Peratrial Balloon Pulmonary Valvotomy in Infants: Right Ventricular Wall None-Touch Technique.

Peratrial balloon pulmonary valvotomy, an alternative technique for severe pulmonary valve stenosis (PVS) in infants, performed exclusively under transesophageal echocardiographic guidance, is hereby described. The technique is performed using a hollow probe through a right minithoracotomy in the fourth intercostal space. The hollow probe introduces a guidewire through the PVS without touching the right ventricular wall, therefore avoiding eliciting ventricular arrhythmias, spasm of the right ventricular outflow tract, and subsequent hemodynamic instability. Unlike conventional approaches, the peratrial technique permits quicker orientation and dilatation and allows quick conversion to open heart surgery when needed.

Percardiac closure of large apical ventricular septal defects in infants: Novel modifications and mid-term results.

BACKGROUND/AIM: Both open heart surgery and percutaneous approaches retain several limitations in closing large apical muscular ventricular septal defects (AmVSD) in infants. We present probe-assisted percardiac device closure (PDC), an exclusively transoesophageal-echocardiography guided technique, as an alternative with midterm results. METHODS: Thirty-six infants with large AmVSDs (single or multiple-holed) underwent PDC in our department. Mean AmVSD for single and multiple-holed measured 7.2 ± 2.4 mm and 6.3 ± 3.4 mm, respectively. Subjects presented with a spectrum of cardiopulmonary sequelae and growth retardation, either alone or combined. Some were ventilator dependent and re-do cases. In addition, AmVSDs were categorized: cylindrical, tunnel and cave-like shaped as per color Doppler interrogation. Pursuant to cardiac access and deployment technique, subjects were apportioned: group A; inferior median sternotomy (perventricular), B; right mini-thoracotomy (peratrial) and C; complete median sternotomy (perventricular). Under exclusive echocardiography, the Z- or J probe-assisted delivery system was utilized to access AmVSDs and implant device(s) via aforementioned techniques. RESULTS: Forty-two muscular ventricular septal devices (8.4 ± 2.6 mm) were implanted in 36 subjects uneventfully. Seventeen "complex," and 10 cylindrical or straight tunnel-shapedAmVSDs (including 2 re-do patients) suited perventricular and peratrial techniques respectively. Comparatively, group B exhibited shorter procedural indices than A (p < .01). Five of 15 multiple-holed AmVSDs (four Swiss cheese) required two or three devices for a satisfactory occlusion. Nevertheless, post occlusion insignificant residual shunts( ≤ 2 mm) seldom achieved spontaneous closure, and at 36-month follow-up complete closure was 67%. Residual shunt persisted amongst multiple-holed. All patients improved during follow up. CONCLUSION: PDC is feasible, safe and effective alternative technique for AmVSD in infants.

Comparision between indocyanine green fluorescence-guided lumpectomy of nonpalpable breast cancer and ultrasound-guided excision / 中国医师进修杂志

Objective:To date, a vast array of localization techniques for excisions of nonpalpable breast cancer (NBC) is available, but the best choice remains unclear. Although ultrasound localization (US) is a widely available and feasible tool, it has several disadvantages for excisions of NBC. The purpose of this study was to evaluate the use of indocyanine green-guided nonpalpable breast cancer lesion localization (INBCL) and to compare it with US.Methods:The clinical data of 78 consecutive patients who underwent breast-conserving surgery for NBC in Dalian Central Hospital from January 2014 to December 2019 were prospectively reviewed the. Of all 78 excision.42 (53.8%) were localized by INBCL and 36 (46.1%) by US. Patients with preoperatively diagnosed primary ductal carcinoma in situ and multifocal disease were excluded from the study.Results:Both techniques resulted in 100.0% retrieval of the lesions. The rate of clear margins was 90.5% (38/42) in the INBCL group compared to the 83.3% (30/36) in the US group ( P>0.05). The margin width at first excision for both INBCL and US series of patients was compared. In the INBCL series, 92.9% (39/42) of cases had a margin less than 5 mm, whereas for US series it was 72.2% (26/36)( P<0.05). When results of the excised tissue were taken into account, the mean specimen volume for INBCL was 58 cm 3, wheres for US excision it was larger at 73 cm3,but there was not significantly different ( P = 0.058). Conclusions:INBCL for NBCs is more accurate than US, because a smaller volume of the tissue may be excised by using the technique, without compromising margin status in nonpalpable lesions. Therefore INBCL is an attractive alternative to US.

