Cardiac Catheterization ; adverse effects ; Device Removal ; Humans ; Male ; Middle Aged

Cardiac catheterization is rarely performed in neonates in China. The medical records of 26 neonates who underwent cardiac catheterization in Shanghai Children's Medical Center from June 1994 to June 2004 were reviewed. These infants weighed 2300 to 4500 g (mean 3 400 +/- 500 g). Postnatal age ranged from 5 to 28 days (mean 15.2 +/- 8.7 days). Right heart ventricle angiography was performed in 24 cases, left heart ventricle angiography in 20 cases and pulmonary angiography in 6 cases. Balloon aortic septostomy (BAS) was performed in 10 cases. Twenty cases were diagnosed with complex cyanotic cardiovascular malformations and 4 with acyanotic heart disease. The implantation of a temporary cardiac pacemaker was performed in 2 cases. All diagnostic and interventional procedures were successfully performed. The catheterization-related complications occurred in 15.3% of the 26 cases, but without mortality. In conclusion, cardiac catheterization is an accurate and safe method for diagnosing complex congenital heart diseases in neonates. Interventional catheterization is useful in the treatment of complex congenital heart malformations.
Cardiac Catheterization ; adverse effects ; methods ; Female ; Heart Defects, Congenital ; diagnosis ; therapy ; Humans ; Infant, Newborn ; Male

Adult ; Cardiac Catheterization ; adverse effects ; Female ; Heart Septal Defects, Ventricular ; surgery ; Hemolysis ; Humans ; Postoperative Complications ; etiology

Adult ; Cardiac Catheterization ; adverse effects ; Female ; Heart Septal Defects, Atrial ; therapy ; Hemolysis ; Humans

OBJECTIVETo discuss the treatment of arrhythmia occurs in the process of transcatheter closure of perimembranous ventricular septal defects (VSD) in pediatric patients.

METHODS182 cases (mean age: 6.2 +/- 3.3 years) with membranous VSD underwent transcatheter occlusion procedure. Two different devices were used: the Amplatzer membranous VSD occluder in 81 patients and the domestic-made device in 101 patients. Electrocardiogram of all patients was recorded before and during closure and at one day after the procedure, and Holter monitoring was performed one week after the procedure.

RESULTSPerioperation arrhythmia occurred in thirty-one patients (17%). Second- or third-degree atrioventricular bundle (AVB) was noted during the procedure in four patients. Normal AV conduction recovered spontaneously before the catheters were withdrawn in three cases and another patient underwent surgical repair. In the other twenty-seven patients, arrhythmia was first documented between one day and one week after the procedure. Third-degree AVB was found in three (1.6%) children after the procedure and underwent the temporary pacemaker (TPM) was implanted, two of them recovered to normal sinus rhythm within one week, another patient underwent elective surgery to remove the occluder and repair the defect. Other arrhythmias were: left bundle-branch block (n = 3), right bundle-branch block (n = 12), second-degree AVB (n = 2), sinus tachycardia (n = 6).

CONCLUSIONSIn properly selected cases of perimembranous VSD, the transcatheter closure is safe and effective by using appropriate devices. During and after the procedure, closure of VSD can be associated with some kinds of arrhythmia, such as A-V block, more intensive observation and follow-up were therefore needed.

Adolescent ; Arrhythmias, Cardiac ; therapy ; Cardiac Catheterization ; adverse effects ; methods ; Child ; Child, Preschool ; Female ; Heart Septal Defects, Ventricular ; surgery ; Humans ; Male

BACKGROUNDCurrently, transcatheter closure of perimembranous ventricular septal defect (pmVSD) is a widely accepted therapeutic modality. However, arrhythmias, especially postprocedural heart blocks, are a concern and outcomes are not very clear. This study explored the outcomes and risk factors of arrhythmias associated with transcatheter device closure of pmVSD.

