Use of covered Cheatham-Platinum stent as the primary modality in the treatment for native coarctation of the aorta / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Bare stent implantation in the treatment for native and recurrent coarctation of the aorta (CoA) has become established as an alternative to surgery and balloon angioplasty. However, this modality still encounters significant complications during the procedure and/or follow-up. The covered Cheatham-Platinum (CP) stent commonly used to be chosen as a rescue treatment in these patients. The purpose of this study was to evaluate the use of covered CP stent as the primary modality in the treatment for native CoA.</p><p><b>METHODS</b>Twenty-five covered CP stents and 2 bare CP stents were implanted in 25 patients with native CoA. All patients after the intervention were invited for follow-up examinations.</p><p><b>RESULTS</b>The peak systolic gradient across the lesion decreased significantly from a median value of 67.5 mmHg (quartile range, 19.3 mmHg) to 2 mmHg (quartile range, 4.0 mmHg) (P < 0.0001). Stenotic segment diameter increased from a median value of 5.0 mm (quartile range, 1.5 mm) to 17.9 mm (quartile range, 2.5 mm) (P < 0.0001). The median ratio of diameter of the coarctation postprocedure to preprocedure was 4.2 (quartile range, 1.6). All of the CP stents were placed in the suitable position without any acute complications. During a follow-up period of up to 72 months, no complications were encountered. Most of the patients (21/25) were normotensive, apart from four patients requiring antihypertensive medication during the follow-up.</p><p><b>CONCLUSION</b>The implantation of covered CP stent as the primary modality is safe and effective in the treatment for native CoA in adolescents and adults.</p>

Value of cardiac CT examination in middle-aged and elderly patients with atrial septal defect before planned transcatheter closure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the value of the cardiac CT examination for decision making in middle-aged and elderly patients before planned transcatheter atrial septal defect (ASD) closure.</p><p><b>METHODS</b>Cardiac CT was performed in 63 adult patients [18 males, aged from 50 to 77 years, mean age (56.87 ± 5.79) years] with ASD before planned transcatheter ASD closure. Coronary CT angiography was made for detection of associated cardiovascular diseases, followed by 3D reconstruction of ASD for determination of the defect size in the GE-workstation, results were compared between transthoracic echocardiography measurement, CT measurement, and atrial septal defect occluder waist diameter.</p><p><b>RESULTS</b>Cardiac CT identified additional cardiovascular diseases in 14 patients and decision making was changed based on cardiac CT results. Coronary artery stenosis was detected in 8 patients by cardiac CT, and proved by coronary angiography, and all of them were given comprehensive management: percutaneous coronary intervention and transcatheter ASD closure were successively performed in 2 cases, and 1 case was referred to surgery for both coronary artery bypass graft and surgical ASD repair, and 5 patients were given pharmacological management for coronary artery disease besides transcatheter ASD closure. Cardiac CT identified large ASD with insufficient rim tissue in 2 cases and transcatheter closures were abandoned. Cardiac CT screened out 1 case from those with insufficient posterior inferior rim by transthoracic echocardiography, and transcatheter ASD closure was successfully performed. Cardiac CT ruled out ASD in 1 patient. In addition, cardiac CT detected 1 partial abnormal pulmonary vein connection and 1 ductus arteriosus in this cohort. A correlation on ASD measurements was found between CT size and TTE size (r = 0.80, P < 0.01; Y = 0.84X + 8.85, R(2) = 0.63, P < 0.05), and between ASO size and CT size (r = 0.92, P < 0.01;Y = 0.93X + 4.78, R(2) = 0.84, P < 0.05).</p><p><b>CONCLUSION</b>In middle-aged and elderly patients with ASD for possible transcatheter closure, cardiac CT is valuable on determine ASD size and morphology and could provide incremental information for optimizing clinical management for ASD patients.</p>

Clinic diagnosis and treatment of patients with Cantrell syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the diagnostic feature, treatment and prognosis of patients with Cantrell syndrome.</p><p><b>METHODS</b>Clinical manifestation, diagnosis, operation and follow-up data of 5 patients with Cantrell syndrome were summarized in this retrospective analysis.</p><p><b>RESULTS</b>The age of the 5 patients was 7 days-76 years, definite diagnosis was made in 3 cases and 2 cases presented feature of incomplete Cantrell syndrome. Three patients with full Cantrell syndrome were correctly diagnosed before operation and confirmed by operation. One patient with incomplete Cantrell syndrome (two-vessel stenosis) received bypass surgery. Another asymptomatic patient with incomplete Cantrell syndrome (apical diverticulum of the left ventricle) does not need operation and is under observation. During follow-up, 1 patient died at 60 months after operation and the remaining 4 patients are alive and well.</p><p><b>CONCLUSIONS</b>With the development of modern imaging technology, it becomes easy to make correct diagnose Cantrell syndrome before operation. Prognosis is fine post timely operation and related intervention.</p>

