Transcatheter Closure of Perimembranous Ventricular Septal Defects Using Dual Wire-Maintaining Technique.

OBJECTIVE: The present study was designed to evaluate the safety and feasibility of transcatheter closure of perimembranous ventricular septal defects (PmVSDs) with dual wire-maintaining technique (DWMT). PATIENTS/METHODS: From January 2010 to December 2013, a total of 241 patients (men: 109, women: 132; mean age: 22.2±15.4 years) with congenital PmVSDs were randomised to either the conventional technique (CT) group (n=118) or the DWMT group (n=123). RESULTS: In the CT group, the track wire was withdrawn before occluder insertion. In the DWMT group, the track wire was maintained in the delivery sheath during the procedure. Both the procedure time and fluoroscope time were reduced significantly in the DWMT group patients who required device replacement compared with CT group patients (median time: 46.0±14.8min vs. 56.0±15.2min, p<0.05; 15.0±11.6min vs. 22.0±10.1min, p<0.05). There was no difference in the incidence of complications between the two groups. CONCLUSION: The DWMT is safe and feasible for transcatheter treatment of PmVSDs, especially in patients requiring device replacement, for it avoids reconstruction of the "arteriovenous wire loop", left ventriculography from the contralateral femoral route, or the use of a larger femoral artery short sheath.

Potential candidate genes for alveolar hypoxia identified by transcriptome network analysis.

BACKGROUND. Alveolar hypoxia is an important condition related to many disorders such as chronic pulmonary hypertension, pulmonary vasoconstriction, and pulmonary vascular remodeling. The aim of present study was to disclose the biological response and the potential transcriptome networks regulating the hypoxia response in the lungs. MATERIALS AND METHODS. In this study, the microarray dataset GSE11341 was used to construct a regulatory network and identify the potential genes related to alveolar hypoxia. In addition, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and Gene Ontology (GO) term enrichment analyses were also performed. RESULTS. Hypoxia inducible factor 1 alpha (HIF-1α), peroxisome proliferator-activated receptor gamma (PPARγ), and nuclear factor of kappa light polypeptide gene enhancer in B cells (NF-кB) were to be the hub nodes in the transcriptome network. HIF-1α may regulate potassium voltage-gated channel, shaker-related subfamily, member (5KCNA5), solute carrier family 2 (facilitated glucose transporter), member (1SLC2A1), and heme oxygenase (decycling) 1 (HMOX1) expression through the regulation of membrane potential, glucose metabolism, and anti-inflammation pathways. HMOX-1 mediates signaling pathways that relate to NF-кB. CCND1 (cyclin D1) expression could be regulated by PPARγ and HIF-1α via the cell cycle pathway. In addition, new transcriptional factors and target genes, such as phosphofructokinase (PFKL, liver), aldolase A (ALDOA, fructose-bisphosphate), and trefoil factor 3 (intestinal) (TFF3), were also identified. CONCLUSIONS. Transcriptome network analysis is a helpful method for the identification of the candidate genes in alveolar hypoxia. The KEGG pathway and GO term analysis are beneficial in the prediction of the underlying molecular mechanism of these identified genes in alveolar hypoxia.

Vascular smooth muscle cell proliferation is influenced by let-7d microRNA and its interaction with KRAS.