The application value of indocyanine green combined with methylene blue in sentinel lymph node biopsy of breast cancer / 中国医师进修杂志

Objective:To evaluate the potential value of indocyanine green combined with methylene blue and methylene blue alone in the detection of sentinel lymph nodes (SLN) in breast cancer.Methods:The clinical data of 118 patients with early breast cancer from November 2016 to October 2018 in Dalian Central Hospital Affiliated to Dalian Medical University were retrospectively analyzed. Among them, 62 patients underwent SLN biopsy under methylene blue (methylene blue group, 160 SLN), and 56 patients underwent SLN biopsy under indocyanine green combined with methylene blue (combined group, 190 SLN). After SLN biopsy, patients underwent grade Ⅰ and Ⅱ axillary lymph node dissection.Results:There was no significant difference in the positive lymph node rate and accuracy rate between 2 groups ( P>0.05); the SLN dyeing rate and SLN biopsy positive rate in combined group were significantly higher than those in methylene blue group: 97.9% (186/190) vs. 93.1% (149/160) and 28.4% (54/190) vs. 18.1% (29/160), and there were statistical differences ( P<0.05); the false negative rate in combined group was lower than that in methylene blue group: 5.3% (3/57) vs. 14.7% (5/34), but there was no statistical difference ( P>0.05). Conclusions:In breast cancer patients, the dual -tracing method of indocyanine green combined with methylene blue is better than using methylene blue alone in identifying SLN and predicting the status of axillary lymph nodes, and it has a tendency to reduce the false negative rate.

Temperature significant change COVID-19 Transmission in 429 cities

BackgroundThere is no evidence supporting that temperature changes COVID-19 transmission. MethodsWe collected the cumulative number of confirmed cases of all cities and regions affected by COVID-19 in the world from January 20 to February 4, 2020, and calculated the daily means of the average, minimum and maximum temperatures in January. Then, restricted cubic spline function and generalized linear mixture model were used to analyze the relationships. ResultsThere were in total 24,139 confirmed cases in China and 26 overseas countries. In total, 16,480 cases (68.01%) were from Hubei Province. The lgN rose as the average temperature went up to a peak of 8.72{degrees}C and then slowly declined. The apexes of the minimum temperature and the maximum temperature were 6.70{degrees}C and 12.42{degrees}C respectively. The curves shared similar shapes. Under the circumstance of lower temperature, every 1{degrees}C increase in average, minimum and maximum temperatures led to an increase of the cumulative number of cases by 0.83, 0.82 and 0.83 respectively. In the single-factor model of the higher-temperature group, every 1{degrees}C increase in the minimum temperature led to a decrease of the cumulative number of cases by 0.86. ConclusionThe study found that, to certain extent, temperature could significant change COVID-19 transmission, and there might be a best temperature for the viral transmission, which may partly explain why it first broke out in Wuhan. It is suggested that countries and regions with a lower temperature in the world adopt the strictest control measures to prevent future reversal.

