Early Cardiac Catheterizations within 30 Days Post Congenital Heart Surgery in Children

Background:This study set out to assess the indications,feasibility,safety,and outcome of early cardiac catheterizations(CC)within 30 days after congenital heart surgery(CHS)in children.Methods and Results:This is a retrospective,single-center case review study of all CC within 30 days after CHS between 1/2010-12/2020.A total of 317(138 diagnostic,179 interventional)CC were performed in 245 patients at a median of 4 days(IQR 13)after CHS.The median age was 3 months(IQR 6),and body weight was 5 kg(IQR 4).A total of 194(61.2%)CC were performed in patients with univentricular hearts.CC revealed significant pathologies leading to early redo-surgery in 37 patients(12%).The transcatheter interventions primarily were needed in patients after cavo-pulmonary connection(n=69%,21.8%),right ventricle to pulmonary artery conduit(n=39%,12.3%),and Norwood-I surgery(n=34%,10.7%)presenting with hypoxemia,prolonged postoperative course,and suspected arterial stenosis on echocardiography.The clinical impact of an early postoperative transcatheter intervention for the following clinical course was high in most cases.There were nine(2.8%)major and 20(6.3%)minor intra-procedural complications.Risk factor analysis revealed no difference for the occurrence of complications for patients’age,weight,and time from initial CHS,underlying uni-vs.biventricular heart disease,or ECMO.Conclusion:Early CC within 30 days after CHS in children can be performed safely with a high diagnostic and therapeutic value.The rate of complications is low,while the therapeutic consequence is relevant.

Effects of General Anesthesia on the Results of Cardiac Catheterization in Pediatric Patients with Ventricular Septal Defect

Background:There is no gold standard sedation method for pediatric cardiac catheterization.In congenital heart diseases with intracardiac shunts,hemodynamic parameters are prone to change depending on the ventilation conditions and anesthetics,although few studies have examined these effects.The purpose of this study was to investigate the effects of two different sedation methods on the hemodynamic parameters.Methods:This study retrospectively evaluated consecutive patients with ventricular septal defect(VSD)below 1 year of age who underwent cardiac catheterization at Aichi Children’s Health and Medical Center,who were divided into age-and VSD diameter-matched general anesthesia(GA)and monitored anesthesia care(MAC)under the natural airway groups(n=40 each),for comparison of hemodynamic parameters.Results:In the GA group,arterial blood pH and arterial partial pressure of oxygen were significantly higher(p<0.01),whereas arterial partial pressure of carbon dioxide was significantly lower than in the MAC group(p<0.01).Mean pulmonary artery pressure(p<0.05)and systemic blood pressure(p<0.01)were lower in the GA group.Pulmonary vascular resistance index(p<0.01)and systemic vascular resistance index(p<0.01)were also significantly lower in the GA group than the MAC group.There were no significant differences in pulmonary blood flow index,systemic blood flow index,and pulmonary/systemic blood flow ratio between the two groups.Conclusions:Cardiac catheterization under GA in VSD patients results in different hemodynamic parameters compared to that under MAC.In particular,when using pulmonary artery pressure and pulmonary vascular resistance measured under GA for judgment regarding the surgical indications or perioperative management,consideration should be given to the fact that these parameters might be lower compared to those measured under MAC.

Efficacy and safety of distal radial approach for cardiac catheterization: A systematic review and meta-analysis

