Reconstruction and analysis of K-Clip surgery process based on finite element method / 中国胸心血管外科临床杂志

@#Objective     To investigate the effects of different types of tricuspid regurgitation, implantation positions, and device models on the treatment outcomes of K-Clip for tricuspid regurgitation using numerical simulations. Methods     Three-dimensional reconstruction of the heart model was performed based on CT images. Two different regurgitation orifices were obtained by modifying the standard parameterized tricuspid valve leaflets and chordae tendineae. The effects of different K-Clip models at different implantation positions (posterior leaflet midpoint, anterior-posterior commissure, anterior leaflet midpoint, posterior septal commissure) were simulated using commercial explicit dynamics software Ls-Dyna. Conclusion     For the two types of regurgitation in this study, clipping at the posterior leaflet midpoint resulted in a better reduction of the regurgitation orifice (up to 75% reduction in area). Higher clamping forces were required for implantation at the anterior leaflet midpoint and posterior septal commissure, which was unfavorable for the smooth closure of the clipping components. There was no statistical difference in the treatment outcomes between the 18T and 16T K-Clip components, and the 16T component required less clamping force. Therefore, the use of the 16T K-Clip component is recommended.

Echo-guiding percutaneous aortic stent implantation for coarctation of the aortic: A case report / 中国胸心血管外科临床杂志

@#Currently, transcatheter intervention has emerged as a first-line treatment for coarctation of the aortic. Due to the radiation exposure associated with catheter interventional therapy, there are numerous restrictions, which harms both patients and medical personnel and is dependent on sizable radiation apparatus. Here, we report for the first time a case of echo-guiding percutaneous aortic stent implantation for a 27 years female patient of reproductive age. After discharge, the patient's aortic coarctation pressure decreased to 18 mm Hg, and the surgical results were satisfactory.

Carotid endarterectomy combined with vertebral artery transposition treating vertebral artery V1 segment stenosis combined with ipsilateral carotid artery stenosis / 中国胸心血管外科临床杂志

@#Objective    To explore the treatment outcome of carotid endarterectomy combined with vertebral artery transposition in patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery. Methods    From June 2017 to September 2020, patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery treated with carotid endarterectomy combined with vertebral artery transposition in Fuwai Hospital were retrospectively analyzed. Results    Finally 12 patients were enrolled, including 10 males and 2 females with an average age of 67.8±6.0 years. Twelve patients were successfully operated and the follow-up time was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 83.5%±11.8% to 24.9%±14.3% (P<0.001). The stenosis degree of carotid artery decreased from 85.6%±11.0% to 0% (P<0.001). Postoperative follow-up showed that the symptoms of symptomatic patients before surgery improved. The 1-year and 3-year patency rates were 100.0%, and there were no peripheral nerve injury complications, perioperative deaths or strokes. Conclusion    Carotid endarterectomy combined with vertebral artery transposition can treat ipsilateral carotid artery  stenosis and vertebral artery stenosis at the same time, improve blood supply to the brain, improve patients' symptoms and has high promotion value.

Contrast-zero ultrasound-guided transcatheter aortic valve replacement: A case report / 中国胸心血管外科临床杂志

@#Conventional transcatheter aortic valve replacement is normally recommended with transthoracic echocardiography, and contrast agent mediated fluoroscopy under anesthesia to guide a better implantation of the transcatheter valve. However, iodine-containing contrast agent possibly damages the patient’s kidney, and even induces the acute kidney injury. We reported a 75-year-old patient diagnosed with severe aortic valve stenosis, moderate regurgitation, and chronic renal failure. We performed the aortic valve replacement under the guidance of fluoroscopy and transesophageal ultrasound without contrast agent. Seven days after surgery, the patient recovered well and discharged with alleviated aortic stenosis and fixed transcatheter aortic valve.

