Objective To evaluate the clinical effect for transcatheter closure of intracristal ventricular septal defects (IVSD) using duct occluder.Methods Between Jun.2012 and Sep.2013,implantaion of duct occluder was conducted in 27 IVSD pmients,which was compmed with acentric ventricular septal occluder attempted in 53 IVSD patients.The transthoracic echocardiography,electrocardiography,and clinical examination were observed at 24 hours,and after 1,3,6 and 12 months follows-up.Results Implantation of duct occluders were achieved in 26 (96.23 ％) patients and implantation of acentric ventricular septal occluder in 42 (79.25％) patients.The mean follow-up time was 6.78 months (1-17 months).The procedure time,fluoroscopic time and residual shunt were not statistically different between the 2 groups (all p ＞ 0.05).The size of VSD (t =-3.124,P =0.003) and occluder diameter (t =-4.285,P ＜0.001)were smaller and the procedure success rate was higher in the duct occluder group (x2 =9.099,P =0.011).Left ventricular end diastolic dimension,left atrial diameter,left ventricular end diastolic dimension,right ventricular end diastolic dimension and pulmonary artery diameter were decreased significantly (F =57.62,5.002,4.754,2.782,P =0.000,0.033,0.001,0.030) after surgical procedure compared with those before procedure,except for the right atrial diameter and left ventricular ejection fraction.No new serious aortic regurgitation or increased mitral regurgitation,tricuspid regurgitation was shown after procedure in 2 groups.Complete left bundle branch block occurred in 2 patients respectively,pericardial effusion and thromboembolism of right femoral artery occurred in 1 patient in the acentric ventricular septal occluder group.Conclusions The duct occluder for IVSD closure has presented a good result,without serious complications,which provides a new method for IVSD closure.Further studies are necessary to determine the long-term results in a larger population of patients.

Central fatigue refers to the central nervous system disease caused by excessive mental pressure or excessive physical activity, which shows a series of fatigue symptoms. The pathological mechanism of central fatigue remains unclear, and the mitochondrial quality control pathway represented by mitophagy is closely related to the occurrence and development of central fatigue. Traditional Chinese medicine considers liver stagnation and spleen deficiency as the key pathogenesis of central fatigue. This paper suggests that oxidative stress may be an important basis for the occurrence of central fatigue, energy metabolism disorders are specific manifestations of liver′s failure of conveyance and dispersion and spleen′s failure of healthy transportation, and the abnormal accumulation of reactive oxygen can be regarded as pathological products of central fatigue. Therefore, based on oxidative stress and energy metabolism, the pathologic mechanism of liver′s failure of conveyance and dispersion and spleen′s failure of healthy transportation in central fatigue from the perspective of mitophagy has a rich theoretical connotation, and provides a theoretical reference for the clinical treatment of central fatigue.