BACKGROUND The traditional radial approach(RA)is recommended as the standard method for coronary angiography(CAG),while a distal RA(DRA)has been recently used for CAG.AIM To assess the efficacy and safety of the DRA vs RA during CAG.METHODS The following databases were searched through December 2020:MEDLINE,the Cochrane Central Register of Controlled Trials,EMBASE,the World Health Organization International Clinical Trials Platform Search Portal,and Clinical-Trials.gov.Individual randomized-controlled trials for adult patients undergoing cardiac catheterization were included.The primary outcomes were the successful cannulation rate and the incidence of radial artery spasm(RAS)and radial artery occlusion(RAO).Study selection,data abstraction and quality assessment were independently performed using the Grading of Recommendations,Assessment,Development,and Evaluation approach.RESULTS Three randomized control trials and 13 registered trials were identified.The two approaches showed similar successful cannulation rates[risk ratio(RR)0.90,95%confidence interval(CI):0.72-1.13].The DRA did not decrease RAS(RR 0.43,95%CI:0.08-2.49)and RAO(RR 0.48,95%CI:0.18-1.29).Patients with the DRA had a shorter hemostasis time in comparison to those with the RA(mean difference-6.64,95%CI:-10.37 to-2.90).The evidence of certainty was low.CONCLUSION For CAG,the DRA would be safer than the RA with comparable cannulation rates.Given the limited data,additional research,including studies with standard protocols,is necessary.

Carotid Artery Cut-Down in Pediatric Cardiac Catheterization: When and How?

Background:Vascular access used for pediatric cardiac catheterization is one of the most important factors that affects the success of the procedure.We aimed to compare the effect,success,and complications of cardiac catheterizations performed by carotid cut-down or femoral puncture in newborns or young infants.Methods:We included who underwent catheterization in our department between 28 January 2017 and 15 April 2021.These patients underwent balloon aortic valvuloplasty,balloon coarctation angioplasty,ductal stenting,diagnostic procedures for aortic arch pathologies,and modified Blalock-Taussig in-shunt intervention.Patients were divided into two groups:femoral puncture(group=1)and carotid cut-down(CC,group=2).Results:Seventy-two catheterization procedures were performed in 64 patients;32(44.4%)were performed via the femoral approach and 40(55.6%)were performed via the carotid approach.Sixteen(22.2%)procedures were diagnostic and 56(77.8%)procedures were interventional.CC was performed in 13(32.5%)patients with failed femoral intervention.Patients in the CC group had shorter durations of procedure,vascular access,and anesthesia,compared with the femoral access group(80.9 and 116.2 min,p=0.001;12.9 and 22.5 min,p=0.001;140.9 and 166.6 min,p=0.001,respectively).Patients who underwent CC had fewer complications than did patients in the femoral access group(2.5%and 21.8%,respectively;p=0.01);larger sheats were used in CC patients(p=0.028).Conclusion:The carotid artery can be successfully used as a primary catheterization route,particularly in patients with small body weight and patients who require rapid vascular access,or stenting of the vertical duct.

Management of ductal spasm in a neonate with pulmonary atresia and an intact ventricular septum during cardiac catheterization:A case report

BACKGROUND Ductal spasm is a rare but life-threatening complication of cardiac catheterization in neonates with pulmonary atresia and an intact ventricular septum.In patients with ductal-dependent pulmonary blood flow,ductal spasm may lead to refractory hypoxemia and severe hemodynamic instability,which need to be treated in perfect order.CASE SUMMARY We present a male infant with a gestational age of 39 wk,and his fetal echocardiography showed pulmonary atresia.At 28 d of age,transcatheter pulmonary valvuloplasty with balloon dilatation was performed.Two hours after the operation,the patient's pulse oxygen saturation continued to decrease.The patient was then transferred to receive cardiac catheterization.During catheterization,the invasive blood pressure and pulse oxygen saturation suddenly decreased,and repeated aortography revealed partial occlusion of the ductus arteriosus.It no longer changed when pulse oxygen saturation rose to 51%after approximately 20 min of maintenance therapy.Therefore,a ductal stent was used for implantation.Hemodynamics and hypoxemia were improved.CONCLUSION We should know that ductal spasm may occur during pulmonary atresia and intact ventricular septum cardiac catheterization.Understand the pathophysiology of ductal-dependent pulmonary blood flow and make comprehensive perioperative preparations essential to deal with hemodynamic disorders caused by ductal spasm.

