2 ((43.29±7.41）mm vs. (39.20±9.59)mm， P=0.013)and L((13.06±3.72)mm vs. (10.19±2.90) mm，P=0.025) of the symptomatic group were all higher than that of the asymptomatic group，while the i value was smaller((3.54±0.88）vs.(3.99±0.93)，P=0.010）. The results of multivariate logistic regression analysis showed that the value of L(OR=1.286，95%CI 1.176-1.406, P=0.002) and the value of i(OR=0.916，95%CI 0.867-0.968, P<0.001) were independent factors of headache symptoms in patients after ASD occlusion, while the value of d and the value of D2 were not independent factors (both P>0.05). Linear equations obtained from asymptomatic patients showed the size of occluder =1.121×the maximum ASD diameter of TTE measured +6.414. Conclusions: There is no correlation between the symptoms with the expanded diameter and the maximum diameter of left umbrella's surface after released. The Postoperative discomfort symptoms is significantly correlated to the thickness of the occluder and the value of i. It is suggested that headache could be induced by the oversized occlude, thus choosing the appropriate size of the occluder is essential to reduce the occurrence of postoperative headache symptoms. Increasing the size of occluder because of worrying about the abscission and removal of the occlude is unreasonable. The antiplatelet therapy should also be strengthened to reduce the occurrence of symptoms and improve the symptoms of the patients if the occluder's size is too large. This regression equation (The size of occluder =1.121 × the maximum ASD diameter of TTE measured +6.414) could be used as a reference for the suitable selection of ASD occluder.

Application prospect of complete biodegradable occluder in congenital heart disease / 中国实用内科杂志

Congenital heart disease(CHD)is one of the most common cardiovascular diseases in children, which ranks the first place of birth defects and severely threatens human health. With the developments of medical apparatus and progress of medical technology,interventional therapy has already become the preferred therapeutic choice for certain types of CHD including atrial septal defect,ventricular septal defect and patent ductus arteriosus, etc. However, occluders currently used are made of NiTi, which exist permanently in human body after implantation. Generally, the surface endothelialization of occluders makes them lose its significance of existence 6 months after implantation. Ideal occluders should gradually undergo self-degradation till they vanish, thus avoiding the permanent existence of metal materials. Nowadays, with the development of medical materials, such an idea has become possible.

Initial experience of occluding special type patent ductus arterioses using the Amplatzer vascular plug / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Occluders licensed for clinical use are not fit for some special Krichenko E patent ductus arterioses. The Amplatzer vascular plug I (AVP1) has not been licensed for use for closure of patent ductus arteriose. We report our initial experience to occluding special type patent ductus arterioses with the AVP1-a single lobe device of single layer Nitinol mesh for short vessel landing zones.</p><p><b>METHODS</b>Patients referred with small and long Krichenko E patent ductus arterioses 1 mm to 3 mm in diameter underwent occlusion using AVP1. All cases underwent pre-, intra- and post-procedural echocardiography and chest X-ray at the completion of the procedure, the next day and at a 30-day, 3-month and 6-month follow-up visits. Device sizing for device waist diameter and length was based on aortography.</p><p><b>RESULTS</b>From April 2008 to June 2012, 26 patients with a mean age of (7.6 ± 8.0) years (range 6 months-32 years) and a mean weight of (23.8 ± 14.8) kg (range 7-67 kg) underwent successful patent ductus arteriose closure. The mean ductus diameter was (2.1 ± 0.7) mm (range 1-3 mm). Transpulmonary (22/26) and transaortic approaches (4/26) were used. No persistent patency was observed after 24 hours and after one month. No device displacement, residual flow and iatrogenic coarctation of the aorta were observed after three months and six months.</p><p><b>CONCLUSIONS</b>The AVP1 makes it easy to close some Krichenko E patent ductus arterioses. Smaller delivery catheter profile and symmetric cylindrical device shape allow for use for small and long Krichenko E patent ductus arterioses 1 mm to 3 mm in diameter and small patients through transaortic approaches. Broader experience is required to further delineate device and patient selection as well as to document its long-term efficacy and safety.</p>