Changes of ascending aortic diameter after transcatheter aortic valve replacement / 中国胸心血管外科临床杂志

@#Objective    To evaluate the changes of ascending aortic (AA) diameter after transcatheter aortic valve replacement (TAVR), and evaluate the safety and efficacy of TAVR in patients with AA dilation. Methods    We retrospectively included 87 patients who underwent TAVR at our center from 2016 to 2019. These patients were divided into 2 groups based on the preoperative AA diameter. There were 17 patients in the AA diameter≥45 mm group (including 10 males, aged 74.4±5.6 years), and 70 patients in the AA diameter<45 mm group (including 39 males, aged 75.9±7.0 years). Results     The baseline variables were similar between two groups (P>0.05). The overall device success rate was 97.7% (85/87). The median computed tomography (CT) follow-up time was 24.2±11.8 months in patients with AA diameter≥45 mm and 23.0±10.7 months in patients with AA diameter<45 mm, and the median annual dilation rate of AA were 0.36 mm/year and 0.00 mm/year, respectively. No statistical significance was observed between two groups (P>0.05). No adverse aortic events occurred during the follow-up period. Conclusion    TAVR is safe and effective in patients with preoperative AA diameter≥45 mm, and the AA diameter remains stable after the procedure. Patients with preoperative AA diameter≥45 mm and AA diameter<45 mm have similar annual dilation rates.

Modified vertebral-carotid transposition treating stenosis at V1 segment of vertebral artery / 中国胸心血管外科临床杂志

@#Objective    To investigate the treatment of modified vertebral-carotid transposition (VCT) in patients with severe stenosis or occlusion at V1 segment of vertebral artery. Methods    A retrospective study of 13 patients with severe stenosis or occlusion at V1 segment of vertebral artery treated by modified VCT in our hospital from October 2016 to December 2018 was done. There were 10 males and 3 females with an average age of 70.5±7.1 years. Results    The operation was successful in this series of patients. The follow-up duration was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 86.8%±7.5% to 17.4%±14.5%. All patients achieved remission of symptoms after the surgery. Temporary peripheral nerve injury occurred in 6 patients. Four patients with neurological complications relieved during follow-up. The patency rate was 100.0% at postoperative 1 and 3 years. There was no perioperative death, stroke or re-intervention. Conclusion    Modified VCT can precisely restore the distal blood flow of patients with severe stenosis or occlusion at V1 segment of vertebral artery, and relieve their symptoms.

Safety and efficacy of percutaneous intervention for children with combined congenital heart abnormality solely guided by transthoracic echocardiography / 中华心血管病杂志

Objective@#To investigate the safety and efficacy of percutaneous intervention of children with combined congenital heart abnormality solely guided by transthoracic echocardiography (TTE) .@*Methods@#From September 2015 to June 2017, 21 children with combined congenital heart abnormality undergoing percutaneous interventional guided by TTE in Fuwai hospital were enrolled in our study, and the clinical data were retrospective analyzed. The atrial septal defect(ASD) closure, ventricular septal defect(VSD) closure, patent ductus arteriosus(PDA) closure or balloon pulmonary valvuloplasty were performed under the guidance of TTE. The procedural effect was evaluated by TTE after operation. The patients were followed up after discharged from the hospital.@*Results@#The age was (37.3±11.6) months, and there were 9 male and 12 female patients. There were 4 cases with ASD and VSD, 6 cases with VSD and PDA, 6 cases with ASD and PDA, 2 cases with VSD and pulmonary stenosis, 3 cases with ASD and pulmonary stenosis. The operations were successfully performed in all patients. No one required extra X ray guidance or open heart surgery. The operation time was (44.6±7.5)min. All patients did not require blood transfusion, inotropic support, and analgesia. There were no complications such as peripheral vascular injury and pericardialeffusion after the operation. The length of hospital stay time was (3.5±0.6) days. All patients were recovered well. The follow-up was (17.6±5.2) months, and post-procedural conduction disturbances, residual shunts, occlude fall off, thrombosis, and new onset of valvular regurgitation were not observed in these patients.@*Conclusion@#Percutaneous interventional of children with combined congenital heart abnormality solely guided by TTE is safe and effective, and the procedure can avoid the potential injuries of X ray and contrast agent.