Cardiac catheter angioplasty for patients after Norwood procedure

Objective To evaluate the outcome of the cardiac catheter angiograplasty for patients after Norwood procedure. Methods 13 patients,who had undergone Norwood procedure (prior to Glenn procedure) received cardiac catheterization and angiography. Interventional therapy

Effects of oral premedication on cognitive status of elderly patients undergoing cardiac catheterization

BackgroundSedatives 和止痛剂经常被管理为诊断、治疗学的过程完成有意识的镇静。适当担心被提起了考虑与仙子程序的药有关的柱子过程谵妄在老。这研究的目的是在老 patients.MethodsPatients &#x02265 在新发作谵妄和程序的照顾上调查 premedication 的效果；70 岁并且安排了因为选任的心脏的 catheterization 随机被分配收到口头的 diphenhydramine 和苯甲二氮卓或没有 premedication (25 mg/5 mg ) 。所有病人经历了微型在过程以前的心理州的考试和谵妄评价使用混乱评价方法并且在过程以后并且在以前在 4 h 重复了排出。病人在过程和容易期间是合作过程以后用视觉模拟规模(管) 被测量。机警的度在到达上立即被估计到地板，并且以后时时两次使用观察员对 93 个病人全部的机警 / 镇静规模(OAA/S ).ResultsA 的评价被注册。吝啬的年龄是 77 年，并且 47 个病人在过程以前收到了 premedication。任何一个都没在任何一个组的病人开发谵妄。病人的合作和过程的容易更大并且在预先药物治疗的组在期间并且在过程以后少些伤害药要求(P &#x0003c；0.05 为两个) 。护士们在预先药物治疗的组与耐心的管理报导了改进(P = 0.08 ).ConclusionsIn 结论， premedication 没在经历心脏的 catheterization 的老病人引起谵妄。减少的疼痛药要求，察觉的程序的容易和柱子过程管理在经历心脏的 catheterization 的老病人赞成 premedication。

Knowledge and Practices among Nurses Regarding Patients’ Care Following Cardiac Catheterization at a Tertiary Care Hospital in Karachi, Pakistan

Aims: The purpose of this study was to assess the knowledge and practices among nurses regarding patient care, following cardiac catheterization, at a tertiary care hospital in Karachi, Pakistan. Background: Cardiovascular diseases (CVDs) are the major cause of morbidity and mortality, globally. Nurses are the largest body of health care professionals who attempt to reduce the burden of cardiovascular diseases. Design: This study employed a descriptive analytical cross-sectional study design to answer the research questions. Methodology: The data were collected from 70 participants using two instruments. Knowledge was assessed through a 50-multiple-choice questions-based questionnaire, whereas, to assess the practices, an observational checklist was utilized which comprised of 20 components. Findings: The majority of the nurses, 54.3%, had adequate, 40% nurses had inadequate, and only 5.7% nurses had excellent knowledge scores. Moreover, 87.1% nurses were observed as carrying out unsatisfactory practices, whereas, only 12.9% nurses were found carrying out satisfactory practices. Conclusion: Since variation in the practices was observed in each of the department, therefore, there is a need for further research, to assess nurses’ attitudes through a qualitative approach and to develop and implement a standard post-cardiac catheterization care protocol.

Delayed cardiac tamponade after simultaneous transcatheter atrial septal defect closure and left atrial appendage closure device implantation: a particular case report

Percutaneous left atrial appendage(LAA)occlusion evolved as an alternative treatment to the patients who are contraindicated or cannot tolerate oral anticoagulants with nonvalvular atrial fibrillation(AF)at risk of stroke or systemic embolism.[1]Abnormal hemodynamic changes in elder atrial septal defect(ASD)patients cause remodeling of the left atrium,which eventually leads to right heart failure.[2]As the ASDs elderly are associated with a higher incidence of AF,simultaneous transcatheter ASD and LAA closure has become a new effective therapeutic strategy.However,only a limited number of articles involving cardiac tamponade complications have been published in the literature.What’s more,previous studies involving early hemodynamically irrelevant pericardial effusion after the procedure attribute to multiple repositioning attempts of LAA occluder or delivery sheath injured the atrial wall.

