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Objective:To evaluate the strategy and safety of the radiofrequency ablation (RFA) on ventricular arrhythmias (VAs) originating from the pulmonary sinus cusp (PSC) in pediatric patients.Methods:Retrospective study.Fifteen patients with VAs originating from the PSC who were intervened by RFA in the Department of Pediatric Cardiology, Guangdong Provincial People′s Hospital between March 2014 to July 2020 were enrolled.All the patients met the indication criteria for RFA in pediatric patients.The electrocardiogram, ablation method of ablation were analyzed.Different curved catheters were selected for RFA according to the age and weight of the patients.The catheter was then inserted in a " U" or inverted " P" shape to the PSC.The long-term effect of ablation were reviewed.Results:The mean age and body weight of 15 patients with VAs originating from the PSC were (11.6±2.6) (6-15) years and (39.9±12.2) (19-65) kg, respectively.The electrocardiogram recorded during VAs originating from the PSC showed left bundle branch block and inferior axis with monomorphic R pattern, as well as a QS-wave in aVR and aVL.The electrocardiogram characteristics varied in patients with VAs originating from the PSC.The ideal excitation point was not found in the right ventricular outflow tract or the ablation was unsuccessful in all patients, and the earliest target was mapped and RFA was successful.Among the 15 patients, the successful ablation site was in the lower regions of the PSC, involving the right cusp in 11 patients(73.3%), the anterior cusp in 3 patients(20.0%), and the left cusp in 1 patient(6.7%). The earliest potential recorded at the PSC ablation site preceded the QRS complex onset by (27.3±6.0) ms.During the follow-up period for (2.7±2.0) years, no recurrence of VAs or complications were recorded.Conclusions:Under the premise of gentle catheterization procedure and appropriate radiofrequency energy, ablation was effective, safe and with low recurrence rate to eradicate VAs originating from the PSC in children.
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Heart failure is a complex clinical syndrome characterized by the heart losing the function of effective blood-pumping and venous return,which will cause a series of symptoms,and its clinical manifestations vary with the age of children.The main causes of heart failure in children are congenital heart disease and cardiomyopathy.Drug therapy for heart failure in children has gained rapid progression recently with Sacubitril/valsartan being a typical one,which was approved by Food and Drug Administration (FDA) in October 2019 for its effective use in symptomatic left ventricular dysfunction in children aged 1 year and above,marking that the drug therapy for heart failure in children stands at a new starting point.Implantable cardioverter defibrillator and cardiac resynchronization therapy are applicable to some patients with indications.Mechanical circulatory support is essential in the treatment of patients with cardiopulmonary failure,including extracorporeal membrane oxygenation and ventricular assist device,which is used as an important transition of short-term circulatory assisted transplantation.Pediatric heart transplantation is a treatment option for end-stage heart failure.
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Heart failure is a complex clinical syndrome characterized by the heart losing the function of effective blood-pumping and venous return, which will cause a series of symptoms, and its clinical manifestations vary with the age of children.The main causes of heart failure in children are congenital heart disease and cardiomyopathy.Drug therapy for heart failure in children has gained rapid progression recently with Sacubitril/valsartan being a typical one, which was approved by Food and Drug Administration (FDA) in October 2019 for its effective use in symptomatic left ventricular dysfunction in children aged 1 year and above, marking that the drug therapy for heart failure in children stands at a new starting point.Implantable cardioverter defibrillator and cardiac resynchronization therapy are applicable to some patients with indications.Mechanical circulatory support is essential in the treatment of patients with cardiopulmonary failure, including extracorporeal membrane oxygenation and ventricular assist device, which is used as an important transition of short-term circulatory assisted transplantation.Pediatric heart transplantation is a treatment option for end-stage heart failure.
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Objective To evaluate the efficacy and safety of percutaneous balloon aortic valvuloplasty (PBAV) in retrograde,antegrade way or right ventricular pacing in children.Methods This was retrospective clinical study included 32 children who were treated with PBAV for congenital aortic stenosis from January 2008 to June 2017 in Guangdong Cardiovascular Institute.The general clinical data including residual stenosis and aortic stenosis again,and degree of artery injury,aortic regurgitation were particularly assessed.Results A total of 32 patients consisting of 27 boys and 5 girls underwent the procedure,with age of (55.8 ± 52.0) months (ranging from 20 days to 15 years) and body weight (18.2 ± 14.0) kg (ranging from 3.5 kg to 59.0 kg).Two infants accepted left cardiac catheterization through femoral vein and one with interventional indication then accepted PBAV through the patent foramen ovale.The others underwent the retrograde way,including 24 cases with rapid right ventricular pacing.The catheter-measured peak systolic the aortic valve gradient decreased from (81.6 ± 28.0) mmHg(1 mmHg =0.133 kPa) to (41.4 ± 19.0) mmHg immediately after percutaneous interventional treatment,and the difference was statistically significant (t =9.543,P =0.000).The peak systolic valve gradient mea-sured pre-PBAV and on the second day after PBAV measured by Doppler echocardiography decreased from (82.7 ±23.0) mmHg to (44.6 ± 18.0) mmHg,and the difference was statistically significant (t =11.732,P =0.000).The diameters of the aortic valve were (13.8 ± 3.0) mm(ranging from 6.5 mm to 21.0 mm) and the balloons were (14.1 ±4.0) mm(ranging from 6 mm to 23 mm).The follow-up period was 1 to 72 months.The peak systolic valve gradient measured by Doppler echocardiography increased from (44.6 ±18.0) mmHg to (58.6 ± 30.0) mmHg,and the difference was statistically significant (t =-2.549,P =0.016).During the procedure,5 children (14.7％) accepted surgery for restenosis or regurgitation.Seven had regurgitation,one had femoral artery embolism and one died on the second day after the procedure.Conclusions With the diversification of procedures and the continuous improvement of interventional devices,PBAV can play a very good role in alleviating congenital aortic stenosis in children,and the safety has been continuously improved.