METHODSA total of 395 patients diagnosed with pmVSD who successfully underwent transcatheter intervention between January 2010 and December 2015 in our center were retrospectively reviewed. Electrocardiographic data before and after the procedure were collected and analyzed. We first evaluated the potential risk factors including gender, age, weight, inlet and outlet diameters of defect, subaortic rim length, occluder size, corrected occluder size into body surface area, fluoroscopy time, presence of aneurysm, and deployment position. We compared the potential risk factors between arrhythmia and nonarrhythmia groups using univariate analysis, followed by logistic analysis for independent risk factors.

RESULTSVarious arrhythmias were detected in 95 cases (24.1%) following transcatheter closure procedure. Logistic regression analysis revealed that eccentric (odds ratio [OR] 2.9, 95% confidence interval [CI]: 1.2-7.2) and large occluders (OR 2.0, 95% CI: 1.6-2.5), as well as long fluoroscopy time (OR 1.1, 95% CI: 1.1-1.2), were correlated with postprocedural arrhythmia. During 35.5 months (range: 9-80 months) of follow-up, most of the patients (74 out of 95) reverted to normal heart rhythm.

CONCLUSIONSThe mid-term outcome of patients with arrhythmias after transcatheter closure of pmVSD was satisfactory as most of the patients recovered normal rhythm. Eccentric, large device and long fluoroscopy time increase the risk of arrhythmias after transcatheter closure of pmVSD.

Arrhythmias, Cardiac ; diagnosis ; etiology ; Cardiac Catheterization ; adverse effects ; Cardiac Surgical Procedures ; adverse effects ; Child ; Child, Preschool ; Electrocardiography ; Female ; Heart Septal Defects, Ventricular ; physiopathology ; surgery ; Humans ; Male ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Septal Occluder Device ; adverse effects ; Treatment Outcome

BACKGROUNDThe risk of radial artery occlusion (RAO) needs particular attention in transradial intervention (TRI). Therefore, reducing vascular occlusion has an important clinical significance. The aim of this study was to determine the appropriate puncture site during TRI through comparing the occurrence of RAO between the different puncture sites to reduce the occurrence of RAO after TRI.

METHODSWe prospectively assessed the occurrence of RAO in 606 consecutive patients undergoing TRI. Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention. Risk factors for RAO were evaluated using a multivariate model analysis.

RESULTSOf the 606 patients, the RAO occurred in 56 patients. Compared with TRI at 2-5 cm away from the radius styloid process, the odds ratio (OR) for occlusion risk at 0 cm and 1 cm were 9.65 (P = 0.033) and 8.90 (P = 0.040), respectively. The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤1 (OR = 2.45, P = 0.004).

CONCLUSIONDistal puncture sites (0-1 cm away from the radius styloid process) can lead to a higher rate of RAO.

TRIAL REGISTRATIONClinicalTrials.gov, NCT01979627; https://clinicaltrials.gov/ct2/show/NCT01979627?term = NCT01979627 and rank = 1.

Aged ; Arterial Occlusive Diseases ; etiology ; Cardiac Catheterization ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Punctures ; Radial Artery

OBJECTIVETo investigate the complications and their prevention in patients with perimembranous ventricular septal defect (VSD) experiencing transcatheter interventional occlusion.

METHODSFrom July, 2002 to May, 2004, totally 262 (138 males, 124 females) perimembranous VSD patients underwent transcatheter interventional occlusion in the department. The age ranged from 2 to 18 years (mean 9.3 +/- 5.8 years), and the body weight ranged from 11.0 to 65.0 kg (mean 30.5 kg). The implanted occluder with imported Amplatzer eccentric perimembranous VSD occluder, domestic double-disk, domestic eccentric perimembranous VSD and PDA occluder were attempted in 12, 212, 28 and 6 cases, respectively. Among them, 3 cases were complicated with ductus arteriosus, 4 with atrial septal defects and 1 with patent ductus arteriosus plus atrial septal defect. The associated defects were treated with other occluders at the same time.

