In recent years, with the continuous development and increasing maturity of interventional techniques, interventional treatment for congenital heart disease (CHD) has been progressively disseminated to county- and city-level hospitals in China. Concurrently, the standardized management of adult CHD (particularly patent foramen ovale) and the lifelong management of complex CHD are gaining increasing clinical attention, while the emergence of new techniques and products continuously advances the discipline. This article aims to review the new progress made in the field of interventional treatment for congenital heart disease in China during 2024. It specifically reviews and analyzes the following key aspects: (1) annual statistics on interventional closure procedures for CHD; (2) recent insights into patent foramen ovale closure; (3) advances in transcatheter pulmonary valve replacement; (4) interventional treatment and lifelong management strategies for complex CHD; (5) new interventional techniques for acquired heart disease; and (6) the application of artificial intelligence in CHD management. Through the synthesis and discussion of these topics, this article seeks to provide a detailed analysis of the current landscape of interventional treatment for CHD in China and project its future development trends.

Acylcarnitines are metabolic intermediates of fatty acids and branched-chain amino acids having vital biofunctions and pathophysiological significances.Here,we developed a high-throughput method for quantifying hundreds of acylcarnitines in one run using ultrahigh performance liquid chromatography and tandem mass spectrometry(UPLC-MS/MS).This enabled simultaneous quantification of 1136 acyl-carnitines(C0-C26)within 10-min with good sensitivity(limit of detection＜0.7 fmol),linearity(cor-relation coefficient＞0.992),accuracy(relative error＜20％),precision(coefficient of variation(CV),CV＜15％),stability(CV＜15％),and inter-technician consistency(CV＜20％,n=6).We also established a quantitative structure-retention relationship(goodness of fit＞0.998)for predicting retention time(tR)of acylcarnitines with no standards and built a database of their multiple reaction monitoring parameters(tR,ion-pairs,and collision energy).Furthermore,we quantified 514 acylcarnitines in human plasma and urine,mouse kidney,liver,heart,lung,and muscle.This provides a rapid method for quantifying acyl-carnitines in multiple biological matrices.

Objective:Combined with the actual clinical situation, to introduce the application of invasive trans super minimal intercostal device closure in doubly committed ventricular septal defect(DCVSD).Methods:Between January 2017 and July 2020, 82 DCVSD children were recruited. Relevant data such as operation time, length of hospital stay, postoperative complications, etc. were analyzed, and the follow-up of the postoperative period was used to evaluate the effect of the operation.Results:Among them, 2 children’s puncture points were bleeding. Chest closure time was obviously extended. The total operation time of the remaining children was 24-72(47.54±12.06)min, among which the umbrella release time was 5-37(16.16±8.01)min, and the chest opening and closing time was 14-59(31.56±9.58) min. Pericardial effusion occurred in 2 patients after operation, and the discharge time was more than 2 weeks. The remaining children were hospitalized for 3-9(5.79±1.45)days after surgery.Conclusion:Closing DCVSDs through a super minimal intercostal incision under TEE guidance was safe, effective and less trauma.

Objective To explore the value of transesophageal echocardiography ( T EE ) in high ventricular septal defect ( VSD) occlusion via a left parasternal ultra‐minimal intercostal incision ( ≤1 cm ) with eccentric occluder in children . Methods Forty‐eight children with high VSD underwent device occlusion via ultraminimal intercostal incision with eccentric occluder . T he w hole operation , including preoperative evaluation ,intraoperative localization and guidance and postoperation evaluation were performed under the guidance of T EE . Results Forty‐six children with high VSD underwent successfully device closure in all 48 cases and the operation success rate was 95 .8% . T he average size of high VSD was 2 .2－6 .0 ( 3 .70 ± 0 .90) mm and the average size of eccentric occluder was 4－8 ( 5 .48 ± 1 .12) mm . T he average operation duration was 18－98 ( 49 .80 ± 16 .71) min . T here were 2 cases of peri‐membranous high VSD and 44 cases of outlet‐typle VSD ,of w hich 10 cases of mild aortic valve prolapses ( AVOP) ,including 5 cases of aortic valve regurgitation ( AR ) . In addition ,there was 1 case of replacement of device ,1 case of having septum below the margin of the defect and 1 case of using a dilator for a small defect . T he 46 cases were followed up for 6 to 42 months ,and the pericardial effusion occured in 3 cases and disappeared during follow‐up . No other abnormal conditions were found . Conclusions During the surgery of high VSD device occlusion via ultraminimal intercostal incision with eccentric occluder ,T EE has an important value in defect assessment ,intraoperative localization and guidance ,and immediate evaluation of efficacy ,and can effectively guide the device occlusion of high VSD .

