Objective To evaluate the therapeutic effect of transcatheter closure of perimenbranous ventricular septal defect (PMVSD) with membranous VSD occluder device and compare the effect of transcatheter closure of VSD with surgery. Methods The therapeutic effect of transcatheter occlusion in 48 children with VSD is compared with that of other 73 cases who had received surgical treatment. Age, height, weight, pulmmary artery pressure, size of the defect, time for hospitalization, success rate as well as complications after operations are compared between the 2 groups. All the data are proccessed either by means of t test or ? 2 test statistically. Results There are no statistical differences between the two groups in age, height, weight, pulmonary systolic pressure and the rate of success. But the size of VSD is smaller and the time for operation and hospitalization is shorter in the group of transcatheter occlusion. There are no significant differences between the two groups in the rate of complications including the second surgery, residual shunt, bleeding, nerve injury, hemolysis, Ⅲ atrioventricular block, pneumothorax, hydrothorax, hydropericardium, aortic valve insufficiency and infection. But left anterior bundle branch block and complete left bundle branch block occur more often in the group of the catheter interventions during or after the occlusion. Conclusion Transcatheter occlusion shows a promising therapeutic effect on VSD. To prevent complications, therapeutic rules and technical criterias should be obeyed and close monitoring after the closure should be carried out.

The deltoid muscles on both sides of 8 male cadavers were studied within 24 hours after death. According to its fiber architecture, origins and insertions, and nerve distribution, the deltoid muscle was divided into three compartments: an anterior, a middle and a posterior. The muscle samples were taken respectively from the superficial and the deep portion of each compartment of the deltoid muscle. Frozen transverse sections were stained fer myosin ATPase. Muscle fibers were identified as type Ⅰ and type Ⅱ. The proportion of fiber types in each portion was calculated on microscopic photographs and mean cross-sectional areas of both fiber types were measured by imaging analytical system. The results showed that the proportion of type Ⅰ fiber in the superficial and deep portion of the middle compartment is significantly higher than that of the corresponding portion of the anterior and posterior compartments, and the proportion in the deep portion of each compartment is higher than that of the superficial one, however no difference was found between the left and right sides. The fiber size among all portions is not obviously different, but the diameter of type Ⅱ fiber in the deep portion of the middle compartment is significantly smaller than that of other portions. Except the deep portion of the middle compartment, the diameter of both fiber types of the right muscle is larger than those of the left one, although statistical analysis showed that the difference is not significant. The authors suggest that the difference of fiber type distribution within the deltoid muscle is closely related with the functional differentiation of the muscle and the characteristic higher typeⅠ fiber proportion and smaller type Ⅱ fiber diamiter in the deep portion of the middle compartment probably indicate that the main function of this portion is to keep the shoulder joint stability.

Objective To explore the method and therapeutic principle of transcatheter closure of coronary artery fistula, aortopulmonary collaterals and aortopulmonary window. Methods Interventional occlusion of 4 cases of coronary artery fistulas and 1 case of aortopulmonary collaterals with Cook coils, 1 case of coronary artery fistulas and 1 case of aortopulmonary window with AGA Amplatzer duct occluder. The mean age of 7 children were 8.5 years. Results Transcatheter closure of 7 cases of vascular malformations were successful. During the follow-up period of 1 month to 5 years, no residual shunt and other complications appeared. Conclusion The curative effect of transcatheter closure of vascular malformations was good. But for the occlusions′ success and prevention from complications occurrence, the indications of closure should be obeyed, the time of X-ray exposure should be less than 60 minutes.

Objective To analyze the incidence of complications during and after interventional therapy for common con-genital heart disease (CHD) in children. Methods From January 2011 to December 2013, interventional therapy of common congenital heart disease which include ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA) and pulmonary valve stenosis (PS) were performed in 2356 patients. Among them, 159 patients who developed complications during and post to interventional therapy were retrospectively analyzed. Results The overall complication rate was 6.75%(159/2356) (11.40% post VSD occlusion, 7.50% post ASD occlusion, 3.09% post PDA occlusion, 1.63% post percutaneous balloon pulmonary valvuloplasty (PBPV) ).The rate of arrhythmia was 4.41%(102/2356). The severe complication rate was 2.71%(64/2356) (3.62%post VSD occlusion, 2.21%post ASD occlusion, 2.53%post PDA occlusion, 1.63%post PBPV). The intraoperative severe complication rate was 0.51%(12/2356);the early severe complication rate was 1.99%(47/2356);the late severe complication rate was 0.21%(5/2356). Interventional therapy rate was 0.13%(3/2356); cardiovascular surgery rate was 0.64%(15/2356);conservative treatment rate was 1.95%(46/2356). The mortality rate was 0.08%(2/2356). Conclusions The complications and mortality rate of interventional therapy for CHD in children are relatively low, but cannot be ignored. The complication could be reduced by choosing proper indications, following the operational procedures and careful operative follow-up.