BACKGROUND: Several microRNAs (miRNAs) have been reported to regulate cardiovascular biological and pathological processes through inhibiting the translation of certain RNA transcripts. However, little is known about the association between miRNAs and vascular smooth muscle cell (VSMC) proliferation. The aim was to investigate the role of miRNAs in VSMC growth and the potential mechanism. METHODS AND RESULTS: Primary VSMCs were isolated from the medial layer of the thoracic aorta obtained from spontaneously hypertensive rats (SHR) and Wistar Kyoto rats (WKY). miRNA microarrays were used to analyze the difference in miRNA expression between VSMCs of SHR and WKY rats and were validated using TaqMan real-time PCR. Of the potentially related genes under the influence of let-7d identified through literature search, KRAS was verified by western blot and functionally analyzed using miRNA mimics transfection and analysis of transfectants by cell enumeration was made using CCK-8 and flow cytometric analysis of cell cycle progression. let-7d-transfected VSMCs from SHR, WKY and human coronary arteries expressed significantly lower amounts of KRAS protein, displayed reduced cell growth and led to a greater number of cells in the G1 phase than the G2/M phases of the cell cycle. CONCLUSIONS: let-7d was significantly downregulated in VSMCs as an important regulator of cell proliferation. RAS might be involved in the proliferation regulation by let-7d.

[Effect of acupuncture on pain and cerebral hemodynamics in patients with migraine: a randomized controlled trial].

OBJECTIVE: To observe the therapeutic effect between acupuncture combined with medication and simple medication on migraine and cerebral hemodynamics. METHODS: A total of 120 patients with migraine were randomized into an acupuncture plus medication group (60 cases, 3 cases dropped off) and a medication group (60 cases, 6 cases dropped off). In the medication group, flunarizine hydrochloride capsule was given orally before sleep, 10 mg a day. On the basis of the treatment in the medication group, acupuncture was applied at Sizhukong (TE 23), Shuaigu (GB 8), Taiyang (EX-HN 5), Fengchi (GB 20) and etc. in the acupuncture plus medication group, 30 min each time, once a day. Treatment for 4 weeks was required in both groups. Before and after treatment, the visual analogue scale (VAS) score, indexes of cerebral hemodynamic [blood flow velocity of anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), vertebral artery (VA) and basilar artery (BA)] and total TCM syndrome score were observed, and the clinical therapeutic effect and the incidence of the adverse events were evaluated in both groups. RESULTS: Compared before treatment, the VAS scores, the blood flow velocity of ACA, MCA, PCA, VA, BA and the total TCM syndrome scores were decreased in both groups (P<0.05). After treatment, the VAS score, the blood flow velocity of ACA, MCA, PCA, VA, BA and the total TCM syndrome score in the acupuncture plus medication group were lower than those in the medication group (P<0.05). The total effective rate was 96.5% (55/57) in the acupuncture plus medication group, which was superior to 90.7% (49/54) in the medication group (P<0.05). There was no statistical difference in the incidence of adverse events between the two groups (P>0.05). CONCLUSION: Acupuncture combined with flunarizine hydrochloride capsule can effectively relieve the pain in patients with migraine, reduce the cerebral blood flow velocity, the efficacy is superior to simple flunarizine hydrochloride capsule.

Transcatheter closure of perimembranous ventricular septal defects using a novel wire-maintaining technique.

OBJECTIVES: We aimed to evaluate the clinical feasibility and safety of a novel wire-maintaining technique (WMT) for transcatheter closure of perimembranous ventricular septal defects (PmVSDs). BACKGROUND: Transcatheter device closure of PmVSDs has been increasingly performed and this procedure is now offered as primary therapy at many institutions. METHODS: A total of 103 patients with complex PmVSDs were randomized to either the conventional technique (CT) group (n = 51) or the WMT group (n = 52). In the CT group, the track wire was withdrawn before the occluder insertion and deployment. If inappropriate, the initial occluder was withdrawn and the "arteriovenous wire loop" was re-established. In the WMT group, the track wire was maintained in the delivery sheath during the procedure. If the initial occluder was inappropriate, the delivery sheath could be reintroduced over the maintained wire. RESULTS: For those patients who could not achieve optimal results with the initially selected occluders and required further device replacement, the procedure and fluoroscope time was reduced significantly in the WMT group compared with the CT group ([50.8 +/- 13.2] min vs. [61.5 +/- 15.4] min, P < 0.01 and [21.6 +/- 8.6] min vs. [27.3 +/- 7.4] min, P < 0.05; respectively). There was no difference in the incidence of complications of two groups. CONCLUSIONS: The WMT was feasible and safe for the transcatheter treatment of PmVSDs, especially for those complex defects with great challenge. Using this novel technique, the reconstruction of "arteriovenous wire loop" could be avoided in patients requiring device replacement.