Efficacy of percutaneous intervention for patent ductus arteriosus guided by transesophageal echocardiography in obese teenagers / 中国胸心血管外科临床杂志

@#Objective    To explore the safety and efficacy of transesophageal echocardiography (TEE)-guided percutaneous intervention for patent ductus arteriosus (PDA) in obese teenagers. Methods    From January 2018 to June 2019, 21 obese teenagers with PDA treated with femoral artery occlusion guided by TEE in the Department of Cardiac Surgery, Dalian Children's Hospital of Dalian Medical University were included in this study, including 13 males and 8 females aged 12.8-17.3 (15.1±1.7) years, with an average weight of 51.0-89.0 (73.4±10.1) kg. The operative effect was evaluated. Results    All patients successfully received the surgery, and none was changed to radiation-guided or thoracotomy ligation. The average operating time was 23.9±6.8 min, the average postoperative hospitalization time was 3.8±0.6 d. No peripheral vascular injury, intracardiac infection or pericardial effusion occurred. The mean follow-up time was 19.5±4.9 months, and the results of all reexaminations were good. Conclusion    For some PDA children with obesity, emphysema or thoracic malformation, it is difficult to block PDA by transthoracic ultrasound-guided percutaneous intervention, and TEE can avoid the interference of chest wall and lung qi, or other factors. It is an effective supplementary guidance method worthy of promotion.

Device closure of diverse layout of multi-hole secundum atrial septal defect: different techniques and long-term follow-up.

BACKGROUND: There are no unanimous reports on different layouts and classifications of multi-hole secundum atrial septal defects (MHASD) and subsequent standardized occlusion techniques. The MHASD can be isolated or cribriform with variable inter-defects distance. In this retrospective study, experience-based classification and two approaches-based occlusion results are presented. METHODS: We retrospectively collected and analyzed data of 150 MHASD patients from 1320 patients who underwent atrial septal defect occlusion in our institute. The MHASD patients were categorized into 4 types; type A, B, C and D and occluded under exclusive transesophageal echocardiographic guidance. According to different types, 122 patients were occluded using peratrial approach and 28 patients via percutaneous approach. In type A, single device implantation is performed to occlude the large hole and squeeze the small one. For type B single or double-device deployment was performed depending on an inter-defects distance. In type C and D, a patent foramen-ovale (PF) device was selectively positioned to the central defect to occlude the central defect and cover the peripheral ones. In peratrial approach, 8 patients underwent inter-defects septal puncture technique to achieve single-device occlusion. The intracardiac manipulation time, procedural time, double device deployment, redeployment rate, residual shunt, and proportions were analyzed between (and within peratrial technique) two techniques. RESULTS: Successful occlusion was achieved in all 150 patients. Single device occlusion was applied in 78/84 type A and 22/37 type B patients (p < 0.05). Double device occlusion was more applicable to type B than A patients (p < 0.01). Sixteen of 21 type C and all type D patients used PF device for a satisfactory occlusion. Redeployment of the device occurred frequently in type B patients than A (p < 0.01). The intracardiac manipulation time and procedural time were shorter in type A than B (p < 0.05). The intracardiac manipulation time was also shortened in type A peratrial than type A percutaneous group (p < 0.05). Complete occlusion rate for all patients at discharge was 70% and rose to 82% at 1 year follow up. CONCLUSIONS: The diverse layouts and classification of MHASDs can help to choose different techniques and proper devices of different kinds to achieve better occlusion results.

Peratrial Device Closure of Ruptured Sinus of Valsalva Aneurysm Into Right Atrium.

An alternative peratrial device closure technique for ruptured sinus of Valsalva aneurysm into the right atrium under exclusive transesophageal echocardiographic guidance is presented. The ruptured site was occluded with a hollow probe-assisted delivery system through a fourth intercostal mini-incision. The peratrial approach provided perfect alignment and positioning for device deployment to avoid device impingement on the aortic valve. This technique may help a certain number of patients, especially those patients with a prior history of radiocontrast media allergy.

