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 evaluate the clinical outcomes of pulmonary valve replacement (PVR) in patients with tetralogy of Fallot (TOF) after re-PVR surgery.MethodsPubMed, EMbase, the Cochrane Controlled Trials Register databases, CNKI, CBM disc and VIP datebases were searched, and study eligibility and data abstraction were determined independently and in duplicate. Literature searches from database establishment to December 2018. The heterogeneity and data were analyzed by the software of Stata 11.0.ResultsOf 4 831 studies identified, 26 studies met eligibility criteria, and invovled with a total of 3 613 patients. The combined 30-day mortality for PVR was 2.2% (95% CI 1.5%-3.1%) and follow-up mortality was 3.4% (95% CI 2.4%-4.9%), re-PVR rate was 6.8% (95% CI 5.1%-9.2%), and the rate of intervention was 11.4% (95% CI 8.0%-16.4%). Subgroup analysis showed that the patient's age range may be a heterogeneous source of mortality during the follow-up period, and there was no statistical heterogeneity for adult patients (P=0.63, I2=0%), with a lower incidence than those including adolescents patients. The type of valve was likely to be a source of retrospective PVR. There was no statistical heterogeneity in bioprosthetic valves and allograft lobes (P=0.24, I2=25%). And the incidence of re-PVR was lower than that of the mechanical valve patients. Heart function classification (NYHA) of patients with TOF after PVR was statistically improved (P<0.05). Electrocardiogram QRS change was not statistically differently (P>0.05). Postoperative MRI findings showed a decrease in RVEDV, an increase in RVEF, a decrease in RV/LV ratio, and a decrease in pulmonary valve (all P<0.05). Funnel map monitoring, Begg test and Egger's test both indicated that there was no publication bias.ConclusionsAccording to the results of the analysis, PVR after TOF surgery is a more mature surgery, the clinical effect was significant, with lower early and long-term mortality. The long-term mortality rate of adolescent patients undergoing PVR is higher than that of adult patients. Long-term outocme of re-PVR or re-intervention is still the main problem affecting the effect of the operation. Indications for surgery and choice of valve need further investigation.
ObjectiveTo evaluate early outcomes of transthoracic pulmonary valve implantation for the treatment of moderate and severe pulmonary regurgitation by using homemade self-expanding valve (SalusTM). MethodsPatients with severe pulmonary regurgitation who underwent transthoracic pulmonary valve implantation in Guangdong Provincial People’s Hospital from September 2, 2021 to November 25, 2022 were prospectively enrolled. The early postoperative complications and improvement of valve and heart function were summarized and analyzed. ResultsA total of 25 patients were enrolled, including 16 males and 9 females, with an average age of 24.5±1.5 years and an average weight of 57.0±3.0 kg. The mean systolic diameters of the bifurcation near the main pulmonary artery, the stenosis of the middle segment of the aorta and near the valve of the right ventricular outflow tract of the patients were 31.8±7.4 mm, 30.6±5.9 mm and 38.4±8.0 mm, respectively. All patients were successfully implanted with valves, and there were no serious complications such as death, coronary compression, stent fracture, valve displacement and infective endocarditis in the early postoperative period. The indexed left atrial longitudinal diameter, indexed right atrial longitudinal diameter, and indexed right ventricular outflow tract anteroposterior diameter decreased significantly after the operation. The degree of tricuspid and pulmonary valve regurgitation and the indexed regurgitation area decreased significantly. The above differences were statistically significant (P<0.05). ConclusionThe early outcomes of transthoracic pulmonary valve implantation with homemade self-expanding pulmonary valve (SalusTM) in the treatment of severe pulmonary regurgitation is relatively good, and the long-term outcomes need to be verified by the long-term follow-up studies with large samples.
Objective To evaluate possibility and reliability of the technique of artificial pulmonary valve reconstruction in right ventricular outflow tract reconstruction. Methods We retrospectively analyzed the clinical data of 35 patients with artificial pulmonary valve reconstruction of right ventricular outflow tract reconstruction surgery in our hospital between February 2012 and December 2016. There were 35 patients with 19 males and 16 females at age of 10 years ranged 5 months to 42 years and body weight of 26 (8–62) kg. There were 21 patients with artificial moncusp valve, 6 patients with bicuspid technology, 8 patients with comprehensive forming method. Results Average extracorporeal circulation time was 75–251 (120±37) min. Aorta blocking time was 32–185 (72±28) min. ICU stay time was 14–225 (59±51) hours. Breathing machine auxiliary time was 6–68 (24±18) hours. There were 3 early postoperative deaths. There was no death during the long term following-up time. Thirty-two patients survived with heart function of class Ⅰ in 20 patients, class Ⅱ in 10 patients, class Ⅲ in 2 patients. Conclusion In right ventricular outflow tract reconstruction using the technique of artificial pulmonary valve reconstruction in the operation, it can reduce early postoperative right ventricular volume load. To smooth out perioperative patients, the surgical technique is simple, cheap, safe, but long-term follow-up still needs further observation.
