Clinical efficacy analysis of different interventional approaches for patent ductus arteriosus in children (≤7 years) / 中国胸心血管外科临床杂志

@#Objective    To explore the safety and effectiveness of different interventional approaches for the treatment of patent ductus arteriosus (PDA) in children. Methods    The children (≤7 years) who underwent interventional treatment for PDA from 2019 to 2020 in our hospital were retrospectively included. The patients were divided into 3 groups according to the procedures: a conventional arteriovenous approach group, a simple venous approach group, and a retrograde femoral artery approach group. The clinical efficacy of the patients was compared. Results     A total of 220 patients were included. There were 78 males and 142 females, with an average age of 3.21±1.73 years, weight of 14.99±5.35 kg, and height of 96.19±15.77 cm. The average diameter of the PDA was 3.35±1.34 mm. A total of 85 patients received a conventional arteriovenous approach, 104 patients received a simple venous approach, and 31 patients received a retrograde femoral artery approach. The diameter of PDA in the retrograde femoral artery group was smaller than that in the other two groups (3.44±1.43 mm vs. 1.99±0.55 mm; 3.69±1.17 mm vs. 1.99±0.55 mm, P<0.001); the contrast medium usage [40 (30, 50) mL vs. 20 (20, 30) mL; 35 (25, 50) mL vs. 20 (20, 30) mL, P≤0.001] and operation time [32 (26, 44) min vs. 25 (23, 30) min; 29 (25, 38) min vs. 25 (23, 30) min, P<0.05] in the simple venous approach group were significantly less or shorter than those in the other two groups; the length of hospital stay of the conventional arteriovenous group was longer than that in the other two groups [3 (3, 5) d vs. 4 (3, 6) d; 4 (3, 5) d vs. 4 (3, 6) d, P<0.05]. There was no significant difference in postoperative complications. Conclusion    It is safe and effective to close PDA through simple venous approach. The retrograde femoral artery approach has the advantage of simplifying the surgical procedure for PDA with small diameters.

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.

Short and Mid-term Efficacy of Device Closure of Patent Foramen Ovale for Treating the Patients With Patent Foramen Ovale Combining Cryptogenic Stroke and Transient Ischemic Attack / 中国循环杂志

Objective: To explore the short and mid-term efficacy of device closure of patent foramen ovale (PFO) for treating the patients with PFO combining cryptogenic stroke (CS) and transient ischemic attack (TIA). Methods: A total of 56 PFO patients with CS and TIA receiving device closure in our hospital from 2009-05 to 2015-12 were retrospectively studied. Transthoracic echocardiography (TTE), electrocardiogram (ECG), chest X-ray were examined at 24h, 1 month, 3 and 6 months after theoperation; telephone visit was conducted every 6 months thereafter. Results: There were 54/56 PFO patients combining CS and 2 combining TIA; 53 (94.6%)patients received PFO occluder from Starway medical technology. Aspirin was used for 6 months after the operation. The patients were followed-up for the average of (34.67±23.24) months. No body suffered from post-operative stroke and TIA; no residual shunt was observed. Conclusion: The short and mid-term efficacy of device closure has been satisfactory for treating the patients with PFO combining CS and TIA; its overall clinical value should be further investigated in large population and long-term study.

Cardiac Functional Changes in 8 Patients After Percutaneous Pulmonary Valve Implantation / 中国循环杂志

Objective: To evaluate the changes of left and right ventricular function in patients after percutaneous pulmonary valve implantation (PPVI). Methods: A total of 8 patients with successful PPVI in our hospital from 2014-05-27 to 2015-03-25 were studied. The patients received pre-operative evaluation including clinical symptoms, plasma BNP levels, ECG, chest X-ray, echocardiography, CT and MRI examinations. Post-operative follow-up study was conducted at 6 months after PPVI to compare the ventricular functional changes. Results: The average age in 8 patients was 14-42 (25.4±8.1) years including 7 with tetralogy of Fallot correction and 1 with pulmonary stenosis plasty for 24 years. Echocardiography found that 3 patients with mid to large pulmonary regurgitation and 5 with large regurgitation. Compared with pre-operation, at 6 months after PPIV, all patients had decreased right ventricular end-diastolic diameter (RVEDD) as (44.0±4.8) mm vs (33.6±7.1) mm, right ventricular end-diastolic volume index (RVEDVI) (150.1±25.7) ml/m2 vs (111.4±39.1) ml/m2, RVESVI (107.8±21.5) ml/m2 vs (80.7±22.2) ml/m2 and right ventricular cardiac output (RV-CO) (6.8±1.3) L/min vs (4.9±0.8) L/min, but right ventricular ejection fraction (RVEF) was similar (40.5±6.2) % vs (39.5±9.9) %, P>0.05; while increased LVEDD (42.9±4.4) mm vs (46.1±3.0) mm, P0.05. Conclusion: PPVI may decrease right ventricular preload, improve its reverse remodeling and maintain systolic function at normal level in relevant patients; while the impacts on left ventricular function and geometry should be further studied.