Thrombolytic therapy for femoral artery thrombosis after left cardiac catheterization in children

Background Femoral artery thrombosis is one of the most common complications of catheterizations in infants and young children. This study was conducted to investigate the feasibility and effectiveness of thrombolytic therapy for femoral artery thrombosis after left cardiac catheterization in children. Methods Thrombolytic therapy with urokinase was carried out in children with femoral artery thrombosis after left cardiac catheterization. Each patient was given a bolus injection of heparin （100 U/kg）. A bolus of urokinase （30 000 - 100 000 U） was injected intravenously, and then a continuous infusion of 10 000-50 000 U/h was administered. Transcatheter thrombolysis was performed once previous procedures failed. Results Eight patients （aged （3.1±2.3） years （8 months to 7 years）, body weight （13.1±4.2） kg （7 to 20 kg）） presented lower limbs ischemia after left cardiac catheterizations was performed. Seven patients accepted thrombolytic therapy with urokinase. In 5 patients, peripheral intravenous thrombolysis was successful with restoration of a normal pulse. In the other 3 cases, peripheral intravenous thrombolysis failed, followed by successful transcatheter thrombolysis. The average duration of therapy was （7.25±5.31） hours （1-17 hours）. The average doses of heparin and urokinase were （1600±723） U （800-3000 U） and （268 571±177 240） U （50 000-500 000 U）, respectively. There were no statistically significant differences in partial thromboplastin time before and during urokinase therapy （（40.6±22.3） to （49.9±39.2） seconds）. However, the prothrombin time was significantly longer （（12.7±2.58） to （48.1±18.6） seconds, P〈0.05）. Patency of the target vessel was evaluated in all the patients for 2 weeks and no occlusion recurred. Conclusion Thrombolytic therapy with urokinase is a safe and useful modality in children with femoral artery thrombosis after left cardiac catheterization.

Relationship between hemoglobin A1c and contrast-induced acute renal injury in patients with type 2 diabetes mellitus undergoing cardiac catheterization

Background There were few studies to explore the relationship between hemoglobin Alc （HbAlc）and contrast-induced acute renal injury （CI-AKI）in patients with type 2 diabetes mellitus （T2DM）. Methods Two hundred seventy-nine patients with T2DM undergonging elective cardiac catheterization from Dongguan Kanghua Hospital were recruited. Patients were classified into quartiles based on HbAlc （ 〈 6.30%, 6.30- 6.70%, 6.71-7.70, and 〉 7.70%）. Baseline data, CI-AKI incidence and in-hospital outcomes were compared between the groups. Logistic regression was used to assess the relationship between HbAlc and CI-AKI. Results CI-AKI occurred in 26 （9.3%）patients. CI-AKI incidences of HbAlc quartiles were 4.6 %（3/65）, 2.8%（2/71）, 12.3%（9/73） and 17.1%（12/70） （P = 0.003）, respectively. There were no significant differences in in-hospital death or required renal replacement therapy among the four groups. Univariate logistic analysis showed that HbAlc was related with CI-AKI （OR = 1.319, 95%CI： 1.078-1.615, P = 0.007）. Multivariate analysis found that after adjusting eGFR 〈 60 ml/min/1.73 m2, age 〉 70 years and anemia, I-IbAlc 〉17% was still a significant independent risk factor for CI-AKI in patients with T2DM. Conclusions HbAlc is significantly associated with CI-AKI. HbAlc ≥ 7% may increase the risk of CI-AKI in patients with T2DM undergoing elective cardiac catheterization.

