Atrial fibrillation (AF) is a common kind of arrhythmia,it is one of the main reasons causing ischemic stroke in aged patients.Left atrial appendage is the primary site where the thrombus is formed in non-valvular atrial fibrillation (NVAF) patients.Recent researches have indicated that occlusion of left atrial appendage can effectively reduce the occurrence of ischemic stroke in NVAF patients,its curative effect is no less than the preventive treatment effect of warfarin.The use of an ideal left atrial appendage occluder is the key to ensure a successful occlusion of the left atrial appendage.After decades of research,several left atrial appendage occluders have been developed,among them Watchman occluder and Amplatzer cardiac plug (ACP) are commonly used nowadays in clinical practice,and some kinds of occluder are still at their experimental research stage.This article aims to make a brief introduction about the current status of the study and the clinical application of left atrial appendage occluder.(J Intervent Radiol,2017,26:281-284)

Clinically, atrial fibrillation (AF) is one of the most common cardiac arrhythmia, and patients with arterial fibrillation carry high risk of stroke. Oral administration of anticoagulation such as warfarin for the prevention of stroke has some risks to induce bleeding; moreover, some patients are not able to tolerate the medication. Percutaneous occlusion of the left atrial appendage is safe and effective for the prevention of stroke in patients with atrial fibrillation, although at present it is only used for the patients who have contraindications to anticoagulation medication. This paper aims to review a variety of left atrial appendage occlusion devices and to analyze the relationship between the different shape design of occluder and the left atrial appendage morphology.

Objective:To evaluate the feasibility of implanting a new self-expanding valved stent for aortic valve implantation and its influence on coronary blood flow. Methods:We designed a self-expanding valved stent made from super-elastic memory nitinol alloy,with a tubular shape and a wide mesh in the cavate middle part. A valvular ring made of nitinol wire was sutured on the lower part. Fresh porcine pericardium was decellularized,treated with 0. 6% glutaraldehyde solution for 36 h,trimmed into leaflets,and sutured by hand into the valvular ring. The valved stent was pulled into a 14-French sheath by a silk and positioned in the left ventricle of isolated pig heart via the ascending aorta,and then deployed over the native aortic valves by pulling back the outer sheath. Water was injected into the ascending aorta by a silicon tube to evaluate the competence of the prosthetic heart valves and its effect on coronary flow. Results:The prepared valved aortic stent could be stably positioned over the native valves and could be removed after deployment. The prosthetic heart valves showed a satisfactory function and had no influence on coronary flow and mitral valve motion. Conclusion:This self-expanding valved stent is well-designed and allows for aortic valve implantation over the native valves without interfering the coronary flow; it can be evaluated further in vivo.

Objective To analyze the clinical efficacy of multiple renal arteries on outcomes of renal donors and recipients in hand-assisted retroperitoneoscopic donor nephrectomy.Method From 2012 to 2014,121 patients underwent hand-assisted laparoscopic donor nephrectomy,including 92 cases of a single renal artery and 29 cases of multiple arteries.Donor and recipient outcomes for single artery and multiple arteries allografts were compared.Result The study included 121 pairs of donors and recipients.The demographic characteristics between multiple renal artery group and single renal artery group had no significant difference.The operative time,blood loss,postoperative complications,and hospital stay had no significant difference between two groups.Cold ischemia time and warm ischemia time in multiple renal artery group were longer than single donor renal artery group (128.5 ± 13.2 vs.50.2 ± 17.3 min,P＜0.001;196.0 ± 63.3 vs.154.1 ± 55.2 min,P=0.002,respectively).The operative time in multiple renal artery group was longer than in single renal artery group (213.5 ± 28.2 vs.182.2 ± 31.1 min,P＜0.001).There was no significant difference in blood loss,vascular complications and ureternal complications between two groups.The renal functions of two groups were likewise within one year.Conclusion There was no statistically significant difference in clinical efficacy between hand-assis-ted retroperitoneoscopic donor nephrectomy with multiple renal arteries and single artery.The use of these grafts was safe for both recipients and donors.