Clinical study application of Amplatzer duct occluder Ⅱ to occlude aortopulmonary collateral arteries / 中国介入心脏病学杂志

Objective To assess the feasibility and efficacy of Amplatzer duct occluder Ⅱ (ADOⅡ) in occlusion of aortopulmonary collateral arteries. Methods Seven patients,6 males and 1 female, with aortopulmonary collateral circulation diagnosed previously by cardiac Computed Tomograpy or cardioangiography from Mar 2014 to Apr 2015 were enrolled. All of them were treated with ADO Ⅱ. Results The age of the patients ranged between 5 - 71 months old and weight 4. 2 - 22. 0 kg. Successful hybrid approach was achieved in 6 of 7 patients. One patient failed the occlusion because of severe hypoxemia and mild-moderate residual shunt after catheter intervention. Total 15 aortopulmonary collateral vessels were embolized by 7 ADO-Ⅱ, 22 non-detachable coils ( Cook corp. ) and 2 detachable micro-coils ( Boston Scientific corp. ). Complete embolization was achieved in 2 patients,4 patients had mild residual shunt and 1 patient had mild-moderate residual shunt after the embolisation. No interventional complications recorded. Conclusions ADO Ⅱ has high controllability and suitable for application through small delivery catheter for minimally-invasive procedures to the vessels. It is a preferable alternative in treating pediatric patients with large and tortuous aortopulmonary collateral arteries.

Balloon dilation of pulmonary valve stenosis with 10 F domestic balloon catheter in children≥10 kg / 中国介入心脏病学杂志

Objective To assess the safety and efficacy of balloon dilation of pulmonary valve stenosis with 10 F domestic balloon catheter in children ≥ 10 kg. Methods From May 2009 to June 2014, eighty-three consecutive children with weight ≥ 10 kg and age of (4.5±2.8)(ranged from 1-12) years underwent percutaneous balloon pulmonary valvoloplasty(PBPV) with 10 F domestic balloon catheter. Indication for treatment, procedural details, catheterization data, complication rate, peak-to-peak systolic gradient across the valve and pulmonary insufficiency on echocardiography were respectively analyzed. Forty-four patients were followed up 6-44 months after procedure. Results All procedures were completed successfully. The peak-to-peak systolic gradient across the pulmonary valve decreased from (67.7±26.2) mmHg to (15.4±11.6) mmHg (P < 0.01) immediately after PBPV. Two patients developed reactive infundibular spasm after dilation. They were relieved at 6 months post PBPV. No patient had severe pulmonary insufficiency, tricuspid regurgitation or reintervetion. Conclusions PBPV with 10 F domestic balloon catheter in children with weight≥10 kg is a safe and effective method.

Transcatheter closure treatment for patients with atrial septal defect complicated by atrial fibrillation:a postoperative follow-up study / 介入放射学杂志

Objective To explore the prognosis and management of atrial fibrillation (AF) in patients with atrial septal defect(ASD) accompanied by AF after transcatheter closure of ASD. Methods During the period from July 2010 to May 2013, a total of 24 patients with ASD accompanied by AF were admitted to authors’ hospital to receive transcatheter closure of ASD. Electrocardiogram (ECG), chest X-ray film and transthoracic echocardiography (TTE) were performed before and one day after the operation. Follow-up information was obtained through telephone or at out-patient clinic interview. Results Successful occlusion of ASD was obtained in all patients, and in no patient the AF rhythm turned to sinus rhythm after the procedure. In one patient preoperative AF turned to postoperative atrial flutter, and AF recurred in one case who had received transcatheter ablation of AF before the procedure. One female patient developed gastric bleeding during the course of orally taking warfarin, and she died of cerebral infarction at three days after ceasing the use of warfarin. Of the 24 patients, no anticoagulant drug was used in 5 (20.8%), oral administration of aspirin was given in 7 (29.2%), and oral medication of warfarin was employed only in 11 (45.8%). Conclusion The spontaneous conversion rate of AF is very low in patients with ASD complicated by AF after transcatheter closure of ASD. Postoperative medication of anticoagulation should be strictly standardized and carefully managed.