Metformin treatment of antipsychotic-induced dyslipidemia: analysis of two randomized, placebo-controlled trials / 中南大学学报(医学版)

To examine the efficacy and safety for metformin in treating antipsychotic-induced dyslipidemia.
 Methods: Two randomized placebo-controlled trials were included in the analysis. A total of 201 schizophrenia patients with dyslipidemia after treatment with an antipsychotic were collected, and the patients were divided into two groups: a 1 000 mg/d metformin group (n=103) and a placebo group (n=98). The clinical symptoms and metabolic indicators such as body weight, blood glucose, and blood lipids were assessed at baseline, the 12th week and the 24th week after treatment respectively.
 Results: After metformin treatment, the mean difference in the low-density lipoprotein cholesterol (LDL-C) value between the metformin group and the placebo group was from 0.16 mmol/L at baseline to -0.86 mmol/L at the end of the 24th week, which was decreased by 1.02 mmol/L 
(P<0.01). At the 24th week, the LDL-C was more than 3.37 mmol/L in 25.3% patients in the metformin group, which was significantly lower than that in the placebo group (64.8%) (P<0.01). Compared with the placebo group, there were significant changes in the weight, body mass index (BMI), insulin, insulin resistance index, total cholesterol and triglyceride, and high-density lipoprotein cholesterol (HDL-C) in the metformin group (all P<0.05). The treatment effects on weight and insulin resistance appeared at the 12th week and further improved at the 24th week, but the effects on improving dyslipidemia only significantly occurred at the end of the 24th week.
 Conclusion: The metformin treatment is effective in improving antipsychotic-induced dyslipidemia and insulin resistance, and the effect to reduce the antipsychotic-induced insulin resistance appears earlier than the effect to improve dyslipidemia.

Clinical characteristics of papillary thyroid microcarcinoma less than or equal to 5 mm / 中国医师进修杂志

Objective To summarize the clinical characteristics of papillary thyroid microcarcinoma with diameter ≤ 5 mm. Methods The clinical data of 259 papillary thyroid microcarcinoma patients who had underwent radical thyroidectomy from January 2015 to December 2017 were retrospectively analyzed. The patients were divided into 2 groups according to the preoperative tumor diameter: ＞5 mm group (88 cases) and ≤ 5 mm group (171 cases); then according to the lymph node metastasis, the 2 groups were divided into non-lymph node metastasis sub-group and lymph node metastasis sub-group. The reason of lymph node metastasis was analyzed. Results There were no statistical difference in gender composition, age and combined Hashimoto thyroiditis rate between ＞5 mm group and≤5 mm group (P＞0.05). The rates of T3-4 stage, N1a-1b stage and multifocal tumors in＞5 mm group were significantly higher than those in ≤ 5 mm group: 34.1% (30/88) vs. 18.7% (32/171), 45.5% (40/88) vs. 22.8% (39/171) and 39.8% (35/88) vs. 22.8% (39/171), and there were statistical differences (P＜0.05 or＜0.01). In＞5 mm group, lymph node metastasis sub-group had 40 cases, non-lymph node metastasis sub-group had 48 cases; the rate of T3-4 stage in lymph node metastasis sub-group was significantly higher than that in non-lymph node metastasis sub-group: 55.0% (22/40) vs. 16.7% (8/48), and there was statistical difference (P＜0.01). In≤5 mm group, lymph node metastasis sub-group had 39 cases, and non-lymph node metastasis sub-group had 132 cases; the rate of T3-4 stage in lymph node metastasis sub-group was significantly higher than that in non-lymph node metastasis sub-group:51.3% (20/39) vs. 9.1% (12/132), and there was statistical difference (P＜0.01). In＞5 mm group and≤5 mm group, there were no statistical difference in gender composition, age, combined Hashimoto thyroiditis rate and multifocal tumors rate between 2 sub-groups (P＞0.05). Conclusions The clinical behavior of papillary thyroid microcarcinoma with diameter ≤ 5 mm has a less aggressive nature compared to that＞5 mm. Tumor capsular invasion or extra thyroidal extension has a great influence on lymph node metastasis in thyroid papillary microcarcinoma of different diameter.

Peratrial Device Closure of Different Locations of Mitral Paravalvular Leaks.