RESULTSThe diameters of VSD measured by transthoracic echocardiography before occlusion and by ventriculography during the procedure ranged from 2.7 to 13 mm (mean 6.5 mm) and from 1.3 to 14.0 mm (mean 6.8 mm), respectively. The defects in 256 cases (97.7%) were successfully occluded. The implant occluder was from 4 to 16 mm in size. Serious complications occurred in 8 cases (3.1%), including 5 cases of high degree atrioventricular block (AVB) (2.0%), 2 cases of hemolysis (0.8%) and 1 case of displacement of the occluder (0.4%). Amongst 5 cases of high degree AVB, permanent pacemaker was implanted only in 1 case due to high degree AVB 50 days after treatment, whereas the others all recovered. Two cases of hemolysis were completely recovered. One case of occluder displacement was emergently transferred to cardiac surgery. Other complications included residual shunt during 6 month follow-up in 1 case (0.4%), minor aortic regurgitation in 5 cases (2.0%), minor tricuspid regurgitation during 6 month follow-up in 4 cases (1.6%), and accelerated idioventricular rhythm or accelerated atrio-ventricular junctional tachycardia combined with atrioventricular interference-dissociation by ECG in 75 cases (29%) but they recovered after 3 - 5 days of corticosteroid treatment. Forty-one cases (16%) complicated with complete or incomplete right bundle branch block, of whom 50% recovered during follow-up. Still, there were 4 cases (1.6%) who were complicated with complete left bundle branch block but were all recovered during follow-up and 26 cases (10%) who were complicated with intraventricular block. There were no Significant difference in complications between cases who accepted imported Amplatzer occluders and domestic occluders.

CONCLUSIONTranscatheter interventional occlusion is a safe, effective and ideal method with low incidence of serious complications for perimembranous VSD. Long term follow-up and clinical research should be carried out to improve the level of VSD interventional therapy.

Adolescent ; Cardiac Catheterization ; adverse effects ; Child ; Child, Preschool ; Echocardiography ; Female ; Heart Septal Defects, Ventricular ; diagnostic imaging ; therapy ; Humans ; Infant ; Male

Atrioventricular Block ; etiology ; Cardiac Catheterization ; adverse effects ; Heart Septal Defects, Ventricular ; therapy ; Hematologic Diseases ; etiology ; Hemolysis ; Humans

INTRODUCTIONThis study aims to assess the safety and feasibility of brachial arterial puncture for coronary procedures when radial access is not possible. Radial arterial approach is the usual option for coronary procedures in our hospital. Whenever radial access is not possible, the brachial approach is preferred instead of the femoral approach. As many clinicians considered percutaneous brachial coronary angiography as an obsolete and hazardous procedure, we carried out this study to compare the outcomes of the brachial approach to the femoral approach in our centre.

MATERIALS AND METHODSWe retrospectively evaluated all cases of brachial artery puncture and femoral artery puncture in our centre from 1 January 2007 to 31 March 2009 through a prospectively collected database and looked for all complications which occurred in both groups.

RESULTSThe femoral group had a slightly higher incidence of major complications--3 out of 121 cases (2.5%) in the femoral group and 1 out of 180 cases (0.6%) in the brachial group, even though this was not statistically significant (P = 0.15). There was also no difference between these 2 groups for minor complications: 8 patients (4.4%) in the brachial group and 6 patients (5%) in the femoral group developed haematoma that did not require any blood transfusion or surgery. There was no incidence of brachial artery thrombosis and no puncture-related neurological deficit documented in the brachial group.

CONCLUSIONBrachial artery puncture and catheterisation may be a viable, safe and efficient alternative to the transfemoral approach in a centre that is experienced with the arm approach, when radial access is not possible.

Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Brachial Artery ; Cardiac Catheterization ; adverse effects ; methods ; Coronary Angiography ; methods ; Feasibility Studies ; Female ; Femoral Artery ; Humans ; Male ; Middle Aged ; Retrospective Studies