Comparison of transthoracic or percutaneous balloon pulmonary valvuloplasty in the therapy of pulmonary valve stenosis / 中华外科杂志

Objective@#To compare the clinical outcome of patients with pulmonary valve stenosis underwent transthoracic and percutaneous balloon pulmonary valvuloplasty.@*Methods@#Clinical data of 806 patients diagnosed as pulmonary valve stenosis underwent transthoracic(171 patients as group A)or percutaneous balloon pulmonary valvuloplasty (635 patients as Group B) in Fuwai Hospital from February 2006 to January 2016 were analyzed retrospectively. There were 72 males in group A (42.1%) and 344 males in group B (54.2%). The average age was (1.6±1.1) years in group A and (21.0±18.5) years in group B. The median weight was 7.65 (7.68) kg (M(QR)) in group A and 43.75 (47.38) kg in group B. There were 732 (90.9%) patients followed up from 3 months to 10 years, with an average interval of (6.3±3.6) years. Sixty cases were ligated patent ductus arteriosus simultaneously, and 20 cases got Blalock-Taussig shunt at the same time of valvuloplasty in group A. There were 47 cases of transcatheter closure of atrial septal defect and 6 cases of transcatheter closure of patent ductus arteriosus in group B. The t test, rank sum test and χ2 test were used to compare data of two groups.@*Results@#There were no hospital death or cardiac tamponade and other serious complications for all patients. The postoperative hospital stayin group A was significantly longer than that in group B (8(5) days vs. 2(2) days, Z=-9.404, P=0.000). In every further consultation, patients were reviewed with transthoracic echocardiography to assess transpulmonary gradient and pulmonary regurgitation. There were significant difference between group A and B of preoperative transpulmonary pressure gradient ((80.6±22.4) mmHg vs.(72.6±20.5) mmHg, t=1.611, P=0.032, 1 mmHg=0.133 kPa) and so as transpulmonary pressure gradient reduction value ((55.9±21.0) mmHg vs. (46.6±23.4) mmHg, t=-1.710, P=0.026). Patients in both groups had good cardiac function during follow-up interval. One patient needed surgical valvuloplasty 10 months after percutaneous balloon pulmonary valvuloplasty and 1 case occurred moderate to severe tricuspid regurgitation in group B. During follow-up period, there was no significant difference between group A and B of transpulmonary pressure gradient ((22.3±6.5) mmHg vs. (25.2±12.6) mmHg, t=1.320, P=0.072), the incidence of pulmonary valve regurgitation in patients of group A was significantly lower than patients of group B (56.1% vs.65.2%, χ2=4.755, P=0.029).@*Conclusions@#The clinical outcome and complications are similar between patients underwent two different routes of balloon pulmonary valvuloplasty. Transthoracic balloon pulmonary valvuloplasty is more suitable for infant and underweight children patients with pulmonary valve stenosis. Percutaneous balloon pulmonary valvuloplasty is more suitable for the treatment of the elder children or adults.

Percutaneous induced thrombosis closure on small patent ductus arteriosus solely under echocardiography guidance / 中华实用儿科临床杂志