In recent years, with the continuous development and increasing maturity of interventional techniques, interventional treatment for congenital heart disease (CHD) has been progressively disseminated to county- and city-level hospitals in China. Concurrently, the standardized management of adult CHD (particularly patent foramen ovale) and the lifelong management of complex CHD are gaining increasing clinical attention, while the emergence of new techniques and products continuously advances the discipline. This article aims to review the new progress made in the field of interventional treatment for congenital heart disease in China during 2024. It specifically reviews and analyzes the following key aspects: (1) annual statistics on interventional closure procedures for CHD; (2) recent insights into patent foramen ovale closure; (3) advances in transcatheter pulmonary valve replacement; (4) interventional treatment and lifelong management strategies for complex CHD; (5) new interventional techniques for acquired heart disease; and (6) the application of artificial intelligence in CHD management. Through the synthesis and discussion of these topics, this article seeks to provide a detailed analysis of the current landscape of interventional treatment for CHD in China and project its future development trends.
Objective To summarize the immediate and intermediate outcomes of surgical correction on patients with tetralogy of Fallot and absent pulmonary valve (TOF/PVAB). Methods From January 1996 to August 2009, 14 patients，including 5 males and 9 females, aged 3.4±3.4 years (0.2-11.0 years) with an average weight of 12.0±6.3 kg (4-26 kg), underwent complete surgical correction in Beijing Fu Wai Cardiovascular Hospital. The right ventricular outflow tract was reconstructed with valved conduit in 4 patients, and monocusp with transannular patch was used in 10 patients. Six patients underwent pulmonary artery wall reduction, and 2 patients underwent both pulmonary artery plication and wall reduction. Results There were 2 (14.3%) perioperative deaths. Both were low bodyweight infants. One died of low cardiac output and respiratory failure, and the other died of central nervous system complications. Ten patients were followed up for an average time of 8.3±4.3 years (0.6-13.0 years). All patients followed up survived. The echocardiogram found pulmonary valvular dysfunction in 4 patients. The patients’ cardiac function were classified as New York Heart Association(NYHA) Ⅰ to Ⅱ. There was no late death or reoperation. Conclusion The immediate and intermediate outcomes of surgical correction of TOF/PVAB are good, but the function of pulmonary valves and conduit should be followed-up closely.
Objective To analyze and summarize the early and medium-term outcomes of self-expanding interventional pulmonary valve stent (SalusTM) for right ventricular outflow tract dysfunction with severe pulmonary valve regurgitation. Methods We established strict enrollment and follow-up criteria. Patients who received interventional pulmonary valve in transthoracic implantation in Guangdong Provincial People’s Hospital from September 2, 2021 to July 18, 2023 were prospectively included, and all clinical data of patients were collected and analyzed. ResultsA total of 38 patients with severe pulmonary regurgitation were included, with 23 (60.5%) males and 15 (39.5%) females. The mean age was 24.08±8.12 years, and the mean weight was 57.66±13.54 kg. The preoperative mean right ventricular end-diastolic volume index (RVEDVI) and right ventricular end-systolic volume index (RVESVI) were 151.83±42.84 mL/m2 and 83.34±33.05 mL/m2, respectively. All patients successfully underwent transcatheter self-expandable pulmonary valve implantation, with 3 (7.9%) patients experiencing valve stent displacement during the procedure. Perioperative complications included 1 (2.6%) patient of postoperative inferior wall myocardial infarction and 1 (2.6%) patient of poor wound healing. The median follow-up time was 12.00 (6.00, 17.50) months. During the follow-up period, there were no deaths or reinterventions, and no patients had recurrent severe pulmonary regurgitation. Three (7.9%) patients experienced chest tightness and chest pain, and 1 (2.6%) patient developed frequent ventricular premature beats. Compared with preoperative values, the right atrial diameter, right ventricular diameter, and tricuspid annular plane systolic excursion were significantly reduced at 6 months and 1 year postoperatively, with improvement in the degree of pulmonary regurgitation (P<0.01). Compared with preoperative values, RVEDVI and RVESVI decreased to 109.51±17.13 mL/m2 and 55.88±15.66 mL/m2, respectively, at 1 year postoperatively (P<0.01). Conclusion Self-expanding interventional pulmonary valve in transthoracic implantation is safe and effective for severe pulmonary valve regurgitation and shows good clinical and hemodynamic results in one-year outcome.