Objective: To explore the value of transesophageal echocardiography (TEE) in high ventricular septal defect (VSD) occlusion via a left parasternal ultra-minimal intercostal incision (≤1 cm) with eccentric occluder in children. Methods: Forty-eight children with high VSD underwent device occlusion via ultraminimal intercostal incision with eccentric occluder. The whole operation, including preoperative evaluation, intraoperative localization and guidance and postoperation evaluation were performed under the guidance of TEE. Results: Forty-six children with high VSD underwent successfully device closure in all 48 cases and the operation success rate was 95.8%. The average size of high VSD was 2.2-6.0 (3.70±0.90)mm and the average size of eccentric occluder was 4-8 (5.48±1.12)mm. The average operation duration was 18-98 (49.80±16.71)min. There were 2 cases of peri-membranous high VSD and 44 cases of outlet-typle VSD, of which 10 cases of mild aortic valve prolapses (AVOP), including 5 cases of aortic valve regurgitation(AR). In addition, there was 1 case of replacement of device, 1 case of having septum below the margin of the defect and 1 case of using a dilator for a small defect. The 46 cases were followed up for 6 to 42 months, and the pericardial effusion occured in 3 cases and disappeared during follow-up. No other abnormal conditions were found. Conclusions During the surgery of high VSD device occlusion via ultraminimal intercostal incision with eccentric occluder, TEE has an important value in defect assessment, intraoperative localization and guidance, and immediate evaluation of efficacy, and can effectively guide the device occlusion of high VSD.

Objective: To explore the impact of PI3K-Akt-eNOS signaling on atrial fibrillation inducibility in diabetic rats. Method: Eight-week-old male diabetic rats were randomized assigned into GK group, IGF group and L-NAME group (n=8 each) which respectively received normal saline (NS), insulin like growth factor (IGF-1) or L-NAME+IGF-1 through tail vein daily for 4 weeks. Eight 8-week-old male homologous Wister-Kyoto(WKY) rats treated with intravenous NS served as control group (WKY group). Blood glucose was measured once per week. The left atrial diameter (LAD) was measured by echocardiography, the atrial electrical parameters, including the P-wave duration, the atrial effective refractory period (AERP) and its dispersion (AERP-d), the incidence and the duration of atrial fibrillation induced by atrial burst pacing, were evaluated by electro-physiological instrument at 4 weeks post various treatments. Rats were then sacrificed, left atrial (LA) cell morphology was determined on HE stained sections, LA interstitial collagen was determined on Masson stained sections. The protein expression of phosphatidylinositol 3-kinase (PI3K) and phosphate endothelial nitric oxide synthase (p-eNOS) were detected by Western blot. Results: (1) At the beginning of the study, the random blood glucose (GLU) level was significantly higher and LAD was large in GK, IGF and L-NAME groups than in WKY group;after 4 weeks, GLU level and LAD dimension of IGF group were lower than GK and L-NAME groups (P<0.01 or 0.05). (2) One rat in L-NAME group died during operation. Four weeks later, the incidence of atrial fibrillation in GK group, IGF group, L-NAME group and WKY group was 7/8, 2/8, 6/7 and 3/8. The median duration of atrial fibrillation in GK group, IGF group, L-NAME group and WKY group was 11.9(9.3, 13.1), 0(0, 1.8), 11.5(4.4, 12.0), and 0(0, 3.0) s. Compare with WKY group, the P-wave duration and PR interval were significantly longer, AERP-d, incidence, and duration of atrial fibrillation were significantly higher in GK group (P<0.01), these changed were significantly reversed in IGF group compared to GK and L-NAME groups (all P<0.01). Heart rate and AERP were similar among the 4 groups on (P>0.05). (3) Four weeks later, the CSA and CVF of LA were significantly larger in GK group than in WKY group (P<0.01), which were significantly reversed in IGF group (P<0.01 vs. GK group), and the beneficial effects of IGF disappeared by co-treatment with L-NAME (P<0.01 vs. IGF group). (4) Four weeks later, compare with WKY group, the protein expression of PI3K (P<0.01) and p-eNOS (P<0.05) of LA were significantly downregulated in GK group, which could be significantly upregulated by IGF (P<0.01 and 0.05 vs. GK group), these effects diminished by co-treatment with L-NAME (P<0.01 or 0.05 vs. IGF group). Conclusion Increased atrial fibrillation susceptibility in diabetic rat is linked with structural and electrical remodeling in LA, possibly mediated through downregulated PI3K-Akt-eNOS signaling.