Objective To investigate the efficacy and safety of percutaneous induced thrombosis closure on small patent ductus arteriosus (PDA) solely under echocardiography guidance.Methods From June 2013 to September 2016,276 PDA patients were treated by femoral artery retrograde approach under echocardiography guidance.Twenty-five patients (14 boys,11 girls) among them with small PDA received percutaneous induced thrombosis closure because the delivery sheath could not pass PDA,with mean age (3.7 ± 1.6) years,mean body weight (16.6 ±5.4) kg and the mean diameter of the most narrow PDA was (1.3 ± 0.4) mm.All patients were assessed by transthoracic echocardiography,chest radiography and electrocardiography preoperatively.The intraoperative and postoperative effects were evaluated by echocardiography.Outpatient assessment was performed at 1,3,6 and 12 months after operation with electrocardiography and echocardiography,and yearly thereafter.Results Twenty-five patients were successfully treated with percutaneous induced thrombosis closure solely under echocardiography guidance.The mean operation time was (35.2 ± 6.1) minutes.The immediate residual shunt rates and 24 hours after operation were 28.0％ (7/25 cases) and 16.0％ (4/25 cases),respectively.All patients recovered and were discharged from hospital.The average hospitalization stay was (3.0 ± 0.6) days.The mean follow-up was (16.8 ± 12.3) months,residual shunt was observed in 2 patients (8.0％),and it decreased from 1.5 mm and 2.0 mm preoperatively to 0.8 mm and 1.0 mm postoperatively,respectively.All patients survived without peripheral vascular injury,cardiac perforation,PDA rupture or thrombembolia.Conclusions Percutaneous induced thrombosis closure of small PDA solely under echocardiography guidance is safe and effective.It can avoid occluder implantation and radiation injury.However,the residual shunt after operation needs following up closely.

Application of echocardiography-guided percutaneous balloon pulmonary valvuloplasty in children / 中华超声影像学杂志

Objective To evaluate the application of echocardiography in guiding percutaneous balloon pulmonary valvuloplasty in children and to summarize the key echocardiographic planes used in the procedure Methods From February 2013 to September 201 5 38 isolated congenital pulmonary valve stenosis patients were recruited Case inclusion criteria age ≥3 years old purely congenital pulmonary valve stenosis and pulmonary transvalvular pressure gradient ≥40 mmHg Echocardiography was used to assess the severity of pulmonary valve disease and to measure pulmonary transvalvular pressure gradient before procedure Intraoperative transthoracic or transesophageal echocardiography was used to monitor the whole process of percutaneous balloon pulmonary valvuloplasty and to evaluate immediate postoperative efficacy of the procedure All patients were followed up by echocardiography after a month post-discharge Results Thrity eight cases were successfully treated by echocardiography-guided percutaneous balloon pulmonary valvuloplasty The average age of children was 7 1 ±2 5 years mean body weight was 25 3 ±7 1 kg Before the procedure pulmonary transvalvular pressure gradient was 65 9 ± 8 9 mmHg pulmonary annular diameter was 14 6±1 1 mm Immediate postoperative pulmonary transvalvular pressure gradient was 1 5 5 ± 3 4 mmHg All children survived and had no significant complications After a month pulmonary transvalvular pressure was 16 1 ± 3 3 mmHg Conclusions Echocardiography plays an important role in percutaneous balloon pulmonary valvuloplasty for children with congenital pulmonary valve stenosis As a non-x ray guided way it has advantages in preoperative screening of patients intraoperative real-time monitoring and postoperative assessment of efficacy The key sections of echocardiography for intraoperative monitoring are four-chamber and aortic short axis view.

Safety and efficacy of percutaneous patent ductus arteriosus closure solely under thoracic echocardiography guidance / 中华心血管病杂志

<p><b>OBJECTIVE</b>To avoid the radiation injuries and use of contrast agent, we assessed the safety and efficacy of percutaneous patent ductus arteriosus closure solely under thoracic echocardiography guidance.</p><p><b>METHODS</b>From June 2013 to June 2014, thirty patients (mean age: (6.3 ± 2.5) years, mean body weight:(22.5 ± 7.3) kg) with pure patent ductus arteriosus were continuously included in this study. The mean diameter of patent ductus arteriosus was (3.8 ± 0.9) mm. Patients were all treated by percutaneous patent ductus arteriosus closure via right femoral artery solely under thoracic echocardiography guidance. The efficacy of the procedure was evaluated by thoracic echocardiography. Follow-up was performed at one month after procedure.</p><p><b>RESULTS</b>All 30 cases were successfully treated with percutaneous patent ductus arteriosus closure solely under thracic echocardiography guidance. The procedural time was (32.8 ± 5.7) minutes. The mean diameter of Amplatzer ADO II was (4.9 ± 1.0) mm. Postoperative trivial residual shunt occurred in six patients immediately after the procedure. All patients survived without peripheral vascular injury or complications such as cardiac perforation. Hospitalization time was (3.4 ± 0.7) days. At one-month follow-up, no complications such as residual shunt or pericardial effusion were observed.</p><p><b>CONCLUSION</b>Echocardiography guided percutaneous patent ductus arteriosus closure by femoral artery approach is safe and effective, and can avoid X-ray and the use of contrast agents.</p>

