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.