Objective This study was aimed to discuss the safety, feasibility and availability of perimembranous ventricular septal defects(PmVSD) closure via super minimal intercostal incision under transesophageal echocardiography(TEE) guidance in children.Methods There were 81 cases of PmVSD via super minimally invasive transintercostal device closure operation(length of incision ≤ 1cm) from August 2014 to August 2016.TEE was used to guide and monitor the entire procedure.Assessed the effectiveness of device closure by postoperative regular follow-up.Results 80 patients were successfully operated by super minimally invasive transintercostal device closure in all 81 cases.Operation success rate reached 98.77%.The average diameter of ventricular septal defects was(3.72±0.96)mm.The average diameter of amplatzer occluder was(4.88±0.95)mm.Postoperative follow-up time was from 6 months to 24 months.One of 16 cases that with aneurysm of membranous septum had more than two shunts, remained a mild residual shunt beside of the amplatzer occluder but self cured during follow-up.Mild pericardial effusion was found in one patients after the operation and disappeared during follow-up.There were no cases of perioperative death, device deformation or displacement, residual shunt, complete atrioventricular block and valve involvement in the patients whom were successfully operated.One patient transferred to ventricular septal defect repair operation under direct visualization with a cardiopulmonary bypass, because ventricular fibrillation happened when guide wire passed the ventricular septal.Conclusion Super minimally invasive transintercostal device closure of PmVSD in children guided by TEE was safety and availability, that could avoid x-ray radiation and sternotomy, and operate simply, with small incision and low complication.

Objective To report our first clinical experience with a novel modified culotte technique for the treatment of true coronary bifurcation lesions. Methods The novel modified culotte technique (the mono-ring culotte) stenting was done in which the side branch (SB) stent was deployed firstly followed by ex vivo wiring of a most proximal cell of SB stent with the hard end of main branch (MB) wire. Secondly, the MB stent was deployed through the most proximal cell of SB stent. The procedure was ended with kissing balloon dilation. From June 2014 to March 2015, 15 patients with true coronary bifurcation lesion were treated with mono-ring culotte stenting in our center. Results The procedures were successful in all cases without procedural complication and in-hospital major adverse cardiovascular events. The procedural time was (34. 3 ± 9. 6) min, fluoroscopic time was (18. 1 ± 3. 8) min, and contrast volume was (112. 0 ± 24. 5) ml, respectively. Post-procedurally, the residual stenosis of the main and the side branch were (10. 0 ± 2. 5)% and (10. 2 ± 5. 3)% , respectively. Conclusions The mono-ring culotte stenting is safe and feasible for treatment of true coronary bifurcation lesions, and may be superior to the conventional culotte stenting.

