OBJECTIVETo observe the effect of oversized occluder on endothelialization post percutaneous closure of experimental atrial septal defect (ASD) in dogs.

METHODSASD was established with the help of transthoracic echocardiography in 18 dogs. ASD size was (6.0 ± 0.2) mm. Dogs were randomly divided into normal size group (implanted with 8 mm occlude, n = 9) and oversized group (implanted with 12 mm occluder, n = 9). Dogs were randomly killed at 3, 6 and 14 months after percutaneous closure. The endothelialization process on device surface was observed by scanning electron microscope.

RESULTSFour animals died around 1 month post procedure. Microscopic sections from normal group showed nearly complete endothelialization at 3 months after device implantation and complete endothelialization at 6 and 14 months after device implantation. While microscopic sections showed lack of endothelialization at 3 months post implantation, nearly endothelialization at 6 months, and complete endothelialization at 14 months after device implantation in oversized group.

CONCLUSIONIncomplete endothelialization of occluder surface is observed at 6 months after implantation of an oversized ASD occluder device in this model.

Animals ; Dogs ; Echocardiography ; Heart Septal Defects, Atrial ; diagnostic imaging ; therapy ; Percutaneous Coronary Intervention ; Septal Occluder Device

Heart Septal Defects, Atrial/diagnostic imaging* ; Humans ; Liver ; Vena Cava, Inferior ; Vena Cava, Superior

OBJECTIVETo study the clinical technology of transcatheter closure of secundum atrial septal defects (ASD) with Amplatzer device in younger and lower body weight children.

METHODSThe transcatheter closure of ASD using Amplatzer septal occluder (ASO) was performed in 165 children under 5 years of age (75 boys and 90 girls) with secundum ASD from Aug 1998 to May 2004. The age of the cases ranged from 2 to 5 (mean 3.7 +/- 1.1) years. The body weight ranged from 9 to 18 (mean 12.6 +/- 2.3) kg. The ratio of pulmonary circulation quantity to the systemic circulation quantity (Qp/Qs) was 3.2 +/- 1.9. All the patients underwent clinical examination, X-ray, electrocardiography (ECG) and echocardiography (Echo) for diagnosis of secundum ASD. The transthoracic echocardiography (TTE) was used to detect and measure the defect of the patients and even trans-esophageal echocardiography (TEE) had to be used when it was necessary. With Echo and X-ray guidance, the measuring balloon was used in the body and outside the body to determine the balloon-stretch diameters of ASD, and proper occluders were selected accordingly for the patients for interventional treatment of ASD.

RESULTSThe devices were implanted successfully in 163 (98.8%) cases. One failure occurred in a case in whom the device moved into the left atrium after release, and the other failure was that the position of the device was uncertain because of temporary unavailability of a special transducer for TEE. Surgical operations were performed for these two cases. The stretch diameter of ASD was from (8 - 30) mm, (mean 18.3 +/- 5.1) mm. The size of device was selected according to the stretch diameter of ASD. The diameter of the occluders selected was from (8 - 30), (mean 18.6 +/- 5) mm in this series. The occlusion procedure was monitored by fluoroscopy and TTE and in 5 cases (3%) by TEE. The diameter of right ventricle was improved within 2 days after occlusion from (mean 16.4 +/- 4.9) mm to (mean 12.6 +/- 3.8) mm, (p < 0.01). One hundred and forty seven cases belonged to the simple secundum ASD(89%). Thirteen cases who were complicated with other cardiac deformity were treated successfully with different interventional procedure. Six cases had multiple openings and three of these cases had tumour-like changes of the atrial septum which were closed completely just by one occluder. In only one case small quantity of residual shunt remains. No other severe complication was found in this group. About 100 cases (60%) had large ASD, so the procedure was more difficult in those cases.

CONCLUSIONThe clinical effectiveness of treatment of ASD in children under 5 years of age with Amplatzer occluders was satisfactory and therefore this therapeutic procedure is feasible for this age group of patients. Nevertheless, we do not recommend to use the technique for infants and children under 2 years of age. Strict selection of indications and proper size of occluder and good cardiologic and surgical settings are among the basic factors for successful interventional occlusion of ASD in young children.

Child, Preschool ; Echocardiography ; Female ; Heart Septal Defects, Atrial ; diagnostic imaging ; surgery ; Humans ; Male ; Septal Occluder Device ; adverse effects

Echocardiography, Transesophageal ; Electrodes, Implanted ; Heart Septal Defects, Atrial ; diagnostic imaging ; Humans ; Intraoperative Complications ; diagnostic imaging ; Male ; Middle Aged ; Pacemaker, Artificial

OBJECTIVETo describe the morphological features of congenital heart defects and their spatial orientations to the neighboring structures in special two-dimensional echocardiographic views.