BACKGROUND: The current approaches of transcatheter closure of mitral paravalvular leak (MPVL) have different drawbacks. The challenges come from transseptal puncture, accessing the MPVL site, and the absence of dedicated delivery systems. This study introduces a novel peratrial approach for device closure of different locations of MPVLs using a probe-assisted delivery system under three-dimensional transesophageal echocardiography. METHODS: A 4.0-cm minithoracotomy incision was made in the fourth right interspaces. The right atrium and the interatrial septum were punctured and dilated, followed by a guidewire passing through the septum. A specially designed J-shaped bendable hollow probe was advanced into the left atrium. The steerable probe was adjusted to cross the MPVL and introduced a stiff guidewire into the left ventricle. A 7F short delivery sheath was advanced over the wire through the MPVL into the left ventricle. A proper-sized muscular septal occluder was then selected and deployed. RESULTS: Transesophageal echocardiography revealed complete occlusion in 7 of 8 patients after a follow-up of 6 months to 4 years. Mild residual paravalvular regurgitation occurred in an early patient. In 2 patients with a crescent-shaped MPVL, two guidewires were advanced into the left ventricle across the leak, and double devices were deployed sequentially. All patients' symptoms improved by at least one New York Heart Association functional class. CONCLUSIONS: The peratrial technique can access and close MPVLs at different locations through a right minithoracotomy approach. This technique has the advantages of easy transseptal puncture, easy access to the MPVL site, and no exposure to radiation.

The risk of bladder cancer in patients with urinary calculi: a meta-analysis.

The objective of this meta-analysis was to evaluate the association between a history of urinary calculi (UC) and the risk of bladder cancer (BC). A literature search was performed from inception until July 2017. Studies that reported odds ratios (OR), relative risks or hazard ratios comparing the risk of BC in patients with the history of UC vs those without the history of UC were included. Pooled odds ratios and 95% confidence interval (CI) were calculated using a random-effect or fixed-effect method. Thirteen studies were included in our analysis to assess the association between a history of UC and risk of BC. The pooled OR of BC in patients with UC was 1.87 (95% CI, 1.45-2.41). Bladder calculi [OR, 2.17 (95% CI, 1.52-3.08)] had a higher risk of BC than kidney calculi [OR, 1.39 (95% CI, 1.06-1.82)]. The subjects had a history of UC that was associated with increased BC risk both in males [OR, 2.04 (95% CI, 1.41-2.96)] and in females [OR, 2.99 (95% CI, 2.37-3.76)]. The subgroup analysis demonstrated that UC increasing risk of BC both in case-control studies [OR, 1.75 (95% CI, 1.25-2.45)] and cohort studies [OR, 2.27 (95% CI, 1.55-3.32)]. The pooled OR of BC risk in patients with UC were 1.60 (95% CI, 1.15-2.24) in America, 1.36 (95% CI, 1.14-1.64) in Europe and 3.05 (95% CI, 2.21-4.21) in Asia, respectively. Our study demonstrates a significant increased risk of BC in patients with prior UC. This finding suggests that a history of UC is associated with BC and may impact clinical management and cancer surveillance. Further studies still needed to confirm the findings.

rotective effect of bone marrow mesenchymal stem cells-derived exosomes against testicular ischemia-reperfusion injury in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the protective effect of bone marrow mesenchymal stem cells (BMSCs)-derived exosomesagainst testicular ischemia-reperfusion injury (IRI) in rats.</p><p><b>METHODS</b>Rat BMSCs were isolated, cultured and identified in theprimary culture. The exosomes were extracted from the BMSCs and characterized using nanoparticle tracking analysis, transmission electron microscopy, and Western blotting. Twenty-four healthy male SD rats were randomly divided into shamoperation group, testicular IRI with saline treatment group and IRI with exosome treatment group. The contralateral testes ofthe rats were collected for pathological observation, aseessment of superoxide dismutase (SOD) and malondialdehyde (MDA), and detection of HMGB1, caspases-3 and cleaved caspase-3 expressions using Western blotting.</p><p><b>RESULTS</b>We successfullyobtained exosomes from rat BMSCs. Testicular IRI significantly impaired testicular spermatogenesis, which was markedlyimproved by treatment with the exosomes ( < 0.05). Testicular IRI also caused significant increase in the protein expression ofHMGB1, caspase-3 and cleaved caspase-3 in the testicular tissue, and treatment with the exosomes obviously amelioratedthese changes ( < 0.05).</p><p><b>CONCLUSIONS</b>BMSCs-derived exosomes protects against testicular IRI due to the anti-oxidant, antiinflammatory and anti-apoptosis activities of the exosomes.</p>

