Clinical Application of Superior Vena Cava Spectra in Evaluation of Pulmonary Hypertension: A Comparative Echocardiography and Catheterization Study.

This study was designed to assess whether superior vena cava (SVC) Doppler flow velocities are associated with invasive measures of pulmonary arterial pressure. Eighty patients with unrepaired congenital heart disease who underwent cardiac catheterization were included (31 men, 49 women; mean age: 37.3 ± 14.7 y). Compared with the non-pulmonary hypertension group, the moderate and severe pulmonary hypertension groups had decreased SVC ventricular reserve flow velocity and a significantly increased ratio of atrial reverse flow to systolic flow (AR/S). AR/S correlated significantly with invasive pulmonary arterial systolic pressure (r = 0.426, p < 0.0001). A cutoff of 0.45 had a sensitivity and specificity of 74% and 80%, respectively, for prediction of pulmonary hypertension. Good correlation also existed between SVC AR/S and pulmonary arterial systolic pressure in cases without tricuspid regurgitation (r = 0.706, p = 0.034). These results indicate that SVC AR/S may be an alternative method for assessing pulmonary hypertension.

Hemodynamic changes of the middle hepatic vein in patients with pulmonary hypertension using echocardiography.

The aim of this study was to analyze the changes of the middle hepatic vein (MHV) spectra in patients with pulmonary hypertension (PH) caused by congenital heart disease (CHD) and determine the proper parameters of MHV to predict PH. Eighty patients with CHD were included, whose pulmonary artery pressure was measured via right heart catheterization, and the MHV spectra were detected via echocardiography. The peak value of velocity (V) and velocity time integral (VTI) of the waves, including S wave, D wave and A wave, were measured at the end of inspiration. The values of the MHV parameters that were predictive of PH were evaluated and their cut-off points were determined. Compared with the control group, V of S wave (S), VTI of S wave (SVTI), V of D wave (D), VTI of D wave (DVTI) decreased and V of A wave (A), VTI of A wave (AVTI), A/S, AVTI/SVTI, A/(S+D), AVTI/ (SVTI+DVTI) increased in the PH group. These differences were statistically significant (P<0.05). A correlation analysis determined that the ratios of A/S, A/(S+D), AVTI/(SVTI+DVTI) were positively correlated with pulmonary artery mean pressure (r=0.529,0.575,0.438,P<0.001). An ROC curve analysis determined that the diagnostic effect of A/(S+D) was superior to the other two parameters. On the ROC curve, when the ratio of A/(S+D) was 0.30, the sensitivity was 85.37% and specificity was 75.00% for predicting PH. The spectral parameters of MHV, including the ratios of A/S, A/(S+D) and AVTI/(SVTI+DVTI), increased with increasing pulmonary pressure in CHD patients. When the ratio of A/(S+D) was 0.30 in MHV spectra, it had sufficient sensitivity and specificity for diagnosing PH, and this method could be used as a new non-invasive complementary echocardiographic parameter for predicting PH.

Promotion of artery occlusion in dogs by percutaneous rotational atherectomy.

BACKGROUND: This study aims to offer experimental data and indirect evidences for the application of percutaneous rotational atherectomy to treat patent ductus arteriosus (PDA). METHODS: Eleven dogs (6 male dogs and 5 female dogs; aged 14-20 months, with an average of 16.7±3.2 months; weight 20-25 kg, with an average of 22.7±2.5 kg) were enrolled in this study. The diameters of the left and right arteries ranged from 3.2 to 4.8 mm (average 3.9±0.6 mm) on percutaneous angiography. Percutaneous rotational atherectomy with proper rotablator (the size was 1-1.5 mm larger than the artery diameter) was performed in the arterial intima. After 4 weeks from percutaneous rotational atherectomy, arteriography was conducted to observe the changes in artery diameter. Then all dogs were sacrificed and the pathologic examination was conducted on the left and right axillary arteries. RESULTS: There were obvious changes with different degrees in 22 arteries, including 8 arteries with complete occlusion and 12 arteries with stenosis (≥2/3, 1/2, and 1/3 stenosis in 4, 4, and 4 arteries, respectively). The occlusion rate was 36.4% and the total effective rate was 90.9%. It was considered failure in other 2 arteries with <1/3 of stenosis. CONCLUSIONS: Percutaneous rotational atherectomy of arterial intima can promote the occlusion of arteries. This has provided a new choice for the treatment of PDA.

[Clinical analysis of transcatheter closure of atrial septal defects in elderly patients].

