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Ventricular septal defect(VSD) is the most common congenital heart disease, accounting for approximately 25% to 40% of all congenital heart diseases.The traditional treatment for VSD is transthoracic repair under extracorporeal circulation, which is more effective but more traumatic for the patient, and this method cannot completely avoid potential complications related to extracorporeal circulation.In the past 35 years, various types of occluders have been gradually used for the treatment of VSD by means of percutaneous intervention under X-ray or ultrasound guidance, and the main occluders widely used in clinical practice are the domestic membrane VSD occluders(symmetric occluder, eccentric occluder, thin-waist occluder), the domestic muscular VSD occluders and the Amplatzer duct occluders(first and second generation). This article reviews the advantages and disadvantages, indications and use of different types of occluders for transcatheter intervention of VSD.
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Objective To compare the safety and efficacy between transcatheter intervention and surgical closure of para-valvular leakage(PVL)after valve replacement.Methods From May 2010 to May 2014,17 patients of paravalvular leakage af-ter valve replacement underwent interventional therapy and 11 patients underwent surgical closure.The perioperative charac-ters, mortality rate, complications and prognosis were compared between the patients underwent surgical procedure and tran-scatheter intervention.The average follow-up time was 13 months(1-36 months).Results The success rate of transcatheter intervention was 100%, while there were 2 in-hospital deaths in the surgical group(18%).Compared with surgical group, transcatheter intervention group has the benefit of shorter operation time[(84 ±36)min vs.(358 ±88)min](P<0.01),shor-ter hospitalization time[(11.9 ±12.1)d vs.(38.1 ±42.2)d](P<0.05), less transfusion[(1 029 ±455)ml vs.(1 438 ± 908)ml](P<0.05).There was no mechanical ventilation and ICU stay in the transcatheter intervention group.After tran-scatheter intervention, there was 7 residual shunt(47%)with an average shunt volume of(1.6 ±1.7)ml,which is remarkably reduced compared with pre-operation.In the surgical group, there was 1 case of residual shunt(9%).During the follow-up, there was no deaths in both groups, with improved heart function and no serious complications.Conclusion In the treatment of paravalvular leakage after valve replacement,transcatheter interventiontechnique has the advantages of simpler and safe ap-proach, less trauma, shorter time of hospitalization,faster post-operative recovery and lower treatment cost.This method is one of the new technology in the field of minimally invasive cardiac surgery in recent years.By improving operation skills,choosing individualized occluders and treatment of early hemolytic complications, the success rate and long-term effect of interventional therapy can get further improved.
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Objective To assess the safety and efficiency of robotic minimally invasive surgery and transcatheter interventional occlusion for treatment of adult secundum atrial septal defect (ASD) by comparing the early and recent postoperative follow-up results of the two minimally invasive surgery. Methods Thirty adult patients with secundum ASD, who admitted to the General Hospital of PLA from Jan. 2008 to Dec. 2014 and received treatment of da Vinci Surgical System, were recruited as TEASD-R group, meanwhile, another 30 adult patients who received transcatheter interventional occlusion were recruited under the strict 1:1 criterion as TIASD-O group. The early postoperative complications, in-hospital conditions, recent postoperative follow-up results and the quality of life 30d and 6 months after operation were compared and retrospectively analyzed between the two groups. Results The success rates of surgery were 100% in the both groups, no early and recent postoperative complications (residual shunt, pericardial effusion, cerebral infarction, peripheral vascular embolism, new arrhythmia, etc.) were found in TEASD-R group. While some of corresponding complications existed in TISAD-O group, and the differences were of statistical significance (P<0.05) between the two groups in the incidence of postoperative new arrhythmia, tricuspid incompetence and pulmonary hypertension, as well as in the early size of right atrium and in-hospital time. SF-36 quality of life questionnaire showed that the difference of somatic pain 30d after operation was of statistical significance (P<0.05) between the two groups, but the difference disappeared 6 months after operation. Conclusion Robotic minimally invasive surgery for adult secundum ASD is feasible, safe and efficacious since no postoperative complications occurred such as tricuspid incompetence and pulmonary hypertension, but the longer operative and inhosptial time are the shortages of the operation.
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Objective: To study the cause of rapid thrombocytopenia and organ hemorrhage in congenital heart disease (CHD) patients after interventional occlusion. Methods: A total of 665 CHD patients received interventional occlusion in our hospital from 2011-01 to 2015-12 were enrolled. The patients were divided into 3 groups according to the defects: Atrial septal defect (ASD) group,n=100, Ventricular septal defect (VSD) group,n=100 and Patent ductus arteriosus (PDA) group,n=465. Pre- and post-interventional occlusion platelet levels, the relationship between PDA occluder diameter and platelet counts were compared. Pressure difference between both sides of occluder was randomly measured in a part of patients including 50 in ASD group, 50 in VSD group and 102 in PDA group. Based on occluder diameter, the 102 PDA patients were further divided into 2 subgroups: Giant PDA,n=42 and Medium-small PDA,n=60; pressure differences between both sides of occluder were compared between 2 subgroups. Results: No severe thrombocytopenia and organ hemorrhage occurred in ASD group or VSD group. PDA group had 36/465 (7.74%) patients with severe thrombocytopenia, 18 (3.87%) with organ hemorrhage and all of them occurred in giant PDA subgroup; the diameter of PDA occluder was negatively related to post-operative to platelet counts (r=-0.659,P=0.001). For pressure difference on both sides of occluder, compared with prior operation, PDA group showed increased systolic and diastolic pressure differences and increased mean pressure difference at immediately post operation, allP< 0.05; systolic pressure difference in VSD group was (56.57±15.33) mmHg, in Medium-small PDA subgroup was (58.33±26.65) mmHg and in Giant PDA subgroup was (94.66±27.62) mmHg which was much higher than those in VSD group and Medium-small PDA subgroup, allP<0.01. Conclusion: Rapid thrombocytopenia and organ hemorrhage in CHD after interventional occlusion only happened in giant PDA patients. High pressure difference formed high-speed ifltration blood lfow which may cause scouring damage on platelets and it was the main reason for thrombocytopenia occurrence.