Perventricular double-device closure of wide-spaced multi-hole perimembranous ventricular septal defect.

BACKGROUND: Device closure of a wide-spaced multi-hole PmVSD is difficult to succeed in percutaneous approach. This study is to evaluate the feasibility, safety and efficacy of perventricular device closure of wide-spaced multi-hole PmVSD using a double-device implanting technique. METHODS: Sixteen patients with wide-spaced multi-hole PmVSD underwent perventricular closure with two devices through an inferior median sternotomy approach under transesophageal echocardiographic guidance. The largest hole and its adjacent small holes were occluded with an optimal-sized device. The far-away residual hole was occluded with the other device using a probe-assisted delivery system. All patients were followed up for a period of 1 to 4 years to determine the residual shunt, atrioventricular block and the adjacent valvular function. RESULTS: The number of the holes of the PmVSD was 2 to 4. The maximum distance between the holes was 5.0 to 10.0 mm (median, 6.4 mm). The diameter of the largest hole was 2.5 to 7.0 mm (median, 3.6 mm). The success rate of double-device closure was 100%. Immediate residual shunts were found in 6 patients (38%), and incomplete right bundle branch block at discharge occurred in 3 cases (19%). Both complications decreased to 6% at 1-year follow-up. Neither of them had a severe device-related complication. CONCLUSIONS: Perventricular closure of a wide-spaced multi-hole PmVSD using a double-device implanting technique is feasible, safe, and efficacious. In multi-hole PmVSDs with the distance between the holes of more than 5 mm, double-device implantation may achieve a complete occlusion.

Peratrial Device Closure of a Congenital Coronary Artery Fistula through a Right Parasternal Approach: Innovative Use of Available Technology.

Current treatments for congenital coronary artery fistulas (CAFs) include surgical obliteration and transcatheter occlusion. However, surgical techniques involve significant trauma. Transcatheter occlusion is performed under fluoroscopy and angiography, in which radiation injury is inevitable. We present a patient, with a CAF from the left coronary artery to the right atrium, who underwent peratrial device closure of the CAF with a right parasternal approach under transesophageal echocardiography guidance. Complete occlusion was achieved by a symmetric ventricular septal occluder. We suggest that peratrial device closure of a congenital coronary artery fistula through a right parasternal approach may be a safe and effective option.

Comparison of postoperative analgesia between transversus abdominis plane block and caudal block for Hirschsprung??s disease / 临床麻醉学杂志

Objective To compare the analgesia effect of transversus abdominis plane(TAP) block and caudal block after radical surgery of Hirschsprung’s disease.Methods Sixty pediatric pa-tients,52 males,8 females,aged 1-3 yr,of ASA physical status Ⅰ or Ⅱ,scheduled for elective rad-ical surgery on Hirschsprung’s disease,were equally randomized into TAP block group(group TAP) and caudal block group (group CA).0.2% ropivacaine 1 ml/kg was used in both blocks.FLAAC scores were measured at 6,12,18 and 24 h after surgery.The requirement of sufentanil every 6 h, the first passage of flatus,the time of removing urine tube and the incidence of nausea and vomiting within 24 hours were recorded.Results Compared with group TAP,FLAAC scores and the require-ment of sufentanil were significantly decreased at 6 h after operation in group CA(P <0.05).FLAAC scores and the requirement of sufentanil were similar at 12,18 and 24 h in the two groups.The first passage of flatus,the time of removing urine tube in group TAP were significantly shorter than group CA(P < 0.05 ).The incidence of nausea and vomiting were not significantly different in the two groups.Conclusion Although both TAP block and caudal block can provide effective analgesia for the pediatric patients after radical surgery on Hirschsprung’s disease,caudal block provided superior anal-gesia at early stage after operation,however,TAP block is more beneficial for earlier recovery of bowl function.