Effect of interventional occlusion for the treatment of residual leak after repaired of patent ductus arteriosus / 中国医师进修杂志

Objective To observe the effect of interventional occlusion for the treatment of residual leak after repaired of patent ductus arteriosus (PDA).Methods A total of 23 patients with residual leak after repaired of PDA underwent interventional occlusive procedures.Original operative methods:15 patients performed surgical ligation of PDA,4 patients performed neoplasty under cardiopulmonary bypass,4 patients performed transcatheter occlusion.Twenty-three patients were treated by standard interventional occlusion.The lateral descending aortographies and echocardiography were performed to evaluate the immediate results after occlusion 15 min.Echocardiography was rechecked after occlusion 1 week,1 month to find whether there was residual shunt and recanalization.Results Twenty-three patients per formed aortographies in operation showed residual leak.The mean minimum diameter of the residual leak was 2-8 (3.7 ± 1.4) mm.After occlusion 15 min,heart murmur disappeared,the form of interventional occlusive procedures was better.One patient had little residual leak,22 patients (95.65％,22/23) residual leak disappeared.Aftertreated 1 week,1 month,aortographies and echocardiography showed the form of interventional occlusive procedures was better,all patients had no residual leak.Conclusion Residual leak after repaired of PDA can be treated safely and effectively with interventional occlusive procedures.

Imaging of superior sinus venosus atrial septal defect by multi-slice CT / 中华放射学杂志

Objective To evaluate the effectiveness of MSCT in the diagnosis of superior sinus venosus atrial septal defect.Methods The MSCT features of superior sinus venosus atrial septal defect in twenty cases were evaluated retrospectively.The following data were recorded:the size and location of sinus venosus atrial septal defect,the anatomy of pulmonary vein,including number of anomalously draining pulmonary veins and their site of drainage,and associated anomalies.Results In all patients,the superior sinus venosus atrial septal defect locates in the extraseptal wall,which normally separates the right upper pulmonary vein from superior vena cava(SVC).And anomalous connection of right upper pulmonary venous and SVC was identified in all the patients.The mean value of the defect diameter was ( 17.1±5.8) mm.Left superior vena cava was identified in 3 patients.In an elderly patient,left anterior descending branch of coronary artery presented significant stenosis.And in another elderly patient with large atrial septal defect,severe pulmonary hypertension was identified by cardiac catheterization.MSCT findings of superior sinus venosus atrial septal defect in 6 cases were finally confirmed by surgical operation.Conclusions Contrastenhanced MSCT was a useful technique for the diagnosis of superior sinus venosus atrial septal defect,which accurately displayed the anatomical characteristics of the associated malformations for preoperative evaluation.

A comparative study on coronary arterial fistula's treatment between surgical and interventional procedure / 中国医师进修杂志

ObjectiveTo discuss the effect of surgical procedure and interventional procedure on coronary arterial fistula.Methods The clinical data of 25 cases of coronary arterial fistula were retrospectively analyzed.Seven cases received surgical procedures,18 cases received interventional procedures.ResultsOf the 7 cases with surgical procedures,coronary arterial fistula shunt disappeared in 6 cases after review of echocardiography,coronary arterial aneurysms was found in 1 case who had limited residual flow.Of the 18 cases with interventional procedures,12 cases were completely cured,2 cases had limited residual flow,4 cases did not succeeded.ConclusionsSurgical procedures and interventional procedures on coronary arterial fistula are safe and efficient.The choice of method should be based on the specific situation.