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Objective To evaluate the safety and efficacy of percutaneous closure for muscular ventricular septal defect(MVSD).Methods Fifty-one patients diagnosed as MVSD from October 2011 to July 2016 at Guangdong General Hospital were enrolled including 32 males and 19 females,ranging from 1 to 16 (5.12 ±3.52) years in age,weight (20.19 ± 10.55) kg.The diameter of the MVSD was (4.82 ± 2.51) mm which was measured by transthoracic echocardiography (TTE),and multiple defects were found in 10 patients.The choice of plugging device and transport system depended on the size,position and status of MVSD.TTE and left ventricular (LV) angiography were performed before and after release of the device to evaluate the therapeutic effects.Electrocardiogram and TTE were performed during follow-up period at 24 h,1 month,3 months,6 months and 12 months after operation and yearly thereafter.Results Eight cases showed no hemodynamic significance through standard catheter examination then the interventional therapy was stopped.Cardiac arrest was found in 1 case when the long sheath was transported along the track,and the procedure was terminated immediately,and the selective surgical operation was performed after successful rescue.The devices were successfully placed in the rest of 42 patients (97.6％) with operation time (90.68 ± 36.42) min and fluoroscopy time (18.67 ± 10.89) min.The average of follow-up time was (13.82 ± 13.84) months ranging from 1 to 48 months.It was found that mild residual shunts showed in 4 cases during operation,mild tricuspid regurgitation showed in 2 cases and trivial aortic regurgitation showed in 1 case at 6 months after operation,but there was no need to intervene anymore.Conclusions Percutaneous closure of MVSD in children is safe and effective with high successful rate and low incidence of complication.The middle-term follow-up findings were satisfactory.
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[ ABSTRACT] AIM:To investigate the characteristics of the intestinal microbial flora in the pregnant women with congenital heart disease fetus ( PW group) and normal pregnant women ( NW group) .METHODS: Stool samples were collected from 15 NW and 17 PW cases.The bacterial genomic DNA was extracted.The 16S rDNA was amplified by PCR, and the second generation of Illumina sequencing was conducted.RESULTS: We obtained 2 696 276 ( NW group) and 2 445 530 ( PW group) optimized sequences.The coverage was greater than 97%.We obtained 77 243 operational taxono-mic units ( OTUs) in NW group and 75 600 OTUs in PW group after a 97%similarity merge.In NW group, the Chao 1 in-dex and the Shannon index were greater than those in PW group.The diversity analysis of microbial population indicated that they were mainly composed of Firmicutes, Proteobacteria and Actinobacteria.In family, the Bifidobacteriaceae and Cori-obacteriaceae were significantly different through analysis of variance.CONCLUSION: The Bifidobacteriaceae and Cori-obacteriaceae may play an important role in the occurrence of congenital heart disease.
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Objective To study the prevalence and risk factors of heart conduct block after transcatheter closure of ventricular septal defect (VSD)surgery. Methods A total of 1 069 cases underwent transcatheter closure VSD were retrospectively analyzed. The risk factors were assessed by multivariable logistical analysis. Results The median follow-up time was 2.2 (1 to 4.16) years. The early post-procedure heart conduct block was 20.5 %(219 cases), and 35 cases underwent severe conduct block (3.3%). During the follow-up, there were 43 late onset heart conduct block (4.0%), including 4 (0.4%) complete atrioventricular block. Multivariable logistic analysis showed that implanted of asymmetrical occluder from foreign company was the risks factors for early onset severe conduct block, with longer procedure time. Placement of thin-waist-big-side occluder were risk factor for the late onset conduct block. Conclusions Heart conduct block after transcatheter closure VSD is common , light and recovery. The late onset severe conduct block is minor. Symmetrical occluder should be chosen in transcatheter closure VSD if possible.