Transcatheter closure of coronary artery fistula in children / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Transcatheter closure of coronary artery fistula (CAF) has emerged as a successful alternative to surgery. We described our experiences in 10 children patients who were accepted for transcatheter closure of CAF.</p><p><b>METHODS</b>Ten children were 3 - 10 years old (seven males) with CAF who underwent percutaneous transcatheter closure between October 1995 and April 2008. Sites of origin of these fistulas were: right coronary artery in seven, left anterior descending coronary artery in two, and left circumflex coronary artery in one patient. Drainage sites of these fistulas were: right atrium in seven, right ventricle in two and left ventricle in one patient. All of these fistulas were congenital and had only one orificium fistula.</p><p><b>RESULTS</b>A Cook coil was used in four patients and an Amplatzer patent ductus arteriosus (PDA) occluder was used in six patients. Checking the angiogram after the procedure revealed complete occlusion in nine patients (90%) and minimal residual flow in one (10%) patient. Technical success was achieved in all patients. Follow-up studies at short term showed complete abolition of shunt in all patients with no evidence of recanalization leading to recurrence of shunt.</p><p><b>CONCLUSIONS</b>Transcatheter therapy using either Cook coil or Amplatzer PDA occluder is suggested to be a safe and effective method of occlusion. The midterm outcome of the intervention for CAF is satisfactory.</p>

Effects of transcatheter closure of extracardiac Fontan fenestration by Amplatzer duct or septal occluder in three patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>The purpose of this study was to report our experiences from the transcatheter closure of patent fenestration after total cavopulmonary connection (TCPC) with an extra cardiac conduit.</p><p><b>METHODS</b>Three patients (7, 14 and 8 years old) with various forms of functionally univentricular heart lesions received a total cavopulmonary connection with an extra cardiac conduit as a final reconstructive procedure. Transcatheter occlusion of the fenestration was accomplished using a 8/6 mm Amplatzer duct occluder in one patient, and 5 mm or 10 mm Amplatzer septal occluder in the other two patients. Residual shunting following occlusion was assessed using angiography and echocardiography.</p><p><b>RESULTS</b>Post total cavopulmonary connection with an extra cardiac conduit, diagnostic catheterization revealed normal pressures in the superior vena cava and pulmonary artery without obstruction at the site of the anastomosis. Angiography of the extra cardiac conduit confirmed the communication between the conduit and the atrium in all three patients and patients still suffered from cyanosis and low oxygen saturation. Immediate full occlusion of fenestration was obtained in all patients. Post closure, mean central venous pressure returned to normal accompanied with significantly increased oxygen saturation. Cyanosis was also significantly attenuated. There were no procedural complications or device failures at intra-hospital and during the 3 to 6 months follow up period.</p><p><b>CONCLUSIONS</b>The Amplatzer septal or duct occluder device is a safe and effective strategy for the Fontan fenestration occlusion.</p>

Ergonomics principles used in the medical products' designs / 中国医疗器械杂志

This article analyzes the particularities of medical products and introduces a design of a medical cart, based on the principles of ergonomics. Its construction embodies convenience, comfort, safety and efficiency of ergonomic factors.

Identification of viable myocardium delayed enhancement magnetic resonance imaging and 99Tcm-sestamibi or 18F-fluorodeoxyglucose single photon emission computed tomography / 中华心血管病杂志