Objective To define the ideal COI and R-wave sensing values for optimized placement of right ventricular active-fixation pacing leads.Methods Three hundred and six patients underwent right ventricular active-fixation lead implantation in our department from January 2013 to December 2014 were enrolled in this prospective pilot cohort study.According to the times needed for successful implantation,patients were divided into group SP (success poisoning after single procedure,n =229) and group MP (success poisoning after multiple procedures,n =77).Current of injury (COI) was characterized as the magnitude of ST-segment elevation.Pacing parameters were measured up to 10 minutes after lead fixation.Results (1) COI at 1 minute (COI1,(9.34 ± 2.44) mV vs.(3.19 ± 1.36) mV,P ＜ 0.001) and 10 minutes (COI10,(4.99 ± 2.04) mV vs.(1.91 ± 0.62) mV,P ＜ 0.001) after lead fixation was significantly higher in SP group compared to MP group.R-wave sensing measured at 10 minutes after lead fixation (R10 min) was also significantly higher in SP group than in MP group ((14.2 ± 4.5) mV vs.(5.4 ± 0.7) mV,P ＜ 0.001).Pacing threshold measured at 10 minutes after lead fixation was significantly lower ((0.65 ±0.18)V vs.(1.90 ±0.40)V,P＜0.001) in SP group than in MP group.(2) The optimized placement of pacing lead was related with COI1 (OR =0.247,95％ CI0.098-0.623,P =0.003) and R10min (OR =0.081,95 ％ CI 0.015-0.428,P =0.003).(3) The cut-off value of COI1 was 4.77 mV (sensibility 0.97,specificity 0.95),the cut-off value of R10 min was 7.25 mV (sensibility 0.96,specificity 1.00) for optimized lead fixation.After 3 months follow up,pacing threshold was (0.68 ± 0.19)V,R-wave sensing was (12.1 ± 3.6)mV,and pacing impedance was (543 ± 107) Ω for right ventrieular active-fixation pacing leads.Conclusions COI1 ＞ 4.77 mV and R10 min ＞ 7.25 mV are the ideal parameters for identifying optimized placement of right ventricular active-fixation pacing leads.

OBJECTIVETo summarize the features of clinical manifestations, laboratory tests and imaging findings of patients with cardiac amyloidosis (CA).

METHODSA total of 60 CA patients (including 41 male and 19 female patients) from 4 centers admitted between May, 2012 and November, 2013 were included in the study. The demographic data, medical history, clinical manifestations, laboratory test data, ECG, cardiac ultrasound, and cardiac magnetic resonance (CMR) imaging of the patients were analyzed.

RESULTSTwo-thirds of the 60 CA patients, were middle-aged or elderly men, and 47% of the patients had AL-CA. The clinical manifestations included exertional dyspnea (73%), pedal edema (47%), hypotension (47%), and hypertrophy of the tongue (22%); abnormal laboratory test results included albuminuria (53%) and liver (15%) and kidney (28%) dysfunction; blood routine, urine and serum immunoglobulin quantification and immunofixation electrophoresis could help the screening of AL-CA. Kidney (53%) and liver (15%) involvement was common, and 86% of AL-CA patients had kidney involvement. Typical ECG characteristics included poor R wave progression (35%), low voltage in limb leads (33%), and a pseudo infarct Q wave (30%); the latter two were more frequent in AL-CA. The characteristics of ultrasound findings included left ventricle thickening (100%), left atrial enlargement (87%) and enhanced echo of the myocardial granules(92%), and diastolic dysfunction was obvious in all the CA patients regardless of the systolic function. The DT and E/e' of the mitral annulus could be used as an index to evaluate diastolic dysfunction in early stage of the disease. Left ventricular (LV) global subendocardial late gadolinium enhancement (LGE, 81%) accompanied by right ventricular (RV) and atrial LGE was the typical characteristic of CMR, and the range of LGE in the RV and the two atria was wider in AL-CA than in non-AL-CA. NT-proBNP (97%) and cardiac troponin (53%) in CA patients were both elevated, which helped in diagnosing and assessing the severity of cardiac involvement, according to which 50% of the patients were found to be at a high risk, 43% at an intermediate risk, and 7% at a low risk.

CONCLUSIONThe combination of the features of clinical, laboratory tests and imaging findings of CA have important diagnostic and prognostic value for CA.

Adult ; Aged ; Amyloidosis ; diagnosis ; pathology ; physiopathology ; Cardiomyopathies ; diagnosis ; pathology ; physiopathology ; Electrocardiography ; Female ; Humans ; Immunoglobulin Light-chain Amyloidosis ; Magnetic Resonance Imaging ; Male ; Middle Aged