Objective To examine the relationship between hypercalcemia (HC) and the development of posttransplant erythrocytosis (PTE).Method 169 patients with normal graft function who underwent renal transplantation between January 1, 2012 and January 1, 2014 in 309th Hospital of PLA were retrospectively reviewed.Result 169 patients with normal graft function who underwent kidney transplantation for the first time in 309th Hospital from January 1, 2012 to January 1, 2014 were enrolled, including 121 males and 48 females.During the follow-up period, PTE appeared in 48 (28.4％) patients.Thirty-three (19.5％) patients developed HC, PTE occurred in 17/33 (51.5％) patients with HC, and in 31/136 (22.8％) patients without HC.PTE and HC were highly correlated (P＜0.001).Serum calcium levels tended to increase in patients with PTE, but significantly decreased in patients without PTE.HC patients had a higher probability of PTE (51.5％ vs.22.8％;P＜0.001).Similarly, HC was more common among patients with PTE compared with patients without PTE (35.4％ vs.13.2％;P＜0.001).Simple linear regression analysis showed that calcium concentration was independent predictor of hemoglobin levels (P＜0.01).In multivariate analysis, multiple linear regression model showed that the calcium concentration was still a significant predictor of hemoglobin levels (P＜0.001).Multivariate logistic regression analysis showed that the occurrence of HC was an independent risk factor of PTE (P =0.01).Estimated glomerular filtration rate was also associated with PTE (P =0.012).As compared with women, the relative risk of men who had PTE was 4.373 times (P＜0.05).The risk of PTE in patients with HC was about five times higher than in patients with normal blood calcium.Conclusion HC is associated with PTE.HC may lead to the increased PTE in renal transplant recipients.

Objective To discuss the clinical efficacy and safety of improved wire- maintaining technique in performing transcatheter closure of ventricular septal defects. Methods During the period from June 2011 to June 2013 at Changhai Hospital, percutaneous transcatheter closure of ventricular septal defect with improved wire-maintaining technique was carried out in 62 patients. According to the manipulation used , the patients were divided into traditional wire-maintaining technique group (group A, n = 30) and improved wire- maintaining technique group (group B, n = 32). The use of occluder during the procedure, the fluoroscopy time, the operation time and the complications were recorded. Follow-up examinations with ECG, echocardiogram and chest radiograph were performed at 24 hours and at 1 , 3 and 6 months after the procedure. The results were analyzed. Results No statistically significant differences in the use of occluder and in the incidence of complications existed between the two groups (P > 0.05). No severe complications occurred in both groups. The fluoroscopy time and the operation time in group A were (11.96 ± 3.63) min and (53.43 ± 14.48) min respectively, while the fluoroscopy time and the operation time in group B were (9.37 ± 2.77) min and (45.34 ± 10.38) min respectively, and the differences between the two groups were statistically significant (P < 0.05). Conclusion In performing transcatheter closure of ventricular septal defects, the practice.

Objective To explore the feasibility and effectiveness of interventional transcatheter destruction of the aortic valve to establish an animal model with acute aortic valve regurgitation. Methods Eight healthy goats were used for this study. A limited sternotomy approach was used to access the apex of the heart. Puncturing of the apex of the heart was performed to establish a wire track, then, under fluoroscopic guidance a 10 F sheath was inserted along this track of hard wire until to the ascending aorta above the aortic valve. The internal sheath was removed. Via the 10 F sheath a 10 mm occluder of ventricular septal defect (VSD) was introduced into the ascending aorta above the aortic valve. The sheath was pulled back to the left ventricle, while the occluder remained in the ascending aorta above the aortic valve. Then the occluder was quickly pulled back into the left ventricle in order to make some certain damage to the aortic valve. And an acute aortic valve regurgitation model was thus established. Angiography of ascending aorta above the aortic Among the 8 animals, two died of acute left ventricular failure on the spot due to excessive regurgitation blood flow after the operation. Macroscopically, damage of the aortic valve was seen. In the six survivors, angiography of ascending aorta above the aortic valve and Doppler echocardiography showed that moderate degree of regurgitation was detected in 5 and small amount of regurgitation in one. Two experimental goats with moderate degree of regurgitation died of heart failure separately at seven days and fifteen days after the operation. The remaining four experimental goats survived for more than three months. Follow- up checkups with echocardiography suggested the presence of mild- moderate degree of regurgitation. Conclusion Acute aortic valve regurgitation model in experimental goats can be established through transapical transcatheter damage of aortic valve by quickly pulling back a VSD occluder which has been placed in the ascending aorta above the aortic valve. This method is clinically feasible, technically simple and repeatable, the result is reliable, and the degree of regurgitation is controllable.

Objective To observe the curative effect and adverse reaction of benazepril on polycythemia (PTE ) after renal transplantation. Methods Twenty-two patients undergoing kidney transplantation for the first time at the Department of Urinary Surgery of the 309 th Hospital of People's Liberation Army and developed PTE after renal transplantation from June 2012 to June 2013 were enrolled as the object of study.The patients were divided into the hypertension group (n =14)and the normal blood pressure group (n =8)according to whether the patients were with hypertension or not.The hypertension group was given benazepril with an initial dose of 10 mg/d and increased to the maximum dose of 40 mg/d according to the changes of patients’conditions.The normal blood pressure group was given benazepril with an initial dose of 5 mg/d and with the maintenance dose of 2.5 mg/d after hemoglobin and hematokrit returning to normal.The patients in two groups were followed up for 6 months.The curative effect and adverse reactions during the follow-up were compared between the two groups.Results After 6 months of treatment,12 patients had marked effect,1 had effect and 1 was improved in the hypertension group.Six patients had marked effect, 1 had effect and 1 had no effect in the normal blood pressure group.The difference of efficacy had no statistical significance between the two groups (P >0.05).During the treatment,the blood pressure of the hypertension group dropped significantly (P <0.05 ),while that of the normal blood pressure group had no significant change.Red blood cells,neutrophils,platelets,serum creatinine,uric acid and estimated glomerular filtration rate of the two groups had no obvious abnormality before and after treatment.One patient in the hypertension group developed irritable cough during the treatment and recovered after withdrawal.Conclusions It is safe and effective to take benazepril for patients with PTE after renal transplantation.It is recommended to start with small dose and the dose shall be adjusted according to blood pressure.The blood pressure,blood routine and renal function shall be monitored during the treatment.

