Objective To evaluate early results of valved bovine jugular vein patch for reconstruction of the right ventricular outflow tract （RVOT）.?Methods From May 2009 to March 2010， a total of 60 patients with complex congenital heart diseases underwent reconstruction of RVOT with valved bovine jugular vein patch in Wuhan Asia Heart Hospital. There were 42 males and 18 females with their mean age of 6.2±8.9 years （ranging from 5 months to 33 years） and mean body weight of 27.5±24.0 kg， and 34 patients were less than 1 year. Preoperative clinical diagnosis included tetralogy of Fallot （n=38） and double outlet of right ventricle with pulmonary stenosis （n=22）. All the patients underwent one-stage surgical repair. Before operation， 4 patients underwent catheter intervention for their major aortopulmonary collaterals. The diameters of pulmonary arterial ring of all the patients were 2 standard deviation less than normal range， and trans-annular patch was chosen for RVOT reconstruction. All the patients were postoperatively followed up for 18 to 26 months （mean 21.2±4.6 months）.?Results There was no in-hospital death. And no second surgical intervention was needed for conspicuous RVOT stenosis or pulmonary regurgitation. Three patients needed reintubation for lung edema after extubation as a result of major aortopulmonary collaterals. Four patients underwent reexploration for postoperative bleeding. And all the other patients were discharged uneventfully. Mean cardiopulmonary bypass time was 84.0±22.0 min， and mean aortic cross-clamping time was 42.0±12.0 min. Mean RVOT gradient right after surgery was 18.0±4.5 mm Hg， which was not statistically different from mean RVOT gradient of 19.2±5.4 mm Hg measured by transthoracic echocardiography at their last postoperative follow-up（P＞0.05）. The degree of pulmonary regurgitation right after surgery was trivial in 32 patients（1＋）， mild in 28 patients（2＋）， which were not statistically different from the degree of pulmonary regurgitation at their last postoperative follow-up: trivial in 28 patients （1＋）， mild in 27 patients（2＋）， and moderate in 5 patients（3＋）. Calcification was not observed on the valved bovine jugular vein patch and valve cusp， and the valve cusp motioned well. No thrombosis or endocarditis was observed on the valved bovine jugular vein.?Conclusions For patients with tetralogy of Fallot or double outlet of right ventricle （DORV） and pulmonary stenosis， valved bovine jugular vein patch is a good choice for trans-annular reconstruction of RVOT. There is no severe postoperative complication related to bovine jugular vein， the RVOT pressure gradient does not increase significantly， and anti-regurgitation result is satisfactory in short-term follow-up. Further follow-up is required to evaluate its long-term outcome.
ObjectiveTo evaluate the efficacy and safety of transcatheter closure of patent ductus arteriosus (PDA) with transthoracic echocardiography (TTE).MethodsFrom February 2016 to November 2018, 98 patients of pure PDA were selected, including 43 patients of funnel type and 55 patients of tube type. There were 38 males and 60 females at age of 2-48 (9.8±10.4) years. All patients underwent TTE-guided retrograde closure of the PDA through the femoral artery to establish a femoral-abdominal aorta-thoracic aorta-ductus arteriosus-aorta-right ventricle trajectory.Under the guidance of TTE, a suitable closure umbrella was placed through the femoral artery. One month, 3 months, 6 months, 12 months after the surgery, the patients received out-patient clinical follow-up.ResultsNinety eight patients were successfully occluded by TTE. The occluder was replaced many times in an adult PDA patient, but finally it was successfully plugged. The operation time was 33.2±5.8 min. The lumbar diameter was 12±6 mm. And the postoperative murmur disappeared. Ultrasound showed no shunt between the aorta and the pulmonary artery, and the postoperative hospital stay was 3-4 days. No shunt signal was found in 1, 3, 6, 12 months follow-up. Left atrial anteroposterior diameter (25.8±6.1 mm vs. 30.6±8.4 mm) and left ventricular end diastolic diameter (38.5±9.1 mm vs. 45.2±11.5 mm) were significantly smaller (P < 0.05).ConclusionTTE-guided transcatheter closure of PDA via femoral artery is a safe and effective method to avoid the damage of X-ray and contrast medium. The prospect of clinical application is good.