Endoluminal grafting for abdominal aortic aneurysms in high-risk patients / 介入放射学杂志

Objective To evaluate the feasibility and effectiveness of endoluminal grafting for the treatment of abdominal aortic aneurysms in high-risk patients with serious co-morbidities.Methods Endoluminal stent grafting was performed in fifty-one patients(45 males and 6 females,with a mean age of 71.6±7.5 years)with abdominal aortic aneurysms.Of all the patients,21(37.7%)were high-risk surgical candidates because of associated co-morbidities.These patients were classified in grade Ⅱ and Ⅲ according to the criteria assigned by the"Society for Vascular Surgery"and"International Society for Cardiovascular Surgery".Based on the preoperative CT and DSA findings,the appropriate stent was selected for every patient.Post-operative clinical observation and CT scan were regularly carried out,the occurrence of complications and the morphological changes of the aneurysms were observed.The results were evaluated and analyzed.Results Primary technical success was achieved in all patients(100%).No death occurred during the procedure or in 30 days after the procedure.An average follow-up period of(29.1±20.5)months was made.Minor endoleak was noted on CT scans in 10 patients,and the endoleak disappeared in 5 patients during the follow-up period.One patient died from unknown cause.The total mortality rate was 2.0%(1/51).The major complications rate was 9.8%(5/51),including stent thrombosis(n=2),thrombosis at femoral artery(n=1),lymphatic fistula at femoral incision(n=1) and stent dislocation(n=1).Conclusion Endoluminal stent grafting is a safe and feasible technique for the treatment of abdominal aortic aneurysms with excellent medium-term results.This technique is especially suitable for the patients with high surgical risk.

Diagnosis of re-entry tears in type B aortic dissection with CT angiography / 中国医学影像技术

Objective To assess the value of CT angiography (CTA) in diagnosis of re-entry tears in type B aortic dissection. Methods One hundred and ten patients with typical type B aortic dissection were enrolled. Data derived from the CTA scans of all the patients and DSA of 70 patients were reviewed. The number, location and size of the re-entry tears were calculated and analyzed. CTA findings were compared with DSA results by using Kappa statistics. Results The mean number of re-entry tears was 3.41±1.90, and 83.64% (92/110) patients had multiple tears. Re-entry tears occurred in the middle of the abdominal aorta were more common than that in the other palce of aorta. The large ones commonly located in the most remote position of dissection. The sensitivity and specificity of finding re-entry tears with CTA was 93.78% and 88.89% respectively, the Kappa value was 0.827 (P＜0.01). Conclusion The consistency between CTA and DSA was good. The re-entry tears in type B aortic dissection can be depicted clearly with CTA, and CTA can be used as the main method for further observation and follow-up of this disease.

Comparison between transcatheter and surgical closure of secundum atrial septal defect in patients over 40 years old / 介入放射学杂志

Objective To compare the safety and efficacy of transcatheter closure of secundum atrial septal defect(ASD)with surgical closure in patients over 40 years old.Methods A single center, nonrandomized concurrent study was performed in 233 consecutive adults from January,2004 to December, 2005.The patients were assigned to either the device or surgical closure group according to the patients' options.Technical success rate,complications,residual shunt,hospital stay,amount of blood transfusion and cost were compared .Results A total of 137 patients were in the group undergoing device closure,whereas 96 patients were in the surgical group.There was no differences in age,sex distribution or baseline cardiac function between the two groups.The sizes of the ASD were(18.9?5.4)mm for the device group and(24.9?6.8)mm for the surgical group(P＜0.001).The technical success rates were 97.1% for the device group and 100% for the surgical group(P=0.151).The residual shunt rates were 0.7% for the device group and 0% for the surgical group(P=0.583).Mortality was zero for both groups.The complication rates were 16.1% for the device group and 30.2% for the surgical group(P=0.015).The blood transfusion amounts were(273.1?491.5)ml for the surgical group and 0 ml for the device group(P＜0.001).The lengths of hospital stay were (4.6?3.3)days for the device group and(12.0?4.0)days for the surgical group(P＜0.001).The costs of hospital stay were 39 570.0?5 929.5 RMB for the device group and 29 839.6?7 533.1 RMB for the surgical group(P＜0.001).Conclusions The technical success rates for surgical versus device closure of ASD were not significantly different,however,the complication rate was lower and the length of hospital stay was shorter for device closure than those for surgical repair.Transcatheter closure of seeundum ASD is a safe and effective alternative to surgical repair in selected patients.(J Intervent Radiol,2007,16:79-83)