<p><b>OBJECTIVE</b>The aim of this study was to investigate the feasibility and accuracy of delayed enhancement magnetic resonance imaging (DE-MRI) for the assessment of myocardial viability in patients with myocardial infarction in comparison with (99)Tc(m)-sestamibi (MIBI) single photon emission computed tomography (SPECT) and (18)F-fluorodeoxyglucose (FDG) SPECT. Scar was defined as regionally increased MRI signal intensity 15 minutes after injection of 0.2 mmol/kg gadolinium-diethylenetriamine pentaacetic acid or reduced perfusion and glucose metabolism defined by SPECT.</p><p><b>METHODS</b>A total of 34 patients with myocardial infarction (29 males, 58.0 +/- 9.8 years) were imaged with MRI and SPECT.</p><p><b>RESULTS</b>A total of 578 segments were analyzed. DE-MRI and SPECT identified 431 and 336 viable segments respectively and SPECT also identified 30 ischemic segments. Necrotic segments identified by DE-MRI and SPECT were 147 and 212 respectively. Sensitivity and specificity of DE-MRI in identifying segments with matched flow/metabolism defects (scar tissues) was 61.3% and 95.4%, respectively. Quantitatively assessed relative MRI infarct area correlated well with SPECT infarct size. The value of Kappa was 0.51.</p><p><b>CONCLUSION</b>DE-MRI provides a good tool for differentiating viable myocardium from scar tissues and the detection accuracy is comparable between DE-MRI and SPECT.</p>

Clinical characterizations of patients with isolated left ventricular noncompaction diagnosed by magnetic resonance imaging / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the clinical and magnetic resonance imaging (MRI) characterizations in patients with isolated left ventricular noncompaction (LVNC).</p><p><b>METHODS</b>All patients were examined by MRI. The LV was divided into 9 segments for localizing non compacted segments. A new value, C/VS, was introduced to assess the degree of non compacted segments.</p><p><b>RESULTS</b>A total of 31 patients was diagnosed as LVNC (23 males; 39.9 +/- 15.7 years). Palpitations presented in 74% of patients, abnormal EKG found in 93.5% of patients, 33.3% segments were affected and most commonly in the mid-ventricular and apical segments, 84% of patients had > or = 2 affected segments. Right ventricle was affected in 2 patients. Left ventricular thrombi were detected in 3 patients. LVEF was 37.2% +/- 16.5% (14% - 70%), N/C was 3.6 +/- 1.4 (2.2 - 9.2) and C/VS was 0.43 +/- 0.11 (0.27 - 0.69).</p><p><b>CONCLUSIONS</b>Cardiac MRI allows accurate LVNC assessment.</p>

Transcatheter closure of ruptured sinus of valsalva aneurysm using Amplatzer duct occluder / 中华心血管病杂志

<p><b>OBJECTIVE</b>The present study was conducted to investigate the feasibility and efficacy of transcatheter closure of ruptured sinus of Valsalva aneurysm (RSVA).</p><p><b>METHODS</b>Four patients (3 females) aged 7-57 years with RSVA (3 congenital RSVA and 1 post-surgery RSVA) were involved in the present study. Two-dimensional and color Doppler echocardiography revealed the ruptures of right coronary sinus into right ventricle in all cases. The echo estimated size of the defect was 2-10 mm. After the establishment of the arterio-venous wire loop, Amplatzer Duct Occluder (ADO) was successfully deployed by antegrade venous approach in all patients. The diameter of the occluder was chosen to be at least 1 to 2 mm larger than defect.</p><p><b>RESULTS</b>The defects were successfully occluded without any complications. On the follow-up 3 months after operation, there was no device embolization, infective endocarditis and aortic regurgitation.</p><p><b>CONCLUSION</b>Transcatheter closure is a feasible and effective modality for RSVA without other anomalies.</p>

Comparison of pulmonary perfusion imaging with pulmonary angiography in diagnosis of pulmonary involvement in Takayasu's arteritis / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the diagnostic value of (99)Tc(m)-MAA pulmonary perfusion imaging with that of pulmonary angiography for pulmonary involvement in Takayasu's arteritis.</p><p><b>METHODS</b>Twenty-one patients (19 women, 2 men), with diagnosed Takayasu's arteritis and underwent both (99)Tc(m)-MAA pulmonary perfusion imaging and pulmonary angiography, were retrospectively analyzed.</p><p><b>RESULTS</b>Out of the 21 patients, pulmonary angiography detected 11 patients with pulmonary artery involvement whereas 13 patients were revealed perfusion defects by pulmonary perfusion imaging. The agreement of diagnosis by pulmonary perfusion imaging with that by pulmonary angiography existed in 19 patients (90.5%, Kappa = 0.81, P < 0.0001). There were 331 pulmonary segments consistently diagnosed by pulmonary perfusion imaging and pulmonary angiography in 378 pulmonary segments (87.5%, Kappa = 0.74, P < 0.0001).</p><p><b>CONCLUSIONS</b>Pulmonary perfusion imaging is highly accorded with pulmonary angiography in detecting the pulmonary involvement in Takayasu's arteritis. Therefore, pulmonary perfusion imaging could be used as a non-invasive screening test for the pulmonary artery involvement in Takayasu's arteritis.</p>