Nowadays, percutaneous pulmonary valve treatment is a hot topic in valvular heart disease, consisting of percutaneous balloon pulmonary valvuloplasty and percutaneous pulmonary valve implantation (PPVI). The percutaneous balloon pulmonary valvuloplasty is the prime intervention of pulmonary valve stenosis. The main indication of PPVI is pulmonary valve regurgitation and/or obstruction. PPVI is still the research focus, with the improvement of surgical indications and the development of surgical devices. However, compared with surgical pulmonary valve replacement, it still has limitations. This article reviews the treatment progress of percutaneous pulmonary valve treatment, especially PPVI.
This article reports a 16-year-old patient with severe pulmonary valve regurgitation after corrective surgery for tetralogy of Fallot. The shape of the right ventricular outflow tract to the main pulmonary artery was cone-shaped, which is extremely challenging. After admission, percutaneous pulmonary valve replacement with self-expanding valve was successfully performed. The patient’s condition remained stable during the 2-year follow-up period after surgery. This case aims to provide a reference for percutaneous pulmonary valve replacement in patients with cone-shaped right ventricular outflow tract.
Objective To preliminarily investigate the feasibility and clinical outcomes of percutaneous pulmonary valve implantation (PPVI) using a domestic self-expanding valve. Methods Patients with right ventricle outflow tract (RVOT) dysfunction after surgery for congenital heart disease who presented to Beijing Anzhen Hospital from March 2019 to July 2024 and were assessed to be suitable for PPVI via self-expanding valves were retrospectively analyzed. The patients underwent PPVI with either the PT-Valve or the Venus-P. Baseline, surgical, and imaging data were recorded and the patients were followed up. Results A total of 13 patients, including 4 males and 9 females, aged 14 to 55 years, were included. Initial congenital heart disease included tetralogy of Fallot (9 patients), right ventricular double outlet (1 patient), simple pulmonary stenosis (2 patients), and pulmonary atresia (1 patient). All patients underwent RVOT reconstruction with transannular patching. Indications for PPVI intervention included severe pulmonary stenosis with mild regurgitation (1 patient), severe regurgitation of the pulmonary valve (12 patients). PT-Valve was used in 9 patients, and Venus-P was used in 4. Valve implantation was successful in 13 patients, with no psevere erioperative complications. One patient with pulmonary stenosis was implanted with an overlay Cheatham-Platinum stent followed by PT-Valve valve implantation, and the postoperative result was satisfactory. Postoperative pulmonary and perivalvular regurgitation were mild or less, and the median peak flow velocity of the pulmonary valve was 1.32 m/s. At 3-month follow-up, the patient's NYHA classification improved significantly compared with the preoperative period, and the QRS wave width shortened compared with that of the preoperative period, the difference was statistically significant [(159.0±27.6) ms vs. (144.3±33.8) ms, P=0.005]. Ejection fraction and tricuspid annular plane systolic excursion increased, but the difference did not reach statistical significance. The patients had an increased postoperative left ventricular end-diastolic diameter, and the difference was statistically significant [(41.00±3.63) versus (44.77±5.12) mm, P=0.023]. Patients had a reduction in moderate or greater mitral regurgitation postoperatively, the difference was statistically significant. The difference in moderate or greater tricuspid regurgitation was not statistically significant. The follow-up time was (27.7±20.5) months, and no stent fracture or infective endocarditis occurred during the follow-up period; mild valve displacement occurred in one patient, and the remaining patients had good valve position. The patients' NYHA classification was class Ⅰ. Conclusion Domestic self-expanding valves for PPVI are feasible for the treatment of patients with RVOT dysfunction after surgery for congenital heart disease, and their safety and efficacy need to be further verified by studies with longer periods of time and larger sample sizes.