[Outcome of transcatheter closure of perimembranous ventricular septal defect with modified double-disk occluder device].

OBJECTIVE: To evaluate the efficacy and adverse effects of transcatheter closure of perimembranous ventricular septal defect (pmVSD) with modified double-disk occluder device (MDVO). METHODS: Clinical data including clinical examination, electrocardiography daily after the procedure for a week, chest-X-rays and TTE before discharge and at 3-5 days after the procedure were analyzed from 604 patients underwent percutaneous closure of a pmVSD with MDVO at our department between December 2001 and December 2008. RESULTS: Procedure was successful in 576 out of 604 patients (95.4%) and 583 VSD occluders were placed. Endocarditis, thromboembolism, or deaths were not observed after procedure. Conduction block occurred in 81 patients (56 RBBB, 14 LBBB) and transient nonparoxysmal ventricular tachycardia in 31 patients after the procedure. Complete heart block occurred in 11 patients, 9 of them recovered in 3 weeks, permanent pacemaker was implanted in 2 patients (one had transient III degrees AVB before the procedure, the other underwent simultaneous closure of ventricular septal defect and atrial septal defect). Trivial/small residual shunts were found in 69 patients (12.0%). The residual shunts disappeared in 31 patients and remained unchanged in 38 patients (6.6%) 7 days after procedures. Aortic regurgitation developed in 5 patients (2 trivial/small, 3 small/moderate), and tricuspid regurgitation was present in 35 patients (32 trivial/small, 3 moderate). Five patients developed haemolysis (device retrieved via catheter in 1 patient due to persistent haemolysis, the other 4 patients recovered 3-14 days post procedure). Pseudoaneurysm of femoral artery occurred in 1 patient, and disappeared by pressure dressing. Device was successfully replaced in 2 patients with either device embolization (n = 1) or device misplacement (n = 1) after device retrieval by catheter. CONCLUSION: It is safe and effective to close congenital perimembranous ventricular septal defect with domestic-made occluder device.

Complete atrioventricular block after percutaneous device closure of perimembranous ventricular septal defect: A single-center experience on 1046 cases.

BACKGROUND: Complete atrioventricular block (cAVB) has been deemed a rare complication after transcatheter closure for ventricular septal defect (VSD). However, this serious event appears to be underrecognized and is worth being investigated further. OBJECTIVES: To determine the incidence and predisposing factors of cAVB associated with closure of VSD using a modified double-disk occluder (MDO). METHODS: From December 21, 2001 to December 31, 2014, 1046 patients with perimembranous ventricular septal defect underwent percutaneous closure using the MDO. Electrocardiography was evaluated before the procedure, within 1 week after the procedure, and then at 1, 3, 6, and 12 months and every year thereafter. Other baseline and procedural parameters were also evaluated and a comparison between patients requiring pacemakers and those not suffering from cAVB was done. RESULTS: cAVB occurred in 17 patients (1.63%) after the procedure. Of the 17 patients, 8 underwent permanent pacemaker (PPM) implantation. The cAVB occurred within 30 days after the procedure in 14 patients and after 1 year in 3 patients. In comparison patients aged ≤18 years, patients aged >18 years were more prone to cAVB (P = .025). Logistic regression revealed no significant parameter to predict later requirement for PPM. CONCLUSIONS: The incidence of cAVB after transcatheter closure of VSD was acceptable, as part of the cAVB population recovered after administration of corticosteroid and application of a temporary pacemaker. Late cAVB (>1 year) appears to make it more difficult to restore normal conduction block. Because of the recurrence of cAVB, life-long follow-up with periodic electrocardiography examination may be mandatory.