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Objective To make a comparison of transthoracic echocardiography (TTE) and cardiac multi-slice spiral computed tomography (MSCT) in the diagnosis of partial anomalous pulmonary venous connection (PAPVC) in children.Methods One hundred and one patients admitted from February 2008 to April 2014 in Guangdong General Hospital primarily diagnosed with PAPVC with or without other congenital heart diseases were analyzed retrospectively,all the cases underwent routine TTE,which 74 cases underwent cardiac MSCT examination,and the TEE and cardiac MSCT diagnosis results were compared with final surgical findings,then the TTE and cardiac MSCT diagnosis accuracy was calculated.SPSS 13.0 software was used to analyze the data.Results All the patients underwent TTE examination,meanwhile,74 cases received cardiac MSCT examination.Ninety-three cases were confirmed by surgical findings,while 8 cases were misdiagnosed with PAPVC.Sixty-eight cases diagnosed by TTE coincided with surgical findings,and the diagnosis accuracy was 73.12％ (68/93 cases);65 cases diagnosed by cardiac MSCT coincided with surgical findings,and the diagnosis accuracy was 94.20％ (65/69 cases).Among the patients who received both TTE and cardiac MSCT examinations,66 cases were confirmed through final surgical operation,2 cases were mis-diagnosis,so the diagnosis accuracy was 97.06％ (66/68 cases).Conclusions In terms of the diagnosis accuracy of PAPVC,cardial MSCT examination is superior to TTE,as almost all of the cases could be diagnosed by TTE combined with cardial MSCT.In consideration of the acoustics window of children,apart from the conventional parasternal approach of detecting pulmonary veins,the importance of suprasternal and subcostal views should also be attached.
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Objective To analyze the causes of failed transcatheter closure for ventricular septal defects (VSD)in children. Methods One thousand two hundred and eighty children aged 13 to 141 months who underwent transcatheter closure from June 2009 to September 2013 in Guangdong General Hospital were selected. There were 43 failures(3. 36% ). The clinical data including transthoracic echocardiograph( TTE),radiography,interventional ap-proach and surgical findings were analyzed. Results Forty - three patients included 25 male and 18 female. The pa-tients' ages ranged from 13 to 141(43. 0 ± 31. 9)months and their weight ranged from 10 to 35(16. 3 ± 5. 59)kg. The causes of failure including doubly committed subarterial VSD misdiagnosed as perimembranous VSD(PMVSD)or intracristal VSD were in 6 patients. The size of occluder was too small in 13 cases,and there were statistical differences between three measurements of size of VSD(F = 19. 134,P = 0. 001). The size of VSD measured by left ventricular an-giography was significantly smaller than that measured by TTE,and there was statistical difference[(4. 78 ± 1. 11) mm vs(6. 48 ± 1. 43)mm,t = 4. 50,P = 0. 001]. The dimension of VSD measured by left ventricular angiography was significantly smaller than that measured by surgical findings,and there was statistical difference[(4. 78 ± 1. 11) mm vs(7. 02 ± 1. 08)mm,t = 5. 92,P = 0. 001]. But,the size of VSD measured by TTE had no significant difference compared with that measured by surgical findings(t = 1. 42,P = 0. 168). Aortic regurgitation occurred in 14 cases;atrioventricular block or left bundle branch block in 3 patients;tricuspid stenosis in 2 cases and residual shunt in 5 pa-tients. Conclusions Doubly committed subarterial VSD may be misdiagnosed as PMVSD or intracristal VSD. In the ca-ses of VSD concomitant with aortic valve prolapse,size of the occluders should be referred to VSD dimensions measured by TTE. In the cases of VSD adjacent to aortic valve,suitable occluders should be selected and operation technique should be improved to avoid aortic regurgitation.
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Objective To analyze the incidence of complications during and after interventional therapy for common con-genital heart disease (CHD) in children. Methods From January 2011 to December 2013, interventional therapy of common congenital heart disease which include ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA) and pulmonary valve stenosis (PS) were performed in 2356 patients. Among them, 159 patients who developed complications during and post to interventional therapy were retrospectively analyzed. Results The overall complication rate was 6.75%(159/2356) (11.40% post VSD occlusion, 7.50% post ASD occlusion, 3.09% post PDA occlusion, 1.63% post percutaneous balloon pulmonary valvuloplasty (PBPV) ).The rate of arrhythmia was 4.41%(102/2356). The severe complication rate was 2.71%(64/2356) (3.62%post VSD occlusion, 2.21%post ASD occlusion, 2.53%post PDA occlusion, 1.63%post PBPV). The intraoperative severe complication rate was 0.51%(12/2356);the early severe complication rate was 1.99%(47/2356);the late severe complication rate was 0.21%(5/2356). Interventional therapy rate was 0.13%(3/2356); cardiovascular surgery rate was 0.64%(15/2356);conservative treatment rate was 1.95%(46/2356). The mortality rate was 0.08%(2/2356). Conclusions The complications and mortality rate of interventional therapy for CHD in children are relatively low, but cannot be ignored. The complication could be reduced by choosing proper indications, following the operational procedures and careful operative follow-up.