Relationship between postoperative mean systolic blood pressure and contrast-induced nephropathy in patients undergoing cardiac catheterization

Background There were few studies to explore the relationship between postoperative mean systolic blood pressure （PMSBP） within 6 h after cardiac catheterization and contrast-induced nephropathy （CIN）. Methods From June 2010 to February 2013, 299 consecutive patients undergoing cardiac catheterization were recruited. Patients were classified into quartiles based on PMSBP （ 〈 112, 112-120, 121-131, and 〉 132 mmHg）. Baseline data, CIN incidence and in-hospital outcomes were compared between the groups. Logistic regression was used to assess the relationship between PMSBP and CIN. Results CIN occurred in 26（8.7%） patients. The incidence of CIN in PMSBP quartiles were 15.3% （11/72）, 15.1% （11/73）, 2.4% （2/82） and 2.8% （2/72） （P = 0.001） respectively. There were no significant difference in in-hospital death, renal replacement therapy and intra-aortic balloon pump （IABP） support between the groups （P 〉 0.05）. Univariate logistic regression analysis showed that PMSBP was significantly associated with CIN （OR = 0.956, 95% CI： 0.928-0.986, P = 0.004）. Multivariate logistic regression analysis found that after adjusting baseline estimate glomerular filtration rate, age 〉 75 years and acute myocardial infarction, PMSBP 〈 120 mmHg was still an independent risk factor for CIN （OR = 5.049, 95% CI： 1.820-14.009, P = 0.002）. Conclusions Lower PMSBP was significantly associated with an increased risk of CIN. PMSBP 〈 120 mmHg was an independent risk factor for CIN. Intensive blood-pressure control after cardiac catheterization might increase the risk of CIN.

Cardiac catheterization and comprehensive clinical evaluation after bidirectional Glenn shunt surgery in 60 patients with complex congenital heart disease

Background The bidirectional Glenn shunt surgery is a palliative procedure for patients with complex congenital heart disease（CHD） who are not suitable for biventricular repair in early life. There is limited evidence of successful strategies for long-term hemodynamic stabilization. Furthermore, there have been no data on optimal hemodynamics that could be used as a reference for patients＇ follow-on management. Methods Sixty CHD patients, 44 male and 16 female, with bidirectional Glenn shunt surgery and cardiac catheterization were enrolled at our hospital between January 2014 and December 2016. Pre-and post Glenn shunt percutaneous oxygen saturation（SpO_2）, 6-minute walk test（6 MWT）, superior vena cava pressure（SVCP）, pulmonary arterial pressure（PAP）, pulmonary capillary wedge pressure（PCWP）, pulmonary vascular resistance（PVR）, small pulmonary vascular resistance（s PVR） were measured. Pre-and post-total cavopulmonary connection（TCPC） SpO_2, and in-hospital complications were monitored. The optimal hemodynamic cutoff values for TCPC patient selection were estimated by receive operating characteristic（ROC） curve analysis. Results SpO_2 was significantly increased by bidirectional Glenn shunt surgery（75.42 ± 9.62% to 86.98 ± 7.63%, P 〈 0.001） from 82.70 ± 5.99% to 95.00 ±4.07% in the 47 patients with TCPC. Forty-two patients completed the 6 MWT with a mean distance of 362.7 ±75.0 m and a SpO_2 decrease from 81.80 ± 7.84% to 67.59 ± 1.82%（P 〈 0.001）. The △SpO_2 and 6-minute walk distance（6 MWD） in the 32 who underwent TCPC and ten of them did not reach statistical significance（17.22 ±13.82% vs. 13.87 ± 8.74%, P = 0.08 and 358.88 ± 78.97 m vs. 374.80 ± 62.55 m, P = 0.564]. After cardiac catheterization, 47 patients were selected for TCPC. The right pulmonary artery systolic pressure（s RPAP）, mean right pulmonary artery pressure（m RPAP）, mean left pulmonary artery pressure（m LPAP）, PVR, and s PVR were significantly lower in the TCPC group than in the non-TCPC group. The differences in superior vena cava systolic blood pressure（s SVCP）, mean superior vena cava pressure（m SVCP）, and left pulmonary artery systolic pressure（s LPAP） were not significant. The optimal cutoff values for TCPC were s SVCP ≤ 20 mm Hg（P = 0.025）,s RPAP ≤ 22 mm Hg（P = 0.0001, mRPAP ≤ 13 mm Hg（P =0.003）, s LPAP ≤ 27 mm Hg（P =0.03）, m LPAP ≤ 11 mm Hg（P = 0.01）, PVR ≤ 4.3 Wood U/m^2（P 〈0.0001） and were significantly associated with TCPC selection,except for m SVCP ≤ 19 mm Hg（P = 0.06） and s PVR ≤ 2.0 wood U/m^2（P = 0.0531）. One patient died because of low cardiac output after TCPC. In-hospital mortality was 2.1%. Conclusion The SpO_2 can be significantly improved after bidirectional Glenn shunt and TCPC surgery. The 6 MWT is an index of activity tolerance prior toTCPC. Hemodynamic values of s SVCP ≤ 20 mm Hg, s RPAP ≤ 22 mm Hg, m RPAP ≤ 13 mm Hg, s LPAP ≤ 27 mm Hg, m LPAP ≤ 11 mm Hg, and PVR ≤ 4.3 Wood U/m^2 can help identify post Glenn-shunt patients indicated for TCPC.