Objective To evaluate the safety and efficacy of percutaneous closure for muscular ventricular septal defect(MVSD).Methods Fifty-one patients diagnosed as MVSD from October 2011 to July 2016 at Guangdong General Hospital were enrolled including 32 males and 19 females,ranging from 1 to 16 (5.12 ±3.52) years in age,weight (20.19 ± 10.55) kg.The diameter of the MVSD was (4.82 ± 2.51) mm which was measured by transthoracic echocardiography (TTE),and multiple defects were found in 10 patients.The choice of plugging device and transport system depended on the size,position and status of MVSD.TTE and left ventricular (LV) angiography were performed before and after release of the device to evaluate the therapeutic effects.Electrocardiogram and TTE were performed during follow-up period at 24 h,1 month,3 months,6 months and 12 months after operation and yearly thereafter.Results Eight cases showed no hemodynamic significance through standard catheter examination then the interventional therapy was stopped.Cardiac arrest was found in 1 case when the long sheath was transported along the track,and the procedure was terminated immediately,and the selective surgical operation was performed after successful rescue.The devices were successfully placed in the rest of 42 patients (97.6％) with operation time (90.68 ± 36.42) min and fluoroscopy time (18.67 ± 10.89) min.The average of follow-up time was (13.82 ± 13.84) months ranging from 1 to 48 months.It was found that mild residual shunts showed in 4 cases during operation,mild tricuspid regurgitation showed in 2 cases and trivial aortic regurgitation showed in 1 case at 6 months after operation,but there was no need to intervene anymore.Conclusions Percutaneous closure of MVSD in children is safe and effective with high successful rate and low incidence of complication.The middle-term follow-up findings were satisfactory.

[ ABSTRACT] AIM:To investigate the characteristics of the intestinal microbial flora in the pregnant women with congenital heart disease fetus ( PW group) and normal pregnant women ( NW group) .METHODS: Stool samples were collected from 15 NW and 17 PW cases.The bacterial genomic DNA was extracted.The 16S rDNA was amplified by PCR, and the second generation of Illumina sequencing was conducted.RESULTS: We obtained 2 696 276 ( NW group) and 2 445 530 ( PW group) optimized sequences.The coverage was greater than 97%.We obtained 77 243 operational taxono-mic units ( OTUs) in NW group and 75 600 OTUs in PW group after a 97%similarity merge.In NW group, the Chao 1 in-dex and the Shannon index were greater than those in PW group.The diversity analysis of microbial population indicated that they were mainly composed of Firmicutes, Proteobacteria and Actinobacteria.In family, the Bifidobacteriaceae and Cori-obacteriaceae were significantly different through analysis of variance.CONCLUSION: The Bifidobacteriaceae and Cori-obacteriaceae may play an important role in the occurrence of congenital heart disease.

abnormality from cardiomyopathy and endocardial fibroelastosis. Some pediatric patients have overlapped characteristics of both infant and adult type.

Objective To analyze the causes of failed transcatheter closure for ventricular septal defects (VSD)in children. Methods One thousand two hundred and eighty children aged 13 to 141 months who underwent transcatheter closure from June 2009 to September 2013 in Guangdong General Hospital were selected. There were 43 failures(3. 36% ). The clinical data including transthoracic echocardiograph( TTE),radiography,interventional ap-proach and surgical findings were analyzed. Results Forty - three patients included 25 male and 18 female. The pa-tients' ages ranged from 13 to 141(43. 0 ± 31. 9)months and their weight ranged from 10 to 35(16. 3 ± 5. 59)kg. The causes of failure including doubly committed subarterial VSD misdiagnosed as perimembranous VSD(PMVSD)or intracristal VSD were in 6 patients. The size of occluder was too small in 13 cases,and there were statistical differences between three measurements of size of VSD(F = 19. 134,P = 0. 001). The size of VSD measured by left ventricular an-giography was significantly smaller than that measured by TTE,and there was statistical difference[(4. 78 ± 1. 11) mm vs(6. 48 ± 1. 43)mm,t = 4. 50,P = 0. 001]. The dimension of VSD measured by left ventricular angiography was significantly smaller than that measured by surgical findings,and there was statistical difference[(4. 78 ± 1. 11) mm vs(7. 02 ± 1. 08)mm,t = 5. 92,P = 0. 001]. But,the size of VSD measured by TTE had no significant difference compared with that measured by surgical findings(t = 1. 42,P = 0. 168). Aortic regurgitation occurred in 14 cases;atrioventricular block or left bundle branch block in 3 patients;tricuspid stenosis in 2 cases and residual shunt in 5 pa-tients. Conclusions Doubly committed subarterial VSD may be misdiagnosed as PMVSD or intracristal VSD. In the ca-ses of VSD concomitant with aortic valve prolapse,size of the occluders should be referred to VSD dimensions measured by TTE. In the cases of VSD adjacent to aortic valve,suitable occluders should be selected and operation technique should be improved to avoid aortic regurgitation.

Objective To observe and analyze the medium and long term follow-up data of arrhythmias after transcatheter closure of children with ventricular septal defect (VSD). Methods Retrospectively analyzed the clinical data of 1071 children with VSD, who successfully underwent transcatheter device closure, at l, 3, 6, 12 months and ev-ery year post procedure from March 2002 to December 2010. Results Of all 1071 children, 272 cases (25.4%) were ob-served of having arrhythmias within 1 month after intervention, mainly including atrioventricular block (AVB), branch block, junctional tachycardia, atrial and ventricular tachycardia, frequent contractions, etc. Among them, 22 cases (2.1%) had above II degree AVB, complete left bundle branch block (CLBBB) and other causes of serious arrhythmias. After treatment, all cases got better and no permanent pacemaker was necessary. After 1 to 107 months (2.8±1.7 years) fol-low-up, 161 cases (18.2%) were observed of having persistent abnormal ECG mainly caused by AVB and branch block, including 10 cases (1.1%) with serious arrhythmias. In 4 cases with late-onset AVB, 3 cases had already appeared AVB in early postoperative, 1 case had recurrence CLBBB, left ventricle enlarge, and died of heart failure during follow up. Four cases were implanted permanent pacemaker. Conclusion During follow-up, serious arrhythmias after VSD closure, such as AVB or CLBBB, have high risk of recurring. Conduction block arrhythmias may reappear or worsen, while arrhythmias like tachycardia and premature heart rhythm mostly return to normal.

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.