Clinical analysis of transcatheter closure of atrial septal defects in elderly patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the clinical feature of patients with atrial septal defects (ASD) and the safety and efficacy of transcatheter closure of ASD in elderly patients.</p><p><b>METHODS</b>Between May 2000 and June 2010, 82 patients aged (64.5 ± 3.8) years underwent attempted transcatheter ASD closure. Right heart catheterization was performed before intervention. Echocardiography was made at 1 day, 1, 3, 6 months after the procedure. The pre- and post-closure clinical feature, pulmonary artery pressure (PAP) and cardiac function were evaluated.</p><p><b>RESULTS</b>In 82 patients, 37 (45.1%) patients were associated with pulmonary arterial hypertension (PAH). The systolic PAP and mean PAP [(44.1 ± 12.4) mm Hg (1 mm Hg = 0.133 kPa) and (25.2 ± 6.8) mm Hg, respectively] were measured by right heart catheterization before the procedure. One patient was unsuitable for closure because of severe PAH. The remaining 81 patients underwent successful ASD closure without major complications. After closuring, systolic PAP decreased from (52.7 ± 10.3) mm Hg to (31.8 ± 6.3) mm Hg (P < 0.05), and mean PAP descended from (30.9 ± 4.7) mm Hg to (21.8 ± 3.4) mm Hg (P < 0.05) in the 36 patients with PAH. The cardiac function improved post procedure. There were 6 new-onset atrial fibrillations during follow up.</p><p><b>CONCLUSIONS</b>ASD in elderly patients are commonly associated with PAH. Transcatheter ASD closure is safe and effective in the majority of elderly patients.</p>

Effects of transcatheter closure of patent ductus arteriosus in 139 adult patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the clinical feature and the effects of transcatheter closure of adult patients with patent ductus arteriosus (PDA).</p><p><b>METHODS</b>Between January 2000 and April 2009, 139 patients [22 male, aged from 40 to 74: (49.8 +/- 6.8) years] with PDA were hospitalized in our hospital. Clinical data and effects of transcatheter closure of PDA were analyzed.</p><p><b>RESULTS</b>There were 64 patients with NYHA classI, 53 with class II, 16 with class III and 6 with class IV before procedure. In 139 patients, pulmonary arterial hypertension (PAH) was found in 107 out of 139 patients (77.0%). Transcatheter PDA closure was not performed in 3 patients due to severe PAH and successfully performed in the remaining 136 patients (97.8%) without major complications. Post procedure aortic angiography evidenced minor residual shunt in 14 cases, small residual shunt in 2 cases and moderate shunt in 1 case. The NYHA class was significantly improved and the PAH significantly reduced [sPAP: (47.3 +/- 23.9) mm Hg (1 mm Hg = 0.133 kPa) vs. (28.1 +/- 12.3) mm Hg, P < 0.01] post procedure.</p><p><b>CONCLUSION</b>PAH and heart failure were commonly associated with PDA in adult patients. Transcatheter PDA closure is safe and effective in these patients except those with severe PAH.</p>

Risk factors for early arrhythmias post transcatheter closure of perimembranous ventricular septal defects / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the risk factors for early arrhythmias after transcatheter closure of perimembranous ventricular septal defect (PVSD).</p><p><b>METHODS</b>A total of 358 patients [161 males, aged from 3 to 54, mean (10.9 +/- 8.1) years, body weight from 12 to 90, mean (32.8 +/- 17.2) kg] who underwent transcatheter closure of PVSD from August 2002 to February 2006 were included in this retrospective analysis. Electrocardiogram was performed daily after transcatheter closure for seven days. Relationships between arrhythmias and those risk factors such as the defect characteristics and the device size and types were explored by logistic regression analysis. Left ventriculography showed 195 out of 358 patients with PVSD were complicated with membranous aneurysm. The PVSD diameter ranged from 2 to 18 (6.5 +/- 3.1) mm in left ventricular side and from 2 to 12 (4.2 +/- 2.3) mm in right ventricular side. A total of 140 nonsymmetrical and 218 symmetrical occluders with diameter 4 to 18 (8.1 +/- 2.5) mm were used to close those defects.</p><p><b>RESULTS</b>Procedure was successful in all patients. Early arrhythmias after transcatheter closure of PVSD were observed in 135 (37.7%) patients and serious cardiac arrhythmias in 23 (6.4%) patients. The early arrhythmias after transcatheter closure of PVSD were significantly correlated with device size [> or = (8.6 +/- 2.7) mm] and type (nonsymmetrical device), the span between the defect and tricuspid (< or = 3 mm), and the presence of aneurysm.</p><p><b>CONCLUSION</b>Larger device size, nonsymmetrical device, narrow span between the defect and tricuspid and the presence of aneurysm are the risk factors for early arrhythmias after transcatheter closure of PVSD.</p>

