Objective To investigate the efficacy and safety of percutaneous patent ductus arteriosus (PDA) closure via femoral vein solely under transesophageal echocardiography guidance.Methods From May 2014 to May 2015,28 patients(13 boys,15 girls) were selected in Dalian Children's Hospital Affiliated to Dalian Medical University with PDA closure via the femoral vein under transesophageal echocardiography guidance,with mean age (3.5 ± 2.6)years and mean body weight (16.0 ± 6.5) kg.The mean diameter of PDA was (7.1 ± 3.9) mm.Patients were all treated by percutaneous PDA closure solely by transesophageal echocardiography via the femoral vein.The effect of the procedures was evaluated by echocardiography.The transthoracic echocardiography,chest X-ray film,cardiogram at 1 month,3 months and 6 months after procedure were followed up.Results Twenty-seven cases were successfully treated with percutaneous PDA closure via the femoral vein solely under transesophageal echocardiography guidance,while 1 patient was closed by surgical closure with on-pump beating-heart because PDA occluder strayed into the left pulmonary artery on 1-month follow-up.The procedural time was (48.5 ±8.7) min.The mean diameter of PDA occluder was (8.2 ± 4.1) mm.Twenty-seven patients survived without peripheral vascular injury or complications such as residual shunt,arrhythmia and cardiac perforation.One patient was transformed to surgical closure.Hospitalization time was (2.5 ± 0.5) days.At one month follow-up,no complications such as residual shunt or pericardial effusion occurred.Conclusion Transesophageal echocardiography guided percutaneous PDA closure via the femoral vein approach is safe and effective without the damage from radiation and contrast agents,and aviods the use of femoral artery puncture.

Objective:To summarize the experience in diagnosis and treatment of primary cardiac tumors in pediatric patients.Methods:Retrospectively analyzing 7 pediatric patients who were suspected as primary cardiac tumors and diagnosed and treated in Department of Heart Center, Children′s Hospital of Dalian Medical University from August 2013 to February 2019.All patients underwent echocardiography and other examinations, so as to confirm the diagnosis and the treatment plan was chosen based on the size and location of the tumor.All patients were followed up after discharge.Results:A total of 7 patients were diagnosed as primary cardiac tumors by echocardiography, among which 5 cases underwent surgical treatment, and 2 cases were diagnosed with tuberous sclerosis without surgery.In children undergoing surgery, 1 patient underwent autologous heart transplantation to remove the tumor, 1 patient had arrhythmia, 1 patient had mitral regurgitation after surgery, and the mitral regurgitation was corrected again.The remaining children had no adverse complications and were discharged successfully.Histologic examination revealed rhabdomyoma in 4 patients, and fibroma in 1 patient.The patients were followed up for 2-66 months after discharge, and no tumor recurrence was observed in the children who performed surgery.There was a trend of spontaneously regress of cardiac tumor in 2 patients without surgery.Conclusions:Echocardiography is the first choice for the diagnosis of primary cardiac tumors in Pediatric patients.Rhabdomyoma is the most prevalent histologic type of primary cardiac tumors, and tuberous sclerosis should be excluded during the diagnosis process.Patients with tuberous sclerosis selected conservative treatment, and surgical treatment was selected for children with obvious symptoms.According to the location and size of lesion, therapy strategies should be chosen and autologous heart transplantation can be adopted to remove the tumor for children with large tumors.Autologous heart transplantation to remove the tumor is a good surgical treatment.

Objective To explore the safety and therapeutic effect of transesophageal echocardiography(TEE)-guided transthoracic minimally invasive intervention for congenital heart disease complicated with compound heart ab-normalities in children.Methods From September 2013 to January 2018,32 children with congenital heart disease complicated with compound heart abnormalities were collected,who undergoing TEE-guided transthoracic minimally invasive intervention at the Department of Cardiothoracic Surgery,Dalian Children's Hospital were collected.There were 6 cases of ventricular septal defect (VSD)combined with atrial septal defect (ASD),11 cases of VSD combined with patent ductus arteriosus (PDA),9 cases of ASD combined with PDA,3 cases of VSD combined with pulmonary stenosis (PS),and 3 cases of ASD combined with PS.TEE-guided transcatheter closure was performed within a minimally in-vasive transthoracic minimal incision (1 -2 cm)under non-cardiopulmonary bypass.The efficacy of the procedure was evaluated by TEE.The transthoracic echocardiography,chest film and cardiogram after post-procedure examina-tions were followed.Results TEE-guided transthoracic minimally invasive perventricular intervention was successfully performed in all the sick children.The mean duration of operation,intensive care unit monitoring and ventilation were (54.2 ± 21.8)min,(14.3 ± 8.7)h and (3.7 ± 2.9)h,respectively.No patient received diuretic drugs,sedation drugs,blood transfusion or conventional surgical repair. The follow - up period for all the patients lasted 12 -48 months.No arrhythmias,residual shunts or occluder detachments,or thrombosis,hemorrhage,or new valve regurgitation occurred.Conclusions TEE -guided transthoracic minimally invasive intervention is feasible and has a promising prognosis for young children with congenital heart disease combined with compound heart abnormalities.