Application of Percutaneous Ventricular Septal Defect Closure Under Solely Guidance of Echocardiography / 中国循环杂志

Objective: Traditional percutaneous ventricular septal defect (VSD) closure had disadvantages of radiation and contrast media reaction in relevant patients. We want to investigate the efifcacy and safety of percutaneous VSD closure under solely guidance of echocardiography. Methods: A total of 28 VSD patients treated by percutaneous VSD closure under solely guidance of trans-thoracic echocardiography in our hospital from 2014-02 to 2014-10 were summarized. The patients mean age was (9.5 ± 3.1) years with the body weight at (31.3 ± 7.7) kg. The average diameter of VSD was (4.6 ± 0.9) mm, and the clinical follow-up study was conducted by echocardiography at 1, 3, 6 and 12 months after the procedure. Results: There were 26 patients with successful treatment by percutaneous VSD closure under solely guidance of echocardiography. 1 patient was converted to perventricular closure with trans-esophageal echocardiography guidance because the catheter could not pass through the defect; another patient was converted to surgical repair because of the residual shunt > 2 mm. The average procedural time was (63.3 ± 11.7) min and the mean diameter of symmetrical occluder was (6.6 ± 1.0) mm. There were 2 patients with immediate post-operative residual shunt, and the average in-hospital time was (3.7 ± 1.3) days. All patients discharged without the complications as peripheral vascular injury or cardiac perforation. The average follow-up time was (6.2 ± 3.4) months. The residual shunt disappeared in 2 patients at 1 month follow-up time point. No patients suffered from pericardial effusion, occluder malposition, atrio-ventricular block and aortic valve regurgitation. Conclusion: Echocardiography guided percutaneous VSD closure is safe and effective, it may avoid the radiation and contrast media reaction in relevant patients.

Exploration Research of Ventricular Septal Defect Closure via Trans-jugular Approach Solely Under the Guidance of Echocardiography / 中国循环杂志

Objective: In order to avoid the radiation and contrast agent injury, and to extend the echocardiography guided percutaneous ventricular septal defects (VSD) closure, based on femoral artery approach, we assessed the efifcacy and safety of VSD closure via trans-jugular approach solely under the guidance of echocardiography. Methods: A total of 12 patients with peri-membranous VSD treated in our hospital from 2014-10 to 2015-04 were enrolled. The patients were at the age at (1.2-3.5 with the mean of 2.4 ± 0.8 ) years, the body weight at (7-15 with the mean of 11.6 ± 2.6) kg and the diameter of VSD was (3.5-6 with the mean of 4.8 ± 0.7) mm. The patients received percutaneous VSD closure via transjugular approach solely under the guidance of echocardiography. The procedural effect was evaluated by echocardiography and the follow-up study was conducted at 1, 3 and 6 month safter the procedures. Results: There were 9 patients successfully ifnished VSD closure via trans-jugular approach. 1 patient was converted to femoral artery approach because the wire could not pass through the defect of ventricular septal; 1 was converted to minimally invasive per-ventricular closure since the catheter could not pass through the defect; 1 was converted to conventional surgical repair due to the residual shunt was more than 2mm. The procedural time was (53-89 with the mean of 67.2±12.5) min, the diameter of symmetrical occluder was (6-8 with the mean of 7.0±0.9) mm. 2 patients had immediate post-operative residual shunt, all patients were recovered and discharged. No peripheral vascular injury and cardiac perforation occurred, the hospitalization time was (3-5 with the mean of 3.6 ± 0.7) days. The follow-up examination was conducted at (1-6 with the mean of 3.9 ± 2.1) months, the slight residual shunt in 2 patients disappeared at 1 month after procedure; no pericardial effusion, occluder malposition, aortic regurgitation and atria-ventricular block occurred. Conclusion: Echocardiography guided trans-jugular approach of VSD closure is safe and effective, it may particularly avoid the radiation and contrast agent injury in clinical practice.