OBJECTIVE: To evaluate the clinical feature of patients with atrial septal defects (ASD) and the safety and efficacy of transcatheter closure of ASD in elderly patients. METHODS: Between May 2000 and June 2010, 82 patients aged (64.5 ± 3.8) years underwent attempted transcatheter ASD closure. Right heart catheterization was performed before intervention. Echocardiography was made at 1 day, 1, 3, 6 months after the procedure. The pre- and post-closure clinical feature, pulmonary artery pressure (PAP) and cardiac function were evaluated. RESULTS: In 82 patients, 37 (45.1%) patients were associated with pulmonary arterial hypertension (PAH). The systolic PAP and mean PAP [(44.1 ± 12.4) mm Hg (1 mm Hg = 0.133 kPa) and (25.2 ± 6.8) mm Hg, respectively] were measured by right heart catheterization before the procedure. One patient was unsuitable for closure because of severe PAH. The remaining 81 patients underwent successful ASD closure without major complications. After closuring, systolic PAP decreased from (52.7 ± 10.3) mm Hg to (31.8 ± 6.3) mm Hg (P < 0.05), and mean PAP descended from (30.9 ± 4.7) mm Hg to (21.8 ± 3.4) mm Hg (P < 0.05) in the 36 patients with PAH. The cardiac function improved post procedure. There were 6 new-onset atrial fibrillations during follow up. CONCLUSIONS: ASD in elderly patients are commonly associated with PAH. Transcatheter ASD closure is safe and effective in the majority of elderly patients.

[Risk factors for early arrhythmias post transcatheter closure of perimembranous ventricular septal defects].

OBJECTIVE: To analyze the risk factors for early arrhythmias after transcatheter closure of perimembranous ventricular septal defect (PVSD). METHODS: A total of 358 patients [161 males, aged from 3 to 54, mean (10.9 +/- 8.1) years, body weight from 12 to 90, mean (32.8 +/- 17.2) kg] who underwent transcatheter closure of PVSD from August 2002 to February 2006 were included in this retrospective analysis. Electrocardiogram was performed daily after transcatheter closure for seven days. Relationships between arrhythmias and those risk factors such as the defect characteristics and the device size and types were explored by logistic regression analysis. Left ventriculography showed 195 out of 358 patients with PVSD were complicated with membranous aneurysm. The PVSD diameter ranged from 2 to 18 (6.5 +/- 3.1) mm in left ventricular side and from 2 to 12 (4.2 +/- 2.3) mm in right ventricular side. A total of 140 nonsymmetrical and 218 symmetrical occluders with diameter 4 to 18 (8.1 +/- 2.5) mm were used to close those defects. RESULTS: Procedure was successful in all patients. Early arrhythmias after transcatheter closure of PVSD were observed in 135 (37.7%) patients and serious cardiac arrhythmias in 23 (6.4%) patients. The early arrhythmias after transcatheter closure of PVSD were significantly correlated with device size [> or = (8.6 +/- 2.7) mm] and type (nonsymmetrical device), the span between the defect and tricuspid (< or = 3 mm), and the presence of aneurysm. CONCLUSION: Larger device size, nonsymmetrical device, narrow span between the defect and tricuspid and the presence of aneurysm are the risk factors for early arrhythmias after transcatheter closure of PVSD.

[Radiofrequency perforation and balloon valvuloplasty in infants with pulmonary atresia and intact ventricular septum].

OBJECTIVE: To investigate the efficacy and safety of percutaneous radiofrequency perforation and valvuloplasty in infants with pulmonary atresia with intact ventricular septum (PA/IVS). METHODS: Four infants (body weight 4 - 10 kg) aged 11 months, 9 months, 12 days and 9 months old, respectively, were hospitalized for dyspnea and cyanosis. All patients had a continuous murmur in the left second intercostal space. Doppler echocardiogram showed membranous pulmonary atresia with intact ventricular septum. Right ventriculogram showed a tripartite right ventricle, vasiform infundibulum, and membranous pulmonary valve atresia without ventriculocoronary connections. Descending thoracic aortogram showed good-sized confluent pulmonary arteries being filled from a ductus arteriosus. All the patients were taken up for radiofrequency perforation followed by a balloon dilatation. A 6F Judkins right coronary guiding catheter was positioned in the right ventricular outflow tract and under the atretic pulmonary valve membrane. The radiofrequency perforation catheter along with coaxial injectable catheter was then passed through the right coronary guiding catheter, using it as the guide to the imperforate membrane. The proximal end of the radiofrequency perforation catheter was then connected to radiofrequency generator. After the cusps of pulmonary valve were perforated, the coaxial injectable catheter was moved into the main pulmonary artery. A tiny floppy-tipped coronary guidewire was then passed through the coaxial injectable catheter into the main pulmonary artery and directed through the patent ductus arteriosus into the descending thoracic aorta or directed into pulmonary arteriola. Thereafter, serial balloon dilation catheters were introduced across the pulmonary valve, and dilations were sequentially performed with increasing balloon diameters. The balloon was dilated until the concave of the balloons disappeared. The radiofrequency energy (5 to 8 W) was delivered for 2 to 5 seconds once, but commonly twice, to perforate the valves. After a predilation with a 3 mm x 20 mm to 5 mm x 20 mm balloon at 6 - 14 atm pressure, the valve was subsequently dilated with 10 mm x 30 mm to 14 mm x 30 mm balloon once or twice. The duration of procedures was 120 to 150 min and exposure time was 25.4 to 43.9 min. RESULTS: The primary procedure was successful in all the infants except one who died early of cardiac perforation with tamponade. After a follow-up period ranging from 2 to 8 months (mean 4.3 m), the remaining 3 survivors achieved complete biventricular circulation. Two of them were awaiting occlusion of the patent ductus arteriosus and 1 needed right ventricular outflow tract reconstruction because of infundibular obstruction. CONCLUSION: PA/IVS consists of 0.7% to 3.1% of congenital heart defects. 85% of the untreated patients die within half a year. Surgical repair for the infants with PA/IVS is associated with a high mortality. In carefully selected patients with PA/IVS, radiofrequency perforation and balloon dilatation of the pulmonary valve is feasible and may represent a new alternative to surgery due to its low mortality and avoidance of cardiopulmonary bypass.