ObjectiveTo analyze the efficacy and safety of percutaneous balloon pulmonary valvuloplasty (PBPV) for pulmonary valve stenosis guided by ultrasound.MethodsFrom March 2016 to July 2019, 32 patients with pulmonary valve stenosis were treated in our hospital. There were 19 males and 13 females with an average age of 1-12 (6.2±3.1) years and weight of 7-45 (22.7±9.2) kg. The clinical efficacy of PBPV guided by transthoracic echocardiography (TTE) was evaluated.ResultsThe transvalvular pressure gradient (PG) of the patients before PBPV was 65.4±11.9 mm Hg. All patients successfully received PBPV under TTE guidance. The PG was 19.7±4.0 mm Hg immediately after operation, which was significantly decreased (P<0.001). All patients survived without any serious complications. The PG values at 3 months, 6 months and 12 months after operation were 18.4±4.0 mm Hg, 16.4±3.9 mm Hg, 15.2±3.3 mm Hg, respectively, which were significantly lower than that before the operation (P<0.001).ConclusionPBPV guided by echocardiography is safe and effective in the treatment of pulmonary valve stenosis with low complications rate.
ObjectiveTo investigate the clinical efficacy and application value of percutaneous interventional treatment for structural heart diseases under guidance of ultrasound.MethodsThe clinical data of 1 010 patients with structural heart diseases treated by transcutaneous ultrasound-guided occlusion in our hospital from December 2, 2015 to December 31, 2019 were retrospectively reviewed, including 360 males and 650 females, aged 1-50 years. There were 692 patients of atrial septal defect (603 with central type, 9 combined with arterial catheter, 80 with ethmoid type), 116 patent foramen ovale, 25 ventricular septal defects (3 combined with atrial septal defect), 132 patent ductus arteriosus, 32 pulmonary valve stenosis (3 combined with atrial defect), 1 main pulmonary artery window, and 3 aneurysm rupture of aortic sinus. All patients were diagnosed by transthoracic echocardiography (TTE) before operation. Treatment was accomplished intraoperatively through TTE or transesophageal echocardiography (TEE) via the femoral artery or femoral vein. After operation, echocardiography, electrocardiogram and chest radiograph were reexamined.ResultsSatisfactory results were obtained in 1 005 patients, and 1 patient failed to seal the ventricular defect and was repaired under direct vision, occluder detachment occurred in 5 patients after operation (3 patients of atrial septal defects underwent thoracotomy for Amplatzer device and were repaired, 1 patient of atrial septal defects was closed after removing Amplatzer device, 1 patient of patent ductus arteriosus underwent thoracotomy for Amplatzer device and was sutured), mild pulmonary valve regurgitation occurred after balloon dilation in 2 patients with pulmonary stenosis, a small amount of residual shunt was found in 2 patients with ventricular defect, which disappeared after 3 months of follow-up, and 1 patient of right bundle branch block occurred and disappeared after 1 week. After follow-up of 1-24 months, 3 patients of ethmoidal atrial septal defect were reexamined with mild shunt. The occluder was in good position and the pressure difference of pulmonary valve was significantly reduced. There was no complication such as hemolysis, arrhythmia, embolism or rupture of chordae tendinae.ConclusionPercutaneous transfemoral artery and vein guided by TTE or TEE is safe and effective, with little trauma, no radiation or contrast agent damage, and has significant clinical efficacy and application values.