Perventricular device closure of a doubly committed juxtaarterial ventricular septal defect through a left parasternal approach: midterm follow-up results.

BACKGROUND: It is infeasible to occlude a doubly committed juxtaarterial ventricular septal defect (DCVSD) percutaneously. The previous perventricular device closure technique was performed through an inferior median sternotomy approach. The purpose of this study is to evaluate the feasibility, safety and efficacy of perventricular device closure of DCVSDs through a left parasternal approach. METHODS: Sixty-two patients, with the DCVSD of less than 6 mm in diameter, were enrolled in this study. The pericardial space was approached through a left parasternal mini-incision without entering into the pleural space. Two parallel pursestring sutures were placed on the right ventricular outflow tract for puncture. Under transesophageal echocardiographic guidance, a new delivery sheath loaded with the device was inserted into the right ventricle and advanced through the defect into the left ventricle. The device, connected with a device stay suture, was deployed subsequently. RESULTS: Successful device closure of the defects was achieved in 58/62 patients (94 %). The DCVSD failed to close in 4 (6 %) patients due to device-related aortic regurgitation and device migration. The mean DCVSD diameter was 3.4 ± 1.0 mm (range, 2.0 to 6.0 mm). The implanted device size was 5.2 ± 1.3 mm (range, 4 to 8 mm). Forty-four out of 58 patients (76 %) was implanted with an eccentric occluder. The mean intracardiac manipulation time was 14 ± 13 min (range, 2 to 60 min). The procedure time was 66 ± 15 min (range, 42 to 98 min). During the follow-up period of 180 to 1860 (median 880) days, new mild pulmonary regurgitation occurred in 2 patients. No other device-related complications were found. The complete closure rate was 95 % at discharge, 98 % at 1-, 6- and 12-month, 96 % at 2-year, and 100 % at 3-year follow-up. CONCLUSIONS: Perventricular device closure of a DCVSD through a left parasternal approach is feasible, safe, and efficacious in selected patients. This minimally invasive technique permits easy defect crossing and accurate device positioning.

Peratrial device closure of perimembranous ventricular septal defects through a right parasternal approach.

BACKGROUND: Both percutaneous and perventricular device closures of perimembranous ventricular septal defects (PmVSDs) have drawbacks. This study evaluates the feasibility, safety, and efficacy of peratrial device closure of a PmVSD using a probe-assisted delivery system. METHODS: Seventy-three patients (peratrial group) were enrolled in this study. A 1.5- to 2.0-cm parasternal incision was made in the fourth right interspaces. A Z-shaped malleable hollow probe was inserted into the right atrium. Under transesophageal echocardiographic guidance, it was advanced through the tricuspid valve into the right ventricle. The tip of the probe was adjusted to point to or cross the defect. A flexible guidewire was sent to the left ventricle through the probe to establish a delivery pathway. Then the device was delivered and deployed. Seventy matched control patients, who underwent perventricular device closure of PmVSDs, were identified and assigned to the perventricular group. RESULTS: Successful device placement was achieved in 70 of 73 (96%) patients in the peratrial group. The minimal PmVSD diameter ranged from 2.0 to 7.0 mm (median, 3.0 mm). Although the intracardiac manipulation time was longer in the peratrial group, the procedural time and postoperative hospital stays were shorter than in the perventricular group (all p<0.01). During the follow-up period of 6 to 24 months, no significant device-related complication was found in either group. CONCLUSIONS: The peratrial device closure of PmVSDs is feasible, safe, and efficacious. Compared with the perventricular technique, it has the advantages of less trauma, shorter hospital stays and procedure time, and better cosmetic results.