[Short- and mid-term outcomes of arrhythmia after transcatheter and surgical closure of membranous ventricular septal defects: a comparative analysis].

OBJECTIVE: To evaluate the short- and mid-term outcomes of arrhythmia in patients undergoing transcatheter and surgical closure of membraneous ventricular septal defect (VSD). METHODS: 358 VSD patients, 161 male and 197 female, aged (11 +/- 8), underwent transcatheter closure and 50 sex, age, body weight, size of membranous VSD, and percentage of complicated membranous aneurysm-matched VSD patients underwent surgical closure. Electrocardiography was conducted 1, 3, 6, and 12 months after VSD closure. RESULTS: Except bundle branch block other kinds of arrhythmia were resolved in all the patients prior to discharge. The arrhythmias occurring in the patients who underwent transcatheter closure of VSD included complete right bundle branch block (CRBBB, 4 5%), incomplete right bundle branch block (IRBBB, 10.1%), left anterior fascicular block (LAFB, 2.8%), IRBBB complicated with LAFB (1.7%), and CRBBB complicated with LAFB (0.6%), while in the patients who underwent surgical closure included CRBBB (26%) and IRBBB (28%). At the end of 12 months of follow-up, of the 180 patients who had undergone interventional therapy 6 showed CRBBB (3.3%), 6 showed IRBBB (3.3%), 3 showed CRBBB complicated with LAFB (1.7%) and one showed third degree auriculo-ventricular block (0.56%) s, however, no significant change in the ECG findings occurred in the patients who had undergone surgical closure. CONCLUSION: Transcatheter occlusion of membraneous VSD is safer than surgical closure. IRBBB and LAFB caused by interventional therapy are benign, the majority of which may resolve itself 6 - 12 months after the procedure. However, CRBBB and CRBBB complicated with LAFB need a long-term follow-up.

[Transcatheter closure of atrial septal defects in 40 pediatric patients].

OBJECTIVE: To evaluate the clinical efficiency of transcatheter closure of atrial septal defect (ASD) with AGA-Amplatzer occlusion device in pediatric patients. METHODS: Forty patients with ASD, 16 males, 24 females, at a mean age of 10.2 years (ranged from 3 to 15 years of age) and with a mean weight of 35.8 kg (ranged from 11 to 87 kg) were studied. Six cases were complicated with pulmonary stenosis (PS), 1 was complicated with ventricular tachycardia (VT). Right heart catheterizations were done in 40 patients for measuring the pressures of right ventricle and pulmonary artery. The balloon diameter of ASD was measured using balloon catheter with guiding wire. The diameter of ASD was measured by TTE and/or TEE, ascertaining the location and size of ASD. Amplatzer occlusion device was sized to be equal to or 1 - 2 mm more than the diameter of balloon stretched. RESULTS: All patients had successful implantation of the Amplatzer device. The success rate was 100%. The diameter measured by TTE was 7 - 30 mm (mean 17.12 mm). The diameter measured by TEE was 7 - 32 mm (mean 18.44 mm). The diameter of balloon stretched of ASD was 8 - 34 mm. Of the 40 cases, 6 were complicated with PS and accepted percutaneous balloon valvuloplasty (PBPV). One case was complicated with VT and accepted radiofrequency catheter ablation (RFCA). Neither complication nor residual shunt was found in any of the patients. The patients were recovered and followed up for 3 or 4 days after deployment of the Amplatzer device. Clinical symptom, cardiac murmur, and findings in ECG, echocardiography and X-ray were improved markedly. CONCLUSION: AGA-Amplatzer occlusion device is safe and efficient in pediatric patients with ASD.