Arrhythmogenic right ventricular cardiomyopathy with left ventricular involvement:histopathology and MRI features / 中华放射学杂志

Objective The aim of the present investigation was to confirm histopathology and MR features of arrhythmogenic right ventricular cardiomyopathy(ARVC),particularly with the left ventricular involvement.Methods Nine patients(4 male,5 female;13 to 54 years old,mean age 40.44?15.99), with a pathologic diagnosis of ARVC at heart transplantation,were included,of which 7 patients were scanned for MR imaging before transplantation.Results Severe dilation of right ventricular(RV)cavity and left ventricular one(LV)were observed in 7 and 8 hearts,respectively.All hearts showed severe and transmural RV muscle loss,where RV wall was almost completely filled with either fatty tissue(3 cases)or fibrofatty tissue(6 cases).LV involvement was diagnosed histologically in all cases.Both the septum and the LV free wall were affected in 2 cases;7 cases disclosed selective free wall involvement.LV fatty or fibrofatty substitution was predominantly located in the subepicardial and mediomural wall layers in 5 hearts. a diffuse interstitial fibrosis with patchy infiltration was noted in the other 4 hearts.7 patients underwent MR scanning.MR scanning demonstrated global RV severe dilation and thinning in 5 cases,of which linear fatty infiltration was found in 3 cases.RV presented wall thickness preservation and normal cavity in the remaining 2 cases,in which left involvement existed.LV was dilated in all cases(mildly in 3,moderately in 2,severely in 2).The LV ejection fraction was(21.66?7.05)%,and subepicardial fatty infiltration was found in 2 patients,selectively involving posterolateral wall.4 patients showed the LV wall thinning diffusely in free wall,and the other 3 mainly involved septum,apex and posterolateral wall,respectively.All 5 patients with delayed enhancement showed varying degrees of hyperenhancement,mainly involving the posterolateral wall(transmural in 2 and epicardial in 2),septum(mediomural in 2)and apex in 2(focal or transmural).Additionally,transmural hyperenhancement was also found in the RV wall,involving free wall in 2,RV apex in 1 and posterior wall in 1 case,respectively.Conclusions ARVC with reference to left ventricular involvement had severe cardiomegaly and heart failure.MRI can partially reveal tissue characteristics,including fatty infiltration and fibrosis,as well as morphologic features.

Sress cardiomyopathy:clinical features and imaging findings / 中华放射学杂志

Objective One typical case with stress cardiomyopathy was reported and the current knowledge of the syndrome was reviewed to improve relevant knowledge.Methods A 71-year-old female patient presented dyspnea and chest pain due to emotional stress.ECG,echocardiography,selective coronary artery angiography,left ventriculography,~(99)Tc~m-MIBI single photon emission computed tomography (SPECT),~(18)F-FDG SPECT and MRI were performed.Results Electrocardiogram at admission showed ST segment elevation and T wave inversion in leads V1—V4.Pathological Q wave occurred 1 week later,it disappeared 1 month later however and severe T wave inversion occurred.Normal or slightly elevated cardiac enzymes in the blood were found during the course.Left ventriculogram at admission showed left ventricular apical ballooning with LVEF of 30%.The ballooning volume was about 3/4 of left ventricular volume, without any corresponding coronary artery diseases found in coronary angiogram.The abnormal apical ballooning decreased significantly in the follow-up left ventriculogram performed one month later.The LVEF rose up to 63.6%.~(99)Tc~m-MIBI and ~(18)F-FDG SPECT showed mismatch of perfusion and metabolism in the corresponding region,indicating presence of viable myocardium.MRI showed left ventricular apical ballooning without perfusion defect and late enhancement,indicating viability of corresponding myocardium. Conclusions Emotional stress can cause transient left ventricular apical ballooning called"stress cardiomyopathy".Either ~(99)Tc~m-MIBI SPECT associated with ~(18)F-FDG SPECT or delayed enhancement MRI plays an important role in identification of myocardial viability,which can efficiently guide clinical treatment.