ObjectiveTo investigate the effectiveness and safety of esophageal ultrasound-guided percutaneous femoral artery closure of ventricular septal defect (VSD).MethodsThe clinical data of 24 patients with congenital VSD in our hospital from March 2017 to December 2019 were retrospectively analyzed, including 6 males and 18 females, with a median age of 12 (3-42) years, weight of 32 (12-91) kg, and VSD diameter of 4 (3-7) mm. There were 3 patients with VSD combined with atrial septal defect.ResultsTwenty-four patients successfully underwent interventional closure of percutaneous femoral artery under esophageal ultrasound guidance, and the position and shape of the occluders were good. The operation time was 45 (39-54) min, and the waist size of the occluders was 7 (5-12) mm. Among the patients, 14 patients used symmetric ventricular occlusion devices, 8 patients used asymmetric ventricular occlusion devices, and 2 patients used ventricular occlusion muscle occluders. Small amount of residual shunt occurred in 2 patients after the operation and it disappeared 3 months after the operation. One patient with right bundle branch block, which disappeared after 1 week of observation. There were no complications such as occluder closure, pericardial effusion or valve regurgitation during the perioperative period. During the follow-up period [3-18 (9.25±5.04) months], no serious complication occurred.ConclusionTransesophageal ultrasound-guided transfemoral artery occlusion for VSD is simple and safe, and it avoids the damage of radiation and contrast medium. It has advantages over traditional percutaneous interventional occlusion therapy.
ObjectiveTo compare the surgical results of ultrasound-guided percutaneous antegrade or retrograde therapy in the treatment of patent ductus arteriosus.MethodsThe clinical data of 166 patients (44 males and 122 females) who underwent transthoracic echocardiography guided closure of patent ductus arteriosus in Xinjiang Cardiovascular and Cerebrovascular Disease Hospital from February 2016 to August 2020 were retrospectively analyzed, and the patients were divided into two groups: an antegrade group (n=60) and a retrograde group (n=106). The operation time, success rate, bed rest time, postoperative complications and surgical safety were compared between the two groups.ResultsThe immediate success rate of the two groups was 100.0%. Compared with the retrograde group, the antegrade group had shorter time of bed rest and hospital stay, but longer operation time. In the retrograde group, there were 2 patients of complications, including occlusive device falling off to pulmonary artery 12 hours after the operation in 1 patient, and false arterial tumor in 1 patient. Both groups were followed up for 3-18 months, and there was no death in the whole group.ConclusionIt is safe and effective to block patent ductus arteriosus under the guidance of transthoracic echocardiography. Although the operation process of anterior occlusion of patent ductus arteriosus is slightly complex and the operation time is long, the indication is wide, and the bed rest time is short. Therefore it can be used as the first choice for patent ductus arteriosus occlusion.
Objective To introduce the application of transcatheter closure of multi-fenestrated atrial septal defect (ASD) via femoral vein under ultrasound guidance with amplatzer cribriform occluder (ACO) and atrial septal defect occluder (ASDO), as well as to assess its feasibility, effectiveness and safety. Methods The clinical data of 48 patients with fenestrated ASD occluded via femoral vein under ultrasound guidance from December 2015 to May 2018 in our hospital were retrospectively analyzed, including 17 males and 31 females, aged 10 months to 51 years, an average of 11.50±13.86 years, and weighting 6-79 (27.00±20.14) kg. Among 48 patients with fenestrated ASD, 12 patients had double-foramen and 13 atrial septal aneurysm combined with defects and 23 multi-foramen. All patients underwent transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) to complete the closure of fenestrated ASD. Ultrasound, electrocardiogram and chest X-ray were reviewed the next day after surgery to evaluate the curative effect. Results Forty-eight patients with ASD were treated with 49 occluders, due to one patient with two occluders. There were 29 ASDO (8-26 mm) and 20 ACO (18-34 mm). During the operation, TTE/TEE examination showed that 48 patients were completely occluded, 13 patients showed fine bundle shunt in the unreleased push notification rod, and 9 patients had fine bundle shunt after the release of push notification rod. Fine bundle shunt was found in 8 patients 24 hours after operation, and microshunt was found in 3 patients 1 year after operation. All the patients were followed up. The occluder position was good. The right heart was reduced in different degrees, and the X-ray showed that the pulmonary blood was reduced in different degrees. No arrhythmia was found by electrocardiogram after operation. Conclusion It is a safe and effective method to use ACO and ASDO to occlude ASD through femoral approach under ultrasound guidance.