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@#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.
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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.
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@#Objective To investigate the early clinical results of MitraClip system in domestic patients. Methods We retrospectively analyzed the clinical data of 36 patients who underwent transcatheter edge-to-edge repair procedure using MitraClip system in Beijing Fuwai Hospital, Shenzhen Fuwai Hospital and Fuwai Yunnan Cardiovascular Hospital between January and June 2021. There were 24 males and 12 females, with a median age of 70 (47-86) years. Ten (27.8%) patients had 3+ mitral regurgitation (MR) and 26 (72.2%) patients had 4+ MR preoperatively. Results All procedures were successfully performed. The reduction in MR was 2+ at least immediately after surgery, and 91.7% of patients had MR≤2+ at 3 days postoperatively. There was no statistical difference in left ventricular ejection fraction change postoperatively. Forward velocity and peak gradient of mitral valve were increased after the procedure. Mean gradient of mitral valve were increased at 3 days postoperatively than immediately after surgery (P<0.001). Two patients had acute pericardial effusion intraoperatively, and received pericardial puncture and drainage immediately. Conclusion MitraClip system has been applied well in domestic patients and can significantly improve MR. This sutdy has a good consistency with foreign studies, and the early results are satisfactory.
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Objective To explore the changes of serum interleukin-13 (IL-13) and squarnous cell carcinoma antigen (SccAg) levels in pediatric asthma and its clinical significance.Methods 45 children with pediatric asthma were selected as observation group,45 healthy children at the same time were selected as control group.IL-13 and SccAg levels in the two groups were detected by ELISA.The correlation between the serum IL-13,SccAg levels and pediatric asthma was analyzed.Results In the observation group,the IL-13,SccAg levels at the attack stage were (148.96 ± 24.56) ng/L,(3.36 ± 0.69) μg/L,respectively,the IL-13,SccAg levels at the remission stage were (90.65 ± 20.14)ng/L,(2.58 ± 0.34) μg/L,respectively,which in the control group were (76.48 ± 17.54) ng/L,(2.30 ± 0.36) μg/L,respectively,the differences were statistically significant (F =5.36,6.39,all P ＜ 0.05).In the observation group,the IL-13,SccAg levels in the patients with moderate or severe disease were (135.48 ± 21.69)ng/L,(2.86 ± 0.36) μg/L,respectively,the IL-13,SccAg levels in the patients with mild disease were (160.38 ± 22.45) ng/L,(3.30 ±0.41) μg/L,respectively,which in the control group were (76.48 ± 17.54) ng/L,(2.30 ± 0.36) μg/L,respectively,the differences were statistically significant (F =5.78,6.78,all P ＜ 0.05).The serum IL-13 and SccAg levels had significantly positive correlation with pediatric asthma during the attack stage and remission stage (r =0.982,0.965,all P ＜ 0.05).Conclusion The serum IL-13 and SccAg levels have certain association with the incidence of asthma,which play an important role in determining the development and reorientation of asthma.
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Objective: To assess the application value of CT scanning in percutaneous pulmonary valve implantation (PPVI). Methods: A total of 19 patients with severe pulmonary regurgitation planed to receive PPVI in our hospital from 2014-05 to 2016-07 were studied. CT scan and transthoracic echocardiography (TTE) were conducted to collect the data of pulmonary root anatomy and to compare the difference of pulmonary annulus size measured by CT and TTE. The accuracy of pre-operative measurement was evaluated by the follow-up study at (1-26) months after the operation. Results: In all 19 patients, the mean anatomic measurements by CT were as follows: diameter of pulmonary annulus (24.3±3.5) mm, diameter of pulmonary sinotubular junction (25.4±4.0) mm, diameter at distal of main pulmonary artery (27.5±4.8) mm, diameter of right ventricular outflow tract (36.8±7.3) mm, length of main pulmonary artery (45.5±7.0) mm, diameter of left pulmonary artery (17.9±1.5) mm and diameter of right pulmonary artery (18.5±3.6) mm. The diameter of pulmonary annulus measured by CT was larger than TTE, P<0.05. During (1-26) months follow-up period, no patients suffered from stent fracture or translocation, peri-pulmonary valve regurgitation, obvious pulmonary regurgitation or coronary stenosis; 1 patient had increased flow rate at right pulmonary artery opening by stent blocking and 2 patients had residue mild stenosis of pulmonary valve. Conclusion: Pulmonary annulus size measured by CT and TTE was different; CT may precisely assess the morphology of pulmonary root with adjacent area which is important for pre-operative evaluation in PPVI patients.
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Objective To observe the clinical efficacy of collaterals bloodletting in treating simple lower-limb varicose veins.Method Eighty-four patients with simple lower-limb varicose veins were randomized into a treatment group and a control group, 42 cases in each group. The control group was intervened by elastic stockings, while the treatment group was intervened by collaterals bloodletting in addition to the treatment given to the control group. The clinical efficacies were compared after 10-week treatment.Result The total effective rate was 100.0% in the treatment group versus 80.3% in the control group, and the between-group difference was statistically significant (P<0.05). Conclusion Collaterals bloodletting is an effective method in treating simple lower-limb varicose veins.
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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.
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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.
