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经胸微创膜部室间隔缺损封堵术围术期炎症因子的变化

先天性心脏病介入治疗48例

目的 总结对先天性心脏病患者行介入治疗的临床经验，以提高介入治疗的成功率。 方法 48例先天性心脏病患者采用Cardiacure-TM封堵器行介入治疗，其中房间隔缺损（ASD）21例，动脉导管未闭（PDA）12例，室间隔缺损（VSD）12例，ASD合并PDA 1例，VSD合并PDA 2例。 结果 全组患者无死亡，一次性封堵成功44例，介入封堵治疗成功率为91.7％（44/48）;15例次 PDA患者介入封堵治疗成功率为100％（15/15）; 22例次ASD患者成功率为90.9%（20/22）, 14例次VSD患者成功率为85.7％（12/14）。 封堵伞于术中脱落3例，其中ASD伞脱落2例，VSD伞脱落1例；介入治疗未成功1例。4例封堵未成功的患者中3例择期行体外循环修补手术治愈，1例行急诊体外循环修补手术治愈。随访40例，随访时间1~19个月，复查心脏杂音消失，心脏彩色超声心动图提示无残余分流。 结论 介入治疗是治疗先天性心脏病的有效方法，心胸外科医师掌握该项技术有其较多的优势。

Perventricular Closure of Atrial Septal Defect and Ventricular Septal Defect Through a Single Port: The Initial Experience

目的评价单穿刺点经胸微创封堵治疗房间隔缺损（ASD）合并室间隔缺损（VSD）的安全性及有效性。 方法纳入2014年6月至2015年8月于我院成功完成单穿刺点经胸微创封堵术治疗ASD合并VSD的8例患儿，分析患儿在术后第l个月、3个月、6个月的门诊随访资料。观察围术期及随访期间患者残余分流、瓣膜反流、心律失常等并发症发生情况。 结果8例患儿中，术后早期均无残余分流、心律失常，微量三尖瓣反流（TR）患者1例（12.5%）。平均随访时间5～9（6±2）个月，各瓣膜均未发现中度及以上反流，未发现存在血栓、严重心律失常、死亡的患者。 结论单穿刺点经胸微创封堵治疗ASD合并VSD安全、有效，且更为微创。

急性心肌梗死室间隔穿孔介入封堵后残余分流致急性左心衰竭一例

Clinical evaluation of endoscopic bronchial closure of central airway-pleural fistulas with the atrial septal defect occluders: long-term follow-up

Objective To explore the safety and efficacy for patients with central airway-pleural fistula (APF) treated by atrial septal defect (ASD) occluder. Methods This was a retrospective study. Between January 2017 and October 2021, a total of 16 patients with postoperative APF were treated with ASD occluder through bronchoscope under local anesthesia combined with sedation. The efficacy and complication were recorded during and after the procedure. Results Sixteen patients were recruited in this study and the average age was 60.7 years (range 31 - 74 years). The main etiology for APF was lobectomy/segmentectomy (n=12), pneumonectomy (n=2), radical esophagectomy (n=1) or decortication for chronic empyema (n=1). Totally, 4 fistulas were located in right main bronchus, 3 in left main bronchus, 3 in right upper bronchus, 1 in right middle bronchus, 2 in right lower bronchus and 3 in left upper bronchus. The median diameter of APF was 7.8 mm (ranged from 4 to 18 mm) and the median diameter of ASD occluder inserted was 10.0 mm (ranged from 6 to 20 mm). Successful occlusion of APF was observed in 15 patients (15/16) and 1 patient died of multiple organ failure caused by bacteremia 14 days after the procedure. Fourteen patients were recruited for long-term follow-up, on a median follow-up period of 16.2 months (ranged from 3 to 46 months). There were 12 patients of complete remission and 2 patients of partial remission and only one patient took a second operation due to the enlargement of fistula and translocation of occluder. At follow-up, 4 patients died and the reasons were directly related to the primary etiology, and no patient died due to APF recurrence. Conclusion Endobronchial closure of central APF using ASD occluder is a minimally invasive but effective modality of treatment with satisfactory long-term outcome.

经胸微创室间隔缺损封堵术38例临床分析

目的 探讨食管超声心动图（ TEE）引导下应用国产封堵器经胸微创封堵室间隔缺损（VSD）的临床价值。方法 回顾性分析自2011年5月至2012年5月内蒙古医学院第一附属医院38例VSD患者的临床资料，，男20例，女18例；年龄2.6～13.0岁；体重10～35 kg。其中膜部VSD 30例，干下型VSD 6例，肌部VSD 2例。术前经胸超声心动图检查符合封堵条件者在全身麻醉下经口插入食管超声探头，手术开始前重新评估VSD是否符合封堵治疗，如符合，根据VSD最大直径选择合适的封堵伞。于手术开始后，监测整个封堵过程，引导封堵伞的位置，评价即刻封堵效果，确认是否有残余分流及并发症。 结果 38例患者均一次封堵成功，置入封堵器直径4～10 mm，TEE显示封堵器与VSD边缘吻合紧密无残余分流。术后4～7 d复查心脏彩色超声心动图提示封堵器位置正常、牢固，无残余分流，主动脉瓣无反流。随访31例，随访时间10～24个月，未出现新的瓣膜和主动脉瓣反流，无溶血和血栓形成，无封堵器位置移动现象，未发现左、右心室流出道狭窄，手术切口隐蔽，基本不影响美观。 结论经胸微创VSD封堵术安全、有效，无需体外循环、创伤小，无需X线辅助，住院时间短，使该手术成为更简便、可行、成功率更高的封堵方法，值得临床广泛推广应用。

A case of perivalvular leakage and attempt of closure operation after transcatheter aortic valve replacement

This paper reported a 75-year-old female patient. She was admitted to our hospital for “repeated chest pain, shortness of breath for more than 5 years, and syncope 3 times”. The CT scan of the patient showed severe aortic valve stenosis, bicuspid valve, and severe calcification; then she underwent transcatheter aortic valve replacement in our hospital. After the prosthesis was implanted, there was a significant paravalvular leak. Considering the triangular area formed between the calcified clumps, the valve was not fully dilated. Paravalvular leak closure was performed during the operation, attempted through the valve stent mesh to closuring. A rare incarceration of the transmitter occurred. An attempt was made to pull out the incarcerated transmitter through a pull-up technique, which resulted in the prosthesis prolapse. The patient was eventually transferred to surgery aortic valve replacement.