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Objective To evaluate the clinical efficacy of interventional occlusion of ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI). Methods Six patients with VSR complicated after AMI underwent transcatheter interventional occlusion in Chinese PLA General Hospital between May 2009 to May 2015 were retrospectively analyzed. Their clinical features, interventional treatment protocols, and occurance of postoperative complications were studied. Results Among the 6 patients, VSR were successfully occluded in 5 patients. One patient failed the operation due to instability of occluder after it was deployed and the occluder was retrieved. The paitents died of heart failure 6 months later. Among the 5 patients with successful closure, 4 patients presented mild residual shunt after occlusion and acute left heart failure occurred in 1 patient after operation. Two patients died during hospital stay after operation. Between them, one patient died 3 hours after operation because of cardiac tamponade and the other patient died of cardiogenic shock after withdrawal from IABP. Three patients were followed up until now and follow up echocardiography showed satisfactory cardiac function without heart failure. Conclusions Transcatheter occlusion was a reliable therapy for patients with ventricular septal rupture complicated in acute myocardial infarction which could improve cardiac function and reduce mortality.
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Objective To evaluate the efficacy and safety of interventional occlsu ion operait no by analyizn g thes urgical data of 23 csa es of infants with patent ductusa rteriosus complicated with middle and severe pulmo an ry arterial hypertension.Methods Teh 23 cases of infants wiht patne t ductus arteriosus com-plicated with middlea nd severe pulmonary arterial hypertensionw ere collected in the hospital from January 2011 to December2014 .These infatn s rce eived transcateh ter occlusion with intravenuo s anesthesia after the preoperative examination.The operation procse s included:right ventriculography and pulmonary atr ery pressure tested,then lateral angiogar phy of descending aorta was performed to observe the type and size of patent ud ctus atr eriosus and measure ascending aorta,descending aortic pressure,and recorded the pressure re-spectively.1 ml blood sample of ascending aorta,pulmonary artery and inef rior vena vein respectively was used for gas analysis.All these data was used to calculate pulmonary vascular resistance.After tried to plug-ging effectiveyl we can release the occluder.In the postoperative 24 h,1 month,3 months,the infants should be measured with Doppler echocardiography,chest X ray and electrocardiogram examination.Results The clinical symptoms disappeared and the short-term follow-up was not associated with the complications of interventional therapy.Th e comparison of the pressure changes before and after the operation were performed as following, aortic per ssure decreased [ preoperation ( 68.3 ±17.5 )/( 21.4 ±3.7 ) mmHg, postoperation (52.4 ±8.7)/(15.6 ±3.5) mmHg,1 mmHg=0.133 kPa],ascending aorta pressure increased(preoperation (83.5 ±5.9)/(51.3 ±3.6) mmHg,postoperation(88.2 ±5.1)/(52.4 ±2.7) mmHg),and descending aorta pressure increased ( preoperation ( 81.4 ±3.3 )/( 48.2 ±2.7 ) mmHg, postoperation ( 86.5 ±4.7 )/(51.5 ±3.2) mmHg), the differences were statistically significant before and after surgery ( t =5.455/3.945 ,P<0.01;t=-2.696/-1.193 , P<0.05; t=-4.167/-3.745 , P<0.01 ) .Conclusion Under conditions of mastering the appropriate operation time and strengthening the management of the perioperative management,transcatheter measurement is safe and effective for infants with patent ductus arteriosus compli-cated with middle and severe pulmonary arterial hypertension.
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Objective To investigate the interventional treatment strategy for occluding the intercristal ventricular septal defect (VSD) in order to improve the surgical safety and success rate. Methods During the period from January 2012 to December 2013, a total of 31 patients with intercristal VSD were admitted to authors’ hospital to receive interventional catheter occlusion therapy. Preoperative color Doppler ultrasound echocardiography showed that on the short axis view of the aorta the VSD interrupted port was situated at 12:00 - 1:00 o’clock region. Left ventricular and above aortic valve angiography indicated that the VSD location, shape and size, the split vent size on the left ventricle side and its distance from the aortic valve could be correctly measured when the VSD shunt was visualized , which were very helpful in guiding the operator to select the suitable occluder as well as to adjust the release pattern of the occluder. Postoperative imaging findings of the left ventricular and above aortic valve angiography were compared with the preoperative ones. Results Successful occlusion of VSD was obtained in 22 patients , in 13 among them the left ventricular angiography showed that the direction of blood flow beam at the defect hole was from the left ventricle to the right ventricle in an obliquely upward direction. The basal width of the defect on the left ventricle side was (5.12 ± 1.38) mm, and(6 - 10) mm occluder was employed. In the remaining 9 patients the left ventricular angiography showed that the direction of blood flow beam at the defect hole was from the left ventricle to the right ventricle in a direction almost parallel to the aortic valve , and the basal width of the defect on the left ventricle side was (7.18 ± 1.26) mm, and (9 - 12) mm zero-bias occluder was adopted. Interventional occlusion of VSD was unsuccessful in 9 cases as the intercristal hole was rather larger, and two of them had coexisting aortic sinus aneurysm complicated by mid-to-severe degree aortic valve regurgitation. Conclusion Based on the precise analysis of angiographic images by experienced radiologists optimal treatment scheme can be worked out. If conditions permit, symmetrical occluder should be employed so far as possible in order to reduce the degree of operation difficulty and improve the surgical safety and the success rate as well.