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Objective To study the value of plasma brain natriuretic peptide (BNP) levels on the cardiac function evaluation in children with left-right shunt congenital heart disease (CHD).Methods Thirtytwo children with left-right shunt CHD were selected and divided into right ventricular group (14 cases) and left ventricular group (18 cases) according to the heart load capacity types.Twenty healthy children were selected as control group.Then plasma BNP levels were determined by enzyme-linked immunosorbent assay method and the left ventricular ejection fraction (LVEF),left ventricular end-diastolic diameter (LVEDD),right ventricular end-diastolic diameter (RVEDD),pulmonary blood flow (Qp)/systemic blood flow ratio(Qs) and left heart Tei index were determined by echocardiography and compared.Results The plasma BNP levels,LVEDD,RVEDD,Qp/Qs and left heart Tei index were (60.21 ± 26.78) rng/L,(35.71 ± 6.98) mm,(25.04 ± 5.52) mm,1.74 ± 0.24,0.34 ± 0.12 in right ventricular group.The plasma BNP levels,LVEDD,RVEDD,Qp/Qs and left heart Tei index were (64.57 ± 25.18) ng/L,(45.27 ± 7.26) mm,(12.34 ± 2.18) mm,1.78 ± 0.19,0.36 ± 0.11 in left ventricular group.The plasma BNP levels,LVEDD,RVEDD,Qp/Qs and left heart Tei index were (33.42 ± 9.46) ng/L,(32.31 ± 4.87) mm,(10.98 ± 1.60) mm,0.92 ± 0.11,0.28 ± 0.08 in control group.The plasma BNP levels,LVEDD,RVEDD,Qp/Qs and left heart Tei index in right ventricular group and left ventricular group were higher than those in control group,and there were significant differences (P ＜ 0.05).There was no significant difference in LVEF among three groups (P ＞ 0.05).The plasma BNP levels in right ventricular group had positive correlation with RVEDD (r =0.634,P ＜ 0.05),Qp/Qs (r =0.721,P ＜ 0.05) and left heart Tei index (r =0.647,P ＜ 0.05).The plasma BNP levels in left ventricular group had postive correlation with LVEDD (r =0.547,P ＜ 0.05),Qp/Qs(r =0.794,P ＜ 0.05) and left heart Tei index (r =0.745,P ＜ 0.05).There was no correlation between the plasma BNP levels and LVEF in right ventricular group and left ventricular group.Conclusion The plasma BNP levels determination helps the early cardiac function evaluation of left-right shunt CHD,and combined with echocardiography can accurately reflect the early cardiac function of the left-right shunt CHD,which can provide objective basis for the clinical diagnosis and treatment.
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Objective To evaluate two kinds of practical CT three-dimensional volumetric measurement techniques in assessing atrial septal defects (ASDs) for transcatheter device closure.Methods Retrospective assessment of 50 consecutive patients who underwent ASD closure was conducted.Cardiac CT was performed in them before planned transcatheter ASD closure and postoperative chest radiograph was performed in both posteroanterior and lateral view.Coronary CT angiography was made for the detection of coronary artery disease,and three-dimensional reconstruction of ASD was conducted for determination of the defect size in the GE-workstation.Two kinds of practical CT three-dimensional volumetric measurement techniques,one named CT virtual endoscopy assisted volumetric measurement (CTVE) and another called axial sequence assisted volumetric measurement(CTAS),were used to calculate the major axis and the minor axis of the ASD respectively.Thus,the dimensions of the Equivalent Circle were derived,with circunference and area equal to the elliptic ASD according to the formulation (D =√b4/a2 + a2-b2).The ASDs occluder (ASO) dimension was measured in the lateral chest radiograph,and this postoperative occluder-waist size (POS) value was regarded as the gold standard for the measurement of ASD.The results were compared between CTVE and CTAS,and the correlations were evaluated between them and the gold standard.Results The differences in the major dimensions (-9.05 mm,t =-6.60,P ＜ 0.05),minor dimensions (-4.86 mm,t =-4.39,P ＜ 0.05) and Equivalent circle dimensions (-7.65 mm,t =-6.40,P ＜ 0.05) of ASD between CTAS and CTVE were statistically significant.Though the CTAS cannot provide the en face views of ASDs,the Equivalent Circle dimensions measured by CTAS(22.48 ± 5.59) mm was correlated well with POS (27.07 ± 6.83)mm (Y =1.14X + 1.39,r =0.94,P ＜ 0.01),and a good correlation was found between this Equivalent Circle dimensions and ASO size (Y =1.02X + 6.84,R2 =0.78,r =0.88,P ＜ 0.05).The correlation between the Equivalent Circle dimensions measured by using CTVE (30.13 ± 9.27) mm and POS was poor (Y =0.30X + 17.94,r =0.41,P ＜ 0.01),though it can provide the en face views of ASDs.Conclusion CTVE and CTAS are two complementary techniques of assessing ASDs for transcatheter device closure.
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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.
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Aim To explore the neuroprotective effects and possib le mechanism of bellidifolin on focal cerebral ischemia in rats.Methods Focal ce rebral ischemia was induced by permanent occlusion of the proximal portion of ri ght middle cerebral artery occlusion (MCAO). A neurological examination was perf ormed on each rat 4 hours,24 hours after ischemia by the method of Berderson .T he infarcted size was measured by 2,3,5-triphenrytetrazolium chloride(TTC) st aining technique at 24 hours post-ischemia.Effect of bellidifolin on intercellu lar adhesion molecule-1 (ICAM-1) and B lymphocyte myeloma (Bcl-2) immunoreact ive positive cells in peri-infarct region following ischemia and the histological neuronal changes were observed by means of immunohistochemical staining and H E staining.Result Bellidifolin significantly reduced infarc- ted size and improved the neurological deficit in rats .Bellidifolin produced effects of reduction in expression of ICAM-1 and upregulation of antia poptotic protein Bcl-2 on focal cerebral ischemia.Conclusion B ellidifolin has neuroprotective effects on focal cerebral ischemia in rats by or al administration.Mechanism of neuroprotective effects is related to downregulat ion of ICAM-1 and upregulation of antiapoptotic protein Bcl-2 on focal cerebr al ischemia.