A Female Patient With Recurrent Headache and Syncope.

This case report discusses a diagnosis of pulmonary arteriovenous fistulas in a female patient in her 30s who presented with a 5-year history of hypoxia, syncope, and headaches.

Echocardiographic characteristics of transcatheter closure of patent foramen ovale with mallow biodegradable occluder: A single-center, phase III clinical study.

Background: Transcatheter occlusion of patent foramen ovale (PFO) has become a recognized treatment option for high-risk PFO-related diseases. However, traditional metal occluders have some disadvantages, such as permanent retention in the body, abrasion of tissues, and obstruction of access to the left side of the heart for interventional procedures. With biodegradable occluders that release non-toxic degradation products and are absorbable by the body, the risk of long-term complications could be greatly reduced. The experimental results of using a PFO-degradable occluder in beagle dogs in early stages, independently developed by Shanghai Mallow Medical Instrument Co., Ltd., showed that the occluding umbrella disc network was degraded 6 months after occlusion. The occluder also showed good memory, biocompatibility, and mechanical properties. Methods: As one of the multi-center research units, this prospective Phase III clinical trial study included 16 patients with PFO-related complications who were treated with a degradable occluder. The follow-up period lasted for 12 months to analyze the echocardiographic characteristics and procedural feasibility. Results: The immediate success rate of the procedure was 100% with no serious complications. Postoperative color Doppler transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) at 12 months showed that one patient with atrial septal aneurysm (ASA) had a residual shunt at the edge of the occluder, and contrast transcranial Doppler (cTCD) showed that all patients were grade I or 0 right-to-left shunts (RLS), indicating that the occlusion success rate was 100%. The occluder gradually degraded after the procedure, particularly when the umbrella disc structure became vague, and the size of the occluder decreased significantly 6 months after occlusion. Conclusions: PFO closure with a Mallow degradable occluder has a high plugging success rate, is safe and effective, and has no serious complications. However, for PFO closure with special anatomical features, further research with a larger sample size is required. TTE can dynamically, conveniently, and accurately observe the entire degradation process of the occluder. Clinical Trial Registration: ChiCTR1900024036.

Group Visits Improve Health in Patients With COPD in Post-Discharge Transition Period.

OBJECTIVE: Continuous care during the post-discharge transition period is necessary for convalescence in patients with chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the effect of group visits on the health of patients with COPD during the post-discharge transition period. METHODS: In this prospective randomized study, a total of 116 patients with COPD post-discharge were randomly assigned to either the control group (n = 57) or the group visit intervention group (GV; n = 59). A healthy lifestyle, quality of life, self-efficacy and lung function before and after the intervention and acute COPD exacerbation(s) during the intervention were recorded and analyzed. RESULTS: Healthy lifestyle and self-efficacy scores were higher in the GV group after compared with before the intervention and the control group. Lung function was improved in both groups, with greater improvement in the GV group. In addition, the frequency of outpatient emergency services and hospitalizations due to acute COPD exacerbations was lower in the GV group compared with the control group. CONCLUSION: Group visits are efficient administration models in patients with COPD. Through health education and companion support, group visits increase patients' self-efficacy, promote patients' transition to a healthy lifestyle, improve their quality of life, reduce acute exacerbations and lower medical costs during the post-discharge transition period.

Transcatheter closure of postoperative residual ventricular septal defects using Amplatzer-type perimembranous VSD occluders.

OBJECTIVES: The reoperations of postoperative residual ventricular septal defects (VSDs) are associated with higher risks. Our aim is to assess the efficacy and safety of transcatheter closure of postoperative residual VSDs using perimembranous VSD occluders. METHODS: Twenty-one patients with residual VSDs underwent transcatheter closure in our center from January 2005 to January 2012. The study population consisted of 9 males and 12 females whose ages ranged from 1.9 to 54 years (median age, 8.7 years). Eighteen cases had perimembranous VSD repair previously, 3 cases had tetralogy of Fallot surgical treatment. All patients had signs of left ventricle volume overload (Qp/Qs ≥ 1.5). Two types of perimembranous VSD occluders, symmetric and asymmetric, were used in 14 and 7 cases, respectively. The diameter of residual VSDs ranged from 4-16 mm (mean, 7.8 mm). The waist size of occluders ranged from 6-18 mm. RESULTS: There were 0 deaths and 1 serious adverse event. Intravascular hemolysis occurred in 1 patient (4.8%), lasted for 7 days, and recovered with therapy. A trivial intraprosthetic residual shunt was observed in 2 patients (9.5%) after the procedure and 1 patient (4.8%) at 6 months. Two patients (9.5%) had transient left anterior hemiblock and recovered within the first week after the procedure. At the latest follow-up, no atrioventricular block and new-onset aortic regurgitation occurred. CONCLUSIONS: Transcatheter closure is a feasible and safe management option for patients with postoperative residual VSDs and obviates the need for a second surgery and cardiopulmonary bypass.

[Autologous bone marrow stromal cell transplantation with application of granulocyte colony-stimulating factor improves rabbit cardiac performance after acute myocardial infarction].

OBJECTIVE: To test the effect of autologus marrow stromal cells (MSCs) transplantation combined with application of granulocyte colony stimulating factor (G-CSF) on the function of ischemic hearts in vivo. METHODS: Acute myocardial infarction was induced in rabbits by occlusion of the left anterior descending artery, and autologous MSCs labeled with BrdU in vitro was introduced in the infarct area of the same donor rabbit. G-CSF was administered by subcutaneous injection for 5 consecutive days. Four weeks later, the transplanted MSCs were detected by laser scanning confocal microscopy and the cardiac function of the rabbits was examined by echocardiogram and multichannel physiological recorder. The myocardial infarct size was measured on the mid-transverse sections stained with Masson's trichrome. RESULTS: Four weeks after transplantation, the MSCs were found to undergo myogenic differentiation with expressions of alpha-sarcomeric actin and connexin 43 in the intercalated disk. MSC transplantation in combination with G-CSF administration improved the left ventricular contractility and markedly reduced myocardial infarct size as compared with cell transplantation without G-CSF. CONCLUSION: Application of G-CSF following autologous MSC transplantation may represent a promising therapeutic strategy for ischemic heart disease.