Clinical Investigation of Transthoracic Minimally Invasive Patent Ductus Arteriosus Occlusion in Infants and Young Children / 中国循环杂志

Objective: To investigate the safety and efficacy of transthoracic minimally invasive patent ductus arteriosus (PDA) occlusion in infants and young children. Methods: We retrospectively analyzed 105 infants and young children who received the transthoracic minimally invasive PDA occlusion in our hospital from 2012-10 to 2014-10. According to PDA diameter, patients were divided into 2 groups:Group A, the patients with PDA diameter ≥ 4 mm,n=64 and group B, the patients with 2 mm ≤ PDA diameter Results: All 105 patients had successfully implanted PDA occluders. The patients’ gender, age, body weight, tracheal intubation time and the in-hospital time were similar between 2 groups,P>0.05. Compared with Group B, Group A had the larger diameters of PDA (5.7 ± 1.4) mm vs (2.7 ± 0.6) mm, P Conclusion: Transthoracic minimally invasive PDA occlusion is a safe and effective method to treat the relevant infants and young children, while the post-operative residual shunt and thrombocytopenia should be closely observed in patients with large PDA.

Feasibility of transcatheter closure of atrial septal defect under the guidance of transthoracic echocardiography / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the feasibility of transcatheter closure of atrial septal defect (ASD) under transthoracic echocardiography (TTE) guidance.</p><p><b>METHODS</b>Retrospective analysis was performed in 65 patients with simple ASD who underwent transcatheter closure under echocardiography guidance in Fuwai hospital from February to August 2013. They were divided into TTE group (n = 30) and transesophageal echocardiography (TEE) group (n = 35). The TTE group patients who underwent localized anesthesia or basal anesthesia received transcatheter closure of ASD under the guidance of TTE. The TEE group patients who underwent tracheal intubation and general anesthesia received transcatheter closure of ASD under the guidance of TEE. The patients were followed up with TTE and electrocardiogram at one month after procedure at outpatient department.</p><p><b>RESULTS</b>In the TTE group, 28 occluders were implanted successfully and 2 patients were subsequently switched to TEE guidance because of unclear TTE images, and the occluder implantation in these 2 patients was successful. There were no obvious differences in age, sex, body weight, ASD size, and time of hospital stay between the two groups (all P > 0.05) . Compared with TEE group, the TTE group had a significantly shorter operation time ((52.77 ± 9.00 ) min vs. (60.11 ± 9.15) min, P < 0.05), respirator ventilation duration ((0.25 ± 0.95) h vs. (3.17 ± 0.69) h, P < 0.05), and stay time in ICU ((1.50 ± 1.96) h vs. (16.43 ± 6.99) h, P < 0.05). The dose of propofol required was significantly lower in the TTE group compared to TEE group ((2.41 ± 2.97) mg/kg vs. (9.43 ± 3.70) mg/kg, P < 0.05). The patients in both groups had no complications such as residual shunt, peripheral vascular injury or cardiac perforation at the time of hospitalization.No complications, such as occluder dislocation, residual shunt, or pericardial effusion were seen during follow-up at one month post procedure in both groups.</p><p><b>CONCLUSION</b>Transcatheter closure of ASD under TTE guidance is feasible and has a broad application prospects.</p>