Femoral Access with Ultrasound-Guided Puncture and Z-Stitch Hemostasis for Adults with Congenital Heart Diseases Undergoing Electrophysiological Procedures

Aims:Although the application of ultrasound-guided vascular puncture and Z-stitch hemostasis to manage femoral access has been widely utilized,there is limited data on this combined application in adult congenital heart disease(ACHD)patients undergoing electrophysiological(EP)procedures.We sought to evaluate the safety and efficacy of ultrasound-guided puncture and postprocedural Z-stitch hemostasis for ACHD patients under-going EP procedures.Methods and Results:The population of ACHD patients undergoing transfemoral EP pro-cedures at the University of Zurich Heart Center between January 2019 and December 2022 was observed and analyzed.During the study period,femoral access(left/right,arterial/venous)was performed under real-time ultrasound guidance.At the end of the procedure,a single Z-stitch was performed at the puncture site.We eval-uated the incidence of in-hospital complications associated with femoral access puncture in this population.Among 101 patients who had a total of 147 previous ipsilateral vascular punctures(mean 1.5 per person),100 patients underwent successful femoral vascular access for EP procedures.The median age of the patients was 47±15 years and 34(34%)were male.Z-stitches were performed after the procedure in 100 patients with 303 femoral vascular accesses(mean 3 punctures per person).No patient developed vascular puncture relevant inguinal hematoma,pseudo aneurysm,arteriovenousfistula,venous or arterial thrombosis.Conclusion:In ACHD patients undergoing EP procedures,optimal femoral access management can be achieved with ultra-sound-guided puncture and postprocedural Z-stitch hemostasis.

Current Advances in Transcatheter Intervention for Children Born with Congenital Heart Defects: A Review of Literature

This review aims to sum up the improvements witnessed in the field of interventional cardiology during recent times. The last decade has witnessed significant technical advances in the field of radiological imaging and also in interventional cardiology which has helped to offer more non-invasive solutions for the management of congenital heart defects. This has resulted from the use of advanced 3-dimensional fusion imaging instead of conventional 2-dimensional angiography, applying interactive real-time enhancement and using computed tomography and Magnetic Resonance Imaging for interventional procedures. Similarly the introduction of next generation devices, have not only improved the final outcome of the procedure but also has helped in reducing the challenges that were faced before and with the initial generation of devices. These advances have helped not only in reducing the radiation exposure, the use of contrast medium dose but also have resulted in improved early survival. The field of neonatal cardiology has advanced at an unprecedented pace. The transcatheter closure of patent ductus arteriosus has evolved over time and now it has been made possible at much lower body weight. Similarly, early use of stents for aortic coarctation has been found effective in some patients, especially when surgical intervention had been denied. The application of the hybrid approach for the management of complex congenital heart defects has also been effectively applied. More recently transcatheter placement of the pulmonary valve has been introduced for severely stenotic and/or regurgitant pulmonary valve in adolescents and adults. It is anticipated that in near future, this procedure would be available for relatively younger patients. In conclusion: last 2 decades have improvised pediatric interventional cardiology to incorporate less invasive solutions for CHD. The current advances in radio-diagnostic imaging, gadgetry and technical expertise have improved significantly and led to manage many of such defects by trans-catheter approach. This has led also, to replace the early surgical intervention with a more subtle hybrid approach, thus reducing not only the major surgical trauma but also been found to be cost-effective due to a shorter hospital stay. But a learning curve for performers is required for optimum results and also such procedures should be performed in a fully developed facility with an optimum surgical backup.