Objective To investigate the effect of body mass index (BMI)on short-term prognosis of patients after renal transplantation.Methods Clinical data of 1 041 adult patients undergoing the first renal transplantation in the Institute of Organ Transplantation of the 309 th Hospital of People's Liberation Army from March 2009 to March 201 3 were retrospectively studied.According to the Adult Obesity and Overweight Standard commonly used in China,these patients were divided into 4 groups:112 patients in BMI <1 8.5 kg/m2 group (emaciation group),606 patients in BMI 1 8.5-23.9 kg/m2 group (normal group),250 patients in BMI 24.0-27.9 kg/m2 group (overweight group)and 73 patients in BMI≥28.0 kg/m2 group (obesity group).The incidence of delayed graft function (DGF)and acute rejection (AR)of the 4 groups one year after renal transplantation were observed and compared.One-year patient and graft survival rates were calculated.The relationship between BMI and DGF was studied by univariate and multivariate Logistic regression analysis to investigate the effect of different BMI on DGF.Results After the follow-up for one year,the incidence of DGF in the obesity group was significantly higher than that in the emaciation group and the normal group(both in P <0.05).The difference in the incidence of acute rejection one year after renal transplantation as well as one-year patient or graft survival rate had no statistical significance (all in P >0.05).Univariate analysis showed that obesity increased the risk of DGF after renal transplantation (OR was 1 .33,P <0.05).Multivariate analysis showed that both overweight and obesity were independent risk factors of DGF after renal transplantation (OR was respectively 1 .56 and 1 .37,both in P <0.05).Conclusions Overweight and obesity increases the risk of DGF after renal transplantation,but do not increase the incidence of AR after renal transplantation and do no influence short-term patient and graft survival rates after renal transplantation.

Objective To evaluate the feasibility and safety of a delivery pathway for the performance of percutaneous left atrial appendage (LAA) occlusion in experimental canine models. Methods Transseptal puncture was performed via femoral vein approach under fluoroscopic and angiographic guidance in 12 experimental dogs. A pigtail catheter was advanced into the left atrium (LA), which was followed by LA angiography. The diameters of the neck of LAA were measured on LAA angiogram obtained in appropriate projection. After the delivery sheath was advanced along the wire into LA, a pigtail catheter was inserted into the ostium of the LAA and the sheath was then advanced over the pigtail into the LAA. LAA angiography was then performed through the delivery sheath to confirm the position of the delivery sheath. One hour after the procedure both electrocardiography (ECG) and transthoracic echocardiography (TTE) were carried out in five dogs to check the results, immediately after which the five dogs were sacrificed to macroscopically observe the damages of the puncture site of inter-atrial septum as well as inside the LA and LAA. One hour and 2 weeks after the procedure TTE was conducted in the remaining 7 dogs and these dogs were followed up for one month. Results One dog died of pericardial tamponade during the operation. In 8 dogs the LAA was clearly displayed in the projection position of right anterior oblique (RAO) 30°/cranial (CRA) 20°,while in 3 dogs the LAA was well visualized in the projection position of RAO 30° , and in one dog in the projection position of RAO 30°/caudal (CAU) 20°. The diameter of LAA neck was (13.6 ± 5.2) mm. The delivery sheath was safely advanced into the LAA along the pigtail catheter in all dogs, and no air embolism, thrombus or pericardial tamponade occurred. Hematoma at puncture point of groin occurred in 2 dogs, which was absorbed through pressure dressing. Macroscopic examination of the heart performed immediately after the operation showed that no bloody pericardial effusion was found, and mild hematoma at posterior wall of LA was seen in one dog and mild damage of the upper-margin intima of LAA was noted in 2 dogs. The mean fluoroscopy time was (10.1 ± 2.5) minutes and the mean operation time was (58 ± 12) minutes. TEE showed no pericardial effusion 2 weeks after the procedure. During the follow-up period of one month no sudden death, stroke or infection occurred. Conclusion This method of placing the delivery sheath into the LAA is clinically safe and effective, and it can reliably establish a pathway to advance the LAA occluder into LAA.