METHODSConventional two-dimensional echocardiographic sections were obtained in 45 patients with atrial septal defect (ASD) and 15 with ventricular septal defect (VSD) before the en face imaging, a special echocardiographic view, was performed using a transthoracic probe for morphological characterization of the ASD and VSD. En face views of the secundum ASD and perimembranous and outflow tract or doubly committed subarterial VSD were imaged on the interatrial septal section and inflow and outflow interventricular septal section at parasternal or apical position, respectively.

RESULTSThe special echocardiographic section provided en face plane views of the congenital heart defects in 35/43 (81%) of secundum ASD and 10/15 (67%) of VSD patients, and allowed full assessment of their size, shape, circumference and spatial orientations to the neighboring structures, showing also the relationship between two or multiple defects.

CONCLUSIONThe special transthoracic two-dimensional echocardiography not only displays the morphological features of ASD and VSD, but also provides additional information for making clinical decisions.

Adolescent ; Adult ; Child ; Child, Preschool ; Echocardiography ; methods ; Female ; Heart Defects, Congenital ; diagnostic imaging ; Heart Septal Defects, Atrial ; diagnostic imaging ; Heart Septal Defects, Ventricular ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVETo investigate partial anomalous pulmonary venous connection (PAPVC) with echocardiography.

METHODSThe right ventricular volume overload was detected by routine echocardiography in 37 child patients, who underwent further echocardiography to find the abnormal locations of pulmonary vein opening at superior, inferior vena cava and right atrium. The ultrasound results were compared with surgical findings.

RESULTSIn 30 patients the ultrasound diagnosis was consistent with surgery results, 7 were misdiagnosed by ultrasound with a detective rate of 81.1 %. All 37 PAPVC patients presented varying degrees of right heart enlargement; PAPVC combined with atrial septal defect (ASD) was found in 34 cases.

CONCLUSIONThe possibility of PAPVC should be considered when unexplained right heart volume overload was detected by echocardiography. Superior, inferior vena cava and right atrium should be inspected when the pulmonary veins were not seen in echocardiography.

Child ; Child, Preschool ; Echocardiography ; Female ; Heart Atria ; abnormalities ; diagnostic imaging ; Heart Septal Defects, Atrial ; diagnostic imaging ; Humans ; Infant ; Male ; Pulmonary Veins ; abnormalities ; diagnostic imaging

OBJECTIVETo assess the accuracy of echocardiography in diagnosis of total anomalous pulmonary venous connection (TAPVC).

METHODSA combination of suprasternal, parasternal, subcostal and apical views were employed to diagnose TAPVC and to trace the course of the anomalous pulmonary venous connection, the direction of the inter-atrial shunt, enlargement of right atrium (RA) and right ventricle (RV), superior and inferior vena cava. All pediatric patients underwent surgical repair. The results of echocardiography were compared with surgical findings.

RESULTA total of 28 consecutive pediatric patients with suspected TAPVC were included in this study. The TAPVC diagnosis was confirmed in 26 cases after surgery, partial anomalous pulmonary venous connection (PAPVC) in one case, and Cor Triatriatum and possible TAPVC in another. The diagnostic accuracy of TAPVC by echocardiography in the study was 92.86%. There were 17 supracardiac TAPVC, 11 intracardiac TAPVC. In all patients, enlargement of the RA and RV, inter-atrial right-to-left shunt via atrial septal defects were documented in parasternal and subcostal views. Common pulmonary vein or four pulmonary vein direct to RA or via coronary sinus to RA were the draining sites of intracardiac TAPVC. The enlargement of left innominate vein-right superior vena cava draining to RA was seen in supracardiac TAPVC.

CONCLUSIONA combination of suprasternal and subcostal multi-views in echocardiography can increase the diagnostic accuracy of TAPVC in pediatric patients.

Abnormalities, Multiple ; diagnostic imaging ; Child ; Child, Preschool ; Echocardiography, Doppler, Color ; Female ; Heart Septal Defects, Atrial ; diagnostic imaging ; Humans ; Infant ; Infant, Newborn ; Male ; Pulmonary Veins ; abnormalities ; diagnostic imaging

Adolescent ; Cardiac Catheterization ; methods ; Child, Preschool ; Echocardiography, Transesophageal ; methods ; Female ; Heart Septal Defects, Atrial ; diagnostic imaging ; therapy ; Humans ; Treatment Outcome

Adolescent ; Cardiac Catheterization ; methods ; Child ; Child, Preschool ; Echocardiography ; Female ; Heart Septal Defects, Atrial ; diagnostic imaging ; surgery ; Humans ; Infant ; Male

Adolescent ; Child ; Child, Preschool ; Echocardiography, Three-Dimensional ; Female ; Heart Septal Defects, Atrial ; diagnostic imaging ; therapy ; Humans ; Male