血清糖类抗原125对动脉性肺动脉高压严重程度及预后的相关性研究

目的 探讨血清糖类抗原125(CA125)在动脉性肺动脉高压(PAH)患者中的表达水平,分析其与PAH严重程度及预后的关系。方法 前瞻性研究纳入2022年1月至2023年6月于武汉亚洲心脏病医院就诊的87例PAH患者,40例非PAH心脏病患者(疾病对照组)和90例于我院体检的健康人(健康对照组)。收集所有患者入院当天的血清样本,记录患者的临床资料。采用受试者工作特征(ROC)曲线下面积(AUC)评估CA125、NT-proBNP对PAH患者发生临床恶化事件的预测效能,通过Cox风险比例回归及Kaplan-Meier生存分析评估CA125在PAH患者预后中的临床价值。结果 PAH组患者的血清CA125水平高于疾病对照组和健康对照组(P<0.05),并随着NYHA心功能分级的增加而进一步表达(P<0.001)。血清CA125与PAH患者的NT-proBNP、NYHA心功能分级、mRAP呈正相关,与6MWD呈负相关(P<0.05)。通过ROC曲线分析,NT-proBNP联合CA125预测PAH患者预后的效能优于单独使用NT-proBNP,但两者差异无统计学意义(P>0.05)。中位随访384(244,414)天,经多变量Cox分析后显示CA125>19.4U/mL(HR=4.317,95%CI 1.875~9.940,P<0.001),LVEF(HR=0.895,95%CI 0.843~0.950,P<0.001),RVED(HR=1.531,95%CI 1.153~2.034,P=0.003)与临床恶化风险增加有关。结论 PAH患者的血清CA125水平升高,并与PAH患者的严重程度及不良预后相关,是加入多参数危险分层的有希望的生物标志物。

Simultaneous Transcatheter Closure of the Left Atrial Appendage and Congenital Interatrial Communication Closure

Background:Left atrial appendage closure(LAAC)with simultaneous interventional occlusion therapy for congenital interatrial communication has become a new focus of patients with nonvalvular atrial fibrillation.Little is known about the results of mid-and long-term results.Objective:The aim of this study was to evaluate the midand long-term safety and effectiveness of simultaneous transcatheter closure of the left atrial appendage(LAA)and congenital interatrial communication closure in atrial fibrillation(AF)patients.Methods:From Jan 2016 to June 2017,27 patients with AF were treated with simultaneous transcatheter closure of the LAA and atrial septal defect(ASD,n=22),patent foramen ovale(PFO,n=5).Results:The perioperative closure success rate was 96.3%,except for cardiac tamponade occurred in one ASD patient.During the median 37.6-month follow-up period,no cases of cerebrovascular or peripheral vascular embolism,bleeding,infective endocarditis or thrombosis along the occluders were observed.Of the 21 patients with NYHA Class III,nineteen had significant improvements to NYHA Classes I or II,and 81.5%of patients were free from major or minor adverse events during midand long-term follow-up.Conclusions:Simultaneous closure of the LAA and congenital interatrial communication closure is a viable option for patients with nonvalvular atrial fibrillation who are at risk of stroke or systemic embolism,and it is effective and yields excellent mid-and long-term results.

