Echocardiography ; methods ; Female ; Heart Neoplasms ; diagnosis ; surgery ; Humans ; Infant ; Myxoma ; diagnosis ; surgery ; Treatment Outcome ; Tricuspid Valve ; physiopathology ; surgery

Aorta ; pathology ; surgery ; Aortopulmonary Septal Defect ; therapy ; Balloon Occlusion ; methods ; Catheterization, Swan-Ganz ; methods ; Child ; Female ; Humans ; Pulmonary Artery ; pathology ; surgery ; Treatment Outcome

OBJECTIVETo investigate the efficacy and safety of percutaneous radiofrequency perforation and valvuloplasty in infants with pulmonary atresia with intact ventricular septum (PA/IVS).

METHODSFour infants (body weight 4 - 10 kg) aged 11 months, 9 months, 12 days and 9 months old, respectively, were hospitalized for dyspnea and cyanosis. All patients had a continuous murmur in the left second intercostal space. Doppler echocardiogram showed membranous pulmonary atresia with intact ventricular septum. Right ventriculogram showed a tripartite right ventricle, vasiform infundibulum, and membranous pulmonary valve atresia without ventriculocoronary connections. Descending thoracic aortogram showed good-sized confluent pulmonary arteries being filled from a ductus arteriosus. All the patients were taken up for radiofrequency perforation followed by a balloon dilatation. A 6F Judkins right coronary guiding catheter was positioned in the right ventricular outflow tract and under the atretic pulmonary valve membrane. The radiofrequency perforation catheter along with coaxial injectable catheter was then passed through the right coronary guiding catheter, using it as the guide to the imperforate membrane. The proximal end of the radiofrequency perforation catheter was then connected to radiofrequency generator. After the cusps of pulmonary valve were perforated, the coaxial injectable catheter was moved into the main pulmonary artery. A tiny floppy-tipped coronary guidewire was then passed through the coaxial injectable catheter into the main pulmonary artery and directed through the patent ductus arteriosus into the descending thoracic aorta or directed into pulmonary arteriola. Thereafter, serial balloon dilation catheters were introduced across the pulmonary valve, and dilations were sequentially performed with increasing balloon diameters. The balloon was dilated until the concave of the balloons disappeared. The radiofrequency energy (5 to 8 W) was delivered for 2 to 5 seconds once, but commonly twice, to perforate the valves. After a predilation with a 3 mm x 20 mm to 5 mm x 20 mm balloon at 6 - 14 atm pressure, the valve was subsequently dilated with 10 mm x 30 mm to 14 mm x 30 mm balloon once or twice. The duration of procedures was 120 to 150 min and exposure time was 25.4 to 43.9 min.

RESULTSThe primary procedure was successful in all the infants except one who died early of cardiac perforation with tamponade. After a follow-up period ranging from 2 to 8 months (mean 4.3 m), the remaining 3 survivors achieved complete biventricular circulation. Two of them were awaiting occlusion of the patent ductus arteriosus and 1 needed right ventricular outflow tract reconstruction because of infundibular obstruction.

CONCLUSIONPA/IVS consists of 0.7% to 3.1% of congenital heart defects. 85% of the untreated patients die within half a year. Surgical repair for the infants with PA/IVS is associated with a high mortality. In carefully selected patients with PA/IVS, radiofrequency perforation and balloon dilatation of the pulmonary valve is feasible and may represent a new alternative to surgery due to its low mortality and avoidance of cardiopulmonary bypass.

Balloon Occlusion ; Catheter Ablation ; methods ; Catheterization ; methods ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Pulmonary Atresia ; physiopathology ; therapy ; Pulmonary Valve ; surgery ; Ventricular Septum

OBJECTIVETo evaluate the clinical efficiency of transcatheter closure of atrial septal defect (ASD) with AGA-Amplatzer occlusion device in pediatric patients.

METHODSForty patients with ASD, 16 males, 24 females, at a mean age of 10.2 years (ranged from 3 to 15 years of age) and with a mean weight of 35.8 kg (ranged from 11 to 87 kg) were studied. Six cases were complicated with pulmonary stenosis (PS), 1 was complicated with ventricular tachycardia (VT). Right heart catheterizations were done in 40 patients for measuring the pressures of right ventricle and pulmonary artery. The balloon diameter of ASD was measured using balloon catheter with guiding wire. The diameter of ASD was measured by TTE and/or TEE, ascertaining the location and size of ASD. Amplatzer occlusion device was sized to be equal to or 1 - 2 mm more than the diameter of balloon stretched.

RESULTSAll patients had successful implantation of the Amplatzer device. The success rate was 100%. The diameter measured by TTE was 7 - 30 mm (mean 17.12 mm). The diameter measured by TEE was 7 - 32 mm (mean 18.44 mm). The diameter of balloon stretched of ASD was 8 - 34 mm. Of the 40 cases, 6 were complicated with PS and accepted percutaneous balloon valvuloplasty (PBPV). One case was complicated with VT and accepted radiofrequency catheter ablation (RFCA). Neither complication nor residual shunt was found in any of the patients. The patients were recovered and followed up for 3 or 4 days after deployment of the Amplatzer device. Clinical symptom, cardiac murmur, and findings in ECG, echocardiography and X-ray were improved markedly.