A novel polymorphism in the ATP-binding cassette transporter A1 gene (M233V) in Chinese patients with coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To identify ATP-binding cassette transporter A1 (ABCA1) gene polymorphism in Chinese patients with coronary artery disease (CAD).</p><p><b>METHODS</b>Single Nucleotide Polymorphisms in the ABCA1 gene were detected by polymerase chain reaction (PCR)-single strand conformation polymorphism (SSCP)-DNA sequence and restriction-fragment length polymorphism (RFLP) method in 112 patients with CAD.</p><p><b>RESULTS</b>A novel polymorphism in the ABCA1 gene was found in two patients: M233V which exists in exon7 of ABCA1 gene and it's cDNA location is A1092G and converse 233 amino acid from Methionine to Valeric. We further collected the blood samples from 16 family members of one proband and M233V polymorphism was found in 5 out 16 family members.</p><p><b>CONCLUSION</b>M233V is a novel polymorphism in the ATP-binding cassette transporter A1 gene and this AG genotype had family proneness.</p>

Detection of single nucleotide polymorphism of all coding regions in ABCA1 gene in patients with coronary heart disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To study single nucleotide polymorphism (SNP) of all the coding region in ABCA1 gene in 112 patients with coronary heart diseases.</p><p><b>METHODS</b>With polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) combining argentation and glue retrieval, DNA sequencing, and restriction fragment length polymorphism (RFLP), the SNP of the 50 exons in all the coding regions of ABCA1 gene was detected in 112 patients with established diagnosis of coronary heart disease.</p><p><b>RESULTS</b>In the Chinese population with coronary heart disease, besides the SNP variation at R219K and M883I as widely reported, a new single base variation at A1092G in exon 7 was detected, which led to a conversion of the amino-side residue to M223V. This variation was confirmed to represent a novel SNP by RFLP in 108 normal subjects.</p><p><b>CONCLUSIONS</b>The Chinese population with coronary heart disease has not only the reported SNP changes at the sites R219K and M883I, but also changes at the new SNP site of M233V, which is discovered for the first time in M233V of ABCA1 gene. This variation may increase the risks for coronary heart diseases, and its exact function awaits examination in further epidemiologic survey.</p>

Transcatheter closure of atrial septal defects in 40 pediatric patients / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficiency of transcatheter closure of atrial septal defect (ASD) with AGA-Amplatzer occlusion device in pediatric patients.</p><p><b>METHODS</b>Forty patients with ASD, 16 males, 24 females, at a mean age of 10.2 years (ranged from 3 to 15 years of age) and with a mean weight of 35.8 kg (ranged from 11 to 87 kg) were studied. Six cases were complicated with pulmonary stenosis (PS), 1 was complicated with ventricular tachycardia (VT). Right heart catheterizations were done in 40 patients for measuring the pressures of right ventricle and pulmonary artery. The balloon diameter of ASD was measured using balloon catheter with guiding wire. The diameter of ASD was measured by TTE and/or TEE, ascertaining the location and size of ASD. Amplatzer occlusion device was sized to be equal to or 1 - 2 mm more than the diameter of balloon stretched.</p><p><b>RESULTS</b>All patients had successful implantation of the Amplatzer device. The success rate was 100%. The diameter measured by TTE was 7 - 30 mm (mean 17.12 mm). The diameter measured by TEE was 7 - 32 mm (mean 18.44 mm). The diameter of balloon stretched of ASD was 8 - 34 mm. Of the 40 cases, 6 were complicated with PS and accepted percutaneous balloon valvuloplasty (PBPV). One case was complicated with VT and accepted radiofrequency catheter ablation (RFCA). Neither complication nor residual shunt was found in any of the patients. The patients were recovered and followed up for 3 or 4 days after deployment of the Amplatzer device. Clinical symptom, cardiac murmur, and findings in ECG, echocardiography and X-ray were improved markedly.</p><p><b>CONCLUSION</b>AGA-Amplatzer occlusion device is safe and efficient in pediatric patients with ASD.</p>