Anaesthetic Challenges in Cardiac Interventional Procedures

The increasing scope of interventions in the cardiac catheterization laboratory (CCL) and electrophysiological laboratory (EPL) has resulted in new challenges for the anaesthesia teams where they deal with different patient categories, complications and safety issues. Collaboration and planning between cardiologist and anaesthesiologist are required for both patient safety and procedural success. This review aims to discuss procedures performed in interventional cardiology and the importance of anaesthesiologists in managing such patients. Percutaneous interventions are being increasingly performed in adult as well as in pediatric patients. Procedures are usually done under mild to moderate sedation. General anaesthesia is required in certain conditions and also in pediatric patients. Knowledge of echocardiography, individual disease condition and fluoroscopy is important. Anaesthesiologists are assuming an increasingly important role in the multidisciplinary management of complex patients and interventions. A comprehensive understanding of procedures is essential to provide a high level of anaesthetic care and maintain patient safety.

急性心肌梗死患者急救中心导管室前驱激活模式的应用价值

目的探讨心导管室前驱激活模式应用于急性心肌梗死患者急救护理中的价值。方法福建省立医院于2021年12月开始在急救护理中实施心导管室前驱激活模式,方便选取2021年1月—2022年12月到福建省立医院就诊的118例急性心肌梗死患者为研究对象,均接受经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗,将2021年12月前入院就诊的59例患者作为对照组,采用常规急救护理模式,将2021年12月及之后入院就诊的59例患者作为观察组,在常规急救护理中加入心导管室前驱激活模式,对比两组患者的急救效率、PCI成功率、院内病死率、并发症发生率、焦虑情况及家属满意度。结果观察组首次医疗接触至首份心电图(FMC-to-ECG)时间、首次医疗接触至球囊扩张(FMC-to-B)时间、入门至球囊扩张(D-to-B)时间、胸痛发作到球囊扩张时间(S-to-B)分别为(9.68±2.47)、(82.62±8.59)、(18.24±5.33)、(86.73±9.68)min,显著短于对照组,差异有统计学意义(P<0.05)。观察组PCI成功率为93.22%与家属总满意度为94.91%显著高于对照组,差异有统计学意义(χ^(2)=10.951、9.440,P<0.05)。观察组并发症发生率、患者及家属SAS评分显著低于对照组,差异有统计学意义(P<0.05)。两组院内病死率比较,差异无统计学意义(P>0.05)。结论急救护理中心导管室前驱激活模式的应用能够有效缩短急救时间,提高PCI治疗成功率并降低术后并发症发生率,同时能够有效缓解患者及家属的焦虑情绪,提升家属满意度。

孕早期胎儿心轴角度及静脉导管频谱对先天性心脏病的诊断价值

目的探讨孕早期胎儿心轴角度及静脉导管频谱对先天性心脏病的诊断价值。方法回顾性分析2019年6月—2022年6月616例孕早期孕妇资料,其中确诊为孕早期胎儿先天性心脏病孕妇19例(观察组),孕检胎儿健康的孕早期孕妇597例(对照组),对比2组胎儿心轴角度、静脉导管频谱参数〔心室收缩期峰值流速(PSV)、心室舒张期峰值流速(PDV)、心房PSV〕,分析各指标单独及联合诊断先天性心脏病的临床价值。结果观察组心室PSV、心室PDV、心房PSV、心轴角度均高于对照组(P<0.05)。临床结果:616例患者中,阳性19例,阴性597例。静脉导管频谱异常31例,最终诊断为先天性心脏病14例,包括房室间隔缺损2例,单纯室间隔缺损5例,单纯房间隔缺损2例,法洛四联症1例,大动脉转位1例,右位主动脉弓2例,右室双出口1例。心轴左偏7例,右偏3例,最终诊断为先天性心脏病7例,包括室间隔缺损3例,二尖瓣狭窄1例,动脉导管未闭2例,房间隔缺损1例。联合测量均异常23例,最终诊断为先天性心脏病18例。与单独检测相比,联合检测的准确度、特异度更高(P<0.05);联合检测敏感度与静脉导管频谱检测比较,差异无统计学意义(P>0.05),但高于心轴角度检测敏感度(P<0.05)。结论相比单独检测胎儿心轴角度、静脉导管频谱,联合检测对先天性心脏病的诊断效能更高。