CONCLUSIONAGA-Amplatzer occlusion device is safe and efficient in pediatric patients with ASD.

Adolescent ; Cardiac Catheterization ; methods ; Child ; Child, Preschool ; Female ; Heart Septal Defects, Atrial ; surgery ; Humans ; Male ; Postoperative Care ; Preoperative Care ; Treatment Outcome

Objective To evaluate the clinical feature of patients with atrial septal defects (ASD)and the safety and efficacy of transcatheter closure of ASD in elderly patients.Methods Between May 2000and June 2010,82 patients aged (64.5 + 3.8)years underwent attempted transcatheter ASD closure.Right heart catheterization was performed before intervention.Echocardiography was made at 1 day,1,3,6 months after the procedure.The pre- and post-closure clinical feature,pulmonary artery pressure (PAP) and cardiac function were evaluated.Results In 82 patients,37 (45.1％) patients were associated with pulmonary arterial hypertension ( PAH ).The systolic PAP and mean PAP [ (44.1 ± 12.4) mm Hg ( 1mm Hg = 0.133 kPa) and (25.2 + 6.8) mm Hg,respectively ] were measured by right heart catheterization before the procedure.One patient was unsuitable for closure because of severe PAH.The remaining 81patients underwent successful ASD closure without major complications.After closuring,systolic PAP decreased from (52.7 ± 10.3 )mm Hg to (31.8 ± 6.3) mm Hg ( P ＜ 0.05 ),and mean PAP descended from (30.9 ± 4.7 ) mm Hg to (21.8 ± 3.4) mm Hg( P ＜ 0.05 ) in the 36 patients with PAH.The cardiac function improved post procedure.There were 6 new-onset atrial fibrillations during follow up.Conclusions ASD in elderly patients are commonly associated with PAH.Transcatheter ASD closure is safe and effective in the majority of elderly patients.

OBJECTIVETo analyze the risk factors for early arrhythmias after transcatheter closure of perimembranous ventricular septal defect (PVSD).

METHODSA total of 358 patients [161 males, aged from 3 to 54, mean (10.9 +/- 8.1) years, body weight from 12 to 90, mean (32.8 +/- 17.2) kg] who underwent transcatheter closure of PVSD from August 2002 to February 2006 were included in this retrospective analysis. Electrocardiogram was performed daily after transcatheter closure for seven days. Relationships between arrhythmias and those risk factors such as the defect characteristics and the device size and types were explored by logistic regression analysis. Left ventriculography showed 195 out of 358 patients with PVSD were complicated with membranous aneurysm. The PVSD diameter ranged from 2 to 18 (6.5 +/- 3.1) mm in left ventricular side and from 2 to 12 (4.2 +/- 2.3) mm in right ventricular side. A total of 140 nonsymmetrical and 218 symmetrical occluders with diameter 4 to 18 (8.1 +/- 2.5) mm were used to close those defects.

RESULTSProcedure was successful in all patients. Early arrhythmias after transcatheter closure of PVSD were observed in 135 (37.7%) patients and serious cardiac arrhythmias in 23 (6.4%) patients. The early arrhythmias after transcatheter closure of PVSD were significantly correlated with device size [> or = (8.6 +/- 2.7) mm] and type (nonsymmetrical device), the span between the defect and tricuspid (< or = 3 mm), and the presence of aneurysm.

CONCLUSIONLarger device size, nonsymmetrical device, narrow span between the defect and tricuspid and the presence of aneurysm are the risk factors for early arrhythmias after transcatheter closure of PVSD.

Adolescent ; Adult ; Arrhythmias, Cardiac ; etiology ; Cardiac Catheterization ; adverse effects ; Child ; Child, Preschool ; Female ; Heart Septal Defects, Ventricular ; therapy ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Retrospective Studies ; Risk Factors ; Young Adult

Objective: To introduce the construction idea and function for establishing China Cardiovascular Surgery Registry (CCSR)database and to provide a reference for domestic congener databases. Methods: Using peer database as reference, taking current status of cardiovascular surgery registry and hardware in our country with the necessity of international communication, we worked on a variables selection, metadata instruction, logic rules, case report form develpment and finally established a web-based, multi-functional database that enabled cross-database and international merging of data, forming a national intelligent data-exchanging platform for cardiovascular surgery. Results:CCSR database has over 300 variables of multiple topics including basic information, risk factors, medical procedures and endpoint events. Taking clinical and association data exchange standards as reference, it may conduct cross-discipline data connection, record important peri-operative information in relevant patients and meanwhile, it has the functions of automatic logic check, data report, statistical study, data export and importing the electronic medical records. Conclusion:CCSR database is a national platform accord with current status of Chinese cardiovascular surgery and characteristics, meanwhile it gives consideration to international communication and data exchange; which may play a important role in improving medical care and clinical investigation.