[Safety and efficacy of percutaneous left atrial appendage closure in nonvalvular atrial fibrillation patients with left atrial spontaneous echocardiographic contrast].

Objective: To investigate the safety and efficacy of percutaneous left atrial appendage closure (LAAC) in nonvalvular atrial fibrillation patients (NVAF) with left atrial spontaneous echocardiographic contrast (LA SEC). Methods: A total of 95 NVAF patients treated in the Department of Cardiology of Ningbo First Hospital from July 2018 to June 2019 were enrolled in this study. The study population was divided into two group according to the presence or absence of LA SEC detected by transesophageal echocardiography (TEE). TEE was scheduled 45 days post-procedure to detect device-related thrombus (DRT). Stroke and bleeding events were recorded during follow-up. Periprocedural complications and follow-up results were compared between the two groups. Results: LA diameters were smaller in non-LA SEC group than LA SEC group ((44.0±7.4)mm vs (47.3±6.6)mm, P=0.033). Watchman device was successfully implanted into all the enrolled patients. No death, transient ischemic attack (TIA)/stroke, device embolization and major bleeding events occurred. Fifty patients (90.2%) in LA SEC group and 31 patients (91.2%) in non-LA SEC group finished TEE follow-up 45 days post-procedure. No device-related thrombus was detected in non-LA SEC group, while 2 cases (6.5%) were detected in LA SEC group, but there was no significant differences in the incidence between the two groups (P=0.127). The LA SEC group and non-LA SEC group were followed-up for (12.3±3.8) months and (12.9±3.3) months, respectively; and there was no significant differences in the incidence of death, TIA/stroke, major and minor bleeding events between two groups during the follow-up (all P>0.05). Conclusion: LAAC in NVAF patients with LA SEC was safe and effective. However, the incidence of DRT was slightly higher.

Effects of intentional hemodilution on pulmonary stasis and edema in patients and experimental animals.

The therapeutic effects of intentional hemodilution (IHD) on 64 patients of rheumatic mitral valvular disease with chronic pulmonary stasis were estimated. The mean hematocrit was decreased from 0.50 +/- 0.06 to 0.41 +/- 0.04 by withdrawing blood and replacing it with diluent. The whole blood ratio viscosity was decreased from 11.7 +/- 2.4 to 6.4 +/- 0.8 (P < 0.01), the pulmonary arterial pressure was reduced from 6.4 +/- 0.6 to 4.1 +/- 0.5 kPa (0.133 kPa = 1 mmHg) (P < 0.01), the pulmonary vascular resistance brought down from 536.0 +/- 108.0 to 315.0 +/- 62.0 dynes.s.cm-5 (P < 0.01), the cardiac output increased from 3.4 +/- 0.4 to 5.6 +/- 0.5 L/min (P < 0.01), the cardiac index increased from 2.2 +/- 0.5 to 3.5 +/- 0.4 L/min/m2 (P < 0.01), and venous oxygen saturation and oxygen content increased from 28.5 +/- 3.4%, 5.1 +/- 0.5% to 56.0 +/- 5.0%, 11.3 +/- 1.2%, respectively (P < 0.01). The patients' symptoms and signs improved significantly. The protective role of IHD in the early stage of lethal pulmonary edema induced by epinephrine in 39 rabbits and 27 rats was also observed. The experimental data show that intentional hemodilution increased the animals' survival rate (P < 0.01), reduced the pulmonary coefficient, permeability index of Evans blue and protein content in broncho-alveolar lavage fluid (BALF) (all P < 0.01), and alleviated the pathomorphological changes of the lungs of animals in Group IHD were alleviated. The results suggest that IHD acts well in both chronic pulmonary stasis and acute pulmonary edema.