Efficacy of transthoracic device closure versus traditional surgical repair on atrial septal defects: A systematic review and meta-analysis

ObjectiveTo compare the effects of transthoracic device closure and traditional surgical repair on atrial septal defect systemically.MethodsA systematic literature search was conducted using the PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBM, Wanfang Database up to July 31, 2018 to identify trials according to the inclusion and exclusion criteria. Quality was assessed and data of included articles were extracted. The meta-analysis was conducted by RevMan 5.3 and Stata 12.0 software.ResultsThirty studies were identified, including 3 randomized controlled trials (RCTs) and 27 cohort studies involving 3 321 patients. For success rate, the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.34, 95%CI 0.16 to 0.69, P=0.003). There was no statistical difference in mortality between the two groups (CCT, OR=0.43, 95%CI 0.12 to 1.52, P=0.19). Postoperative complication occurred less frequently in the transthoracic closure group than that in the surgical repair group (RCT, OR=0.30, 95%CI 0.12 to 0.77, P=0.01; CCT, OR=0.27, 95%CI 0.17 to 0.42, P<0.000 01). The risk of postoperative arrhythmia in the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.56, 95%CI 0.34 to 0.90, P=0.02). There was no statistical difference in the incidence of postoperative residual shunt in postoperative one month (CCT, OR=4.52, 95%CI 0.45 to 45.82, P=0.20) and in postoperative one year (CCT, OR=1.03, 95%CI 0.29 to 3.68, P=0.97) between the two groups. Although the duration of operation (RCT MD=–55.90, 95%CI –58.69 to –53.11, P<0.000 01; CCT MD=–71.68, 95%CI –79.70 to –63.66, P<0.000 01), hospital stay (CCT, MD=–3.31, 95%CI –4.16, –2.46, P<0.000 01) and ICU stay(CCT, MD=–10.15, 95%CI –14.38 to –5.91, P<0.000 01), mechanical ventilation (CCT, MD=–228.68, 95%CI –247.60 to –209.77, P<0.000 01) in the transthoracic closure group were lower than those in the traditional surgical repair group, the transthoracic closure costed more than traditional surgical repair during being in the hospital (CCT, MD=1 221.42, 95%CI 1 124.70 to 1 318.14, P<0.000 01).ConclusionCompared with traditional surgical repair, the transthoracic closure reduces the hospital stay, shortens the length of ICU stay and the duration of ventilator assisted ventilation, while has less postoperative complications. It is safe and reliable for patients with ASD within the scope of indication.

Clinical efficacy of transthoracic occlusion via a right subaxillary incision and conventional surgery in the treatment of ventricular septal defect: A retrospective cohort study

ObjectiveTo analyze the clinical efficacy of transthoracic occlusion via a right subaxillary incision and conventional surgery in the treatment of ventricular septal defect (VSD).MethodsThe clinical data of patients with congenital VSD undergoing right subaxillary incision surgery in our hospital from January 2017 to January 2020 were retrospectively analyzed. According to the surgical methods, the patients were divided into two groups: a conventional surgery group (conventional group) and a transthoracic occlusion group (occlusion group). There were 221 patients in the conventional group, including 97 males and 124 females, with an average age of 2.6±2.2 years and an average weight of 13.4±6.2 kg; there were 185 patients in the occlusion group, including 90 males and 95 females, with an average age of 3.2±2.6 years and an average weight of 14.7±6.6 kg. The clinical effectiveness was compared.ResultsThe success rate of surgery was 100% in both groups. The intraoperative blood loss was less in the occlusion group (P<0.05). The incision length, operation time, postoperative mechanical ventilation time, retention time in the intensive care unit, the time to resume normal diet and normal activities after operation were all shorter than those in the conventional group (P all <0.05). The total cost during hospitalization of the conventional group was less than that of the occlusion group (P<0.001). There was no statistical difference in the incidence rate of perioperative complications between the two groups (P>0.05). During the follow-up (15.8±8.8 months), the incidence of complications in the conventional group was higher than that in the occlusion group with a statistical difference (P<0.001).ConclusionCompared with conventional surgery, transthoracic occlusion for VSD via right subaxillary incision has the advantages of smaller incision, shorter operation time, less blood loss, shorter postoperative recovery time and less long-term complications. However, the total hospitalization cost is relatively high, mainly because of the high consumables cost, and the long-term effects still need further comparative observation.

Application of adjustable curved sheath in transcatheter closure of atrial septal defect with internal jugular vein solely guided by transthoracic echocardiography: A case report

A case of a 4-month-old child with an aortopulmonary fenestration weighing 6.6 kg who underwent successful transthoracic minimally invasive occlusion in our hospital was reported in this article. The child was transferred from the intensive care unit (ICU) to the general ward 1 day after surgery and discharged 5 days later. Compared with conventional ligation or repair of extracorporeal circulation for the aortopulmonary fenestration, the transthoracic minimally invasive occlusion is characterized by less trauma and faster recovery. However, it requires strict surgical indications and is not suitable for all patients with aortopulmonary fenestration.