Clinical data of 23 children with atrial septal defect and pulmonary valvular stenosis admitted in Dalian Children′s Hospital during March 2015 to March 2018 were retrospectively analyzed. Twenty patients were treated with percutaneous closure of atrial septal defect through femoral vein first, then transthoracic echocardiography-guided balloon pulmonary valvuloplasty was performed; while 3 patients had no balloon pulmonary valvuloplasty after percutaneous closure of atrial septal defect. Patients were followed up by transthoracic echocardiography and all were doing well. The transvalvular pressure fell under 35 mmHg (1 mmHg=0.133 kPa) [(19.5±1.9)mmHg] in all patients, which was significantly lower than that before treatment [(62.0±7.8 mmHg)] (t=28.92, P<0.01). During follow-up, no residual shunt of atrial septal defect was found; and mild pulmonary regurgitation occurred in 3 cases. The study indicates that combined percutaneous treatment with transthoracic echocardiography guidance is effective and safe for children with atrial septal defect and pulmonary valvular stenosis. The pulmonary artery stenosis of some patients can be alleviated, after closuring of the atrial septal defect.

Objective    To summarize the minimally invasive experiences and medium-long-term results of perventricular device closure of ventricular septal defects (VSD) under transesophageal echocardiography (TEE) guidance. Methods    We retrospectively analyzed the clinical data and medium-long-term follow-up results of 783 patients who undertook perventricular device closure under TEE guidance in Dalian Children’s Hospital from July 2011 to January 2020, in which perimembrane VSD were found in 598 patients, VSD with aortic valve prolapse in 135 patients and muscular VSD in 2 patients. There were 463 males and 320 females at age of 5 months to 13 years with average age of 3.3±1.2 years, and body weight of 5.9-51.0 (15.9±8.3) kg. The left ventricular defect diameter of the VSD ranged from 5.0 to 11.0 mm, with an average of 6.3±1.2 mm. The right ventricular defect diameter of the VSD ranged from 2.3 to 8.0 mm, with an average of 4.3±0.9 mm. Results    The procedures were completed successfully in 753 patients. The device of 1 patient (0.1%) fell off and embedded in the right pulmonary artery after the operation, and the occluder was taken out and the VSD was closed with cardiopulmonary bypass (CPB) in the secondary operation. One patient (0.1%) appeared Ⅲ degree atrioventricular block in 2 years after operation. The device was taken out and VSD was closed with CPB in the  secondary operation, and the patient gradually reached to sinus rhythm in post-operation. Eight patients (1.1%) presented delayed pericardial effusion in 1 week after operation, and were cured by pericardiocentesis with ultrasound-guided. Symmetric occluders were used in 580 patients, eccentric occleders were used in 171 patients and muscular occluders were used in 2 patients. The follow-up time was 9 months to 9 years. The rate of loss to follow-up was 96.7% (704/728). No residual shunt, occlude-loss or arrhythmia was found during follow-up. Conclusion  The minimally invasive penventricular device closure of VSD guided by TEE is safe and availabe. Medium-long-term follow-up results are satisfactory, it is worthy of clinical promotion, and longer term follow-up is still needed.

Objective    To evaluate the clinical efficacy of fistula repair by stapler technique in patients with cervical tracheoesophageal fistula. Methods    Retrospective analysis of 8 patients with cervical tracheoesophageal fistula who accepted operative treatment in the Department of Thoracic Surgery, Lanzhou University Second Hospital from October 2014 to October 2016 was conducted. There were 5 males and 3 females at a mean age of 46.4±13.9 years ranging from 23 to 67 years. The fistula was induced by tracheal intubation in 4 patients, by esophageal foreign bodies in 2, by tracheal stent in 1 and by esophageal diverticulum in 1. The fistula was closed by stapler technique. The surgical effects were evaluated through Karnofsky performance score (KPS), image assessment, patient satisfaction score and assessment of improvement in feeding-induced bucking. Results    The operations were performed successfully with time of 117.5±6.6 min and intraoperative blood loss of 60.0±7.0 ml. After the operations, the patients did not suffer incision bleeding and infection, hoarseness, dyspnea, drinking-induced bucking, fistula relapse, tracheoesophageal stenosis or any other complications, and no death occurred during the perioperative period. The chest X-ray test was performed 1 week later showed that the pulmonary infection disappeared, and only 1 patient suffered from esophageal stenosis 1 year later. The postoperative KPS score was 90.0±7.0 points, which significantly improved in contrast to preoperation (P<0.01).   Postoperative pulmonary infection area reduced significantly (P<0.05), tracheoesophageal fistula disappeared, postoperative patients satisfaction rate was 90%, and assessment of feeding-induced bucking was excellent. Conclusion    Using stapler technique to repair cervical tracheoesophageal fistula is safe, easy and useful, with less operation time and postoperative complications.

Objective    To share the experience of treating special cardiac malformations by applying minimally invasive techniques. Methods    Eight children with special cardiac malformations admitted to our hospital from July 2014 to September 2020 were recruited, including 3 males and 5 females, aged 0.8-1.2 (1.1±0.4) years, and weighted 7.8-11.5 (9.6±2.9) kg. There were 2 patients of huge muscular ventricular septal defect (VSD), 3 perimembranous cribriform VSD, 1 right coronary-right atrial fistula, 1 right coronary-right ventricular fistula, and 1 young, low-weight child with large aortopulmonary. All were treated with minimally invasive techniques using transesophageal echocardiography (TEE) as a guiding tool. All children received intraoperative TEE immediately to evaluate the curative effect of the surgery, and all went to outpatient clinic for reexamination of echocardiography, electrocardiogram and chest X-ray after discharge. Results    Eight children underwent minimally invasive surgery successfully without any incision infection, intracardiac infection, arrhythmia or pericardial effusion. None of the 8 children were lost to follow-up, and the results of all reexaminations were satisfactory. Conclusion    The application of minimally invasive techniques is a bold and innovative attempt for the treatment of a few special types of cardiac malformations. It has significant advantages in reducing trauma and medical costs in some suitable patients, and has certain clinical reference values.