改良edge-to-edge二尖瓣成形术治疗成人二尖瓣前叶脱垂的作用

目的探讨改良edge-to-edge二尖瓣成形术治疗成人二尖瓣前叶脱垂的临床疗效。方法回顾性分析2009年1月-2013年1月在我院行二尖瓣成形术的54例成人二尖瓣前叶脱垂患者的临床资料,所有患者都采取根改良edge-to-edge二尖瓣成形术进行治疗。观察患者二尖瓣反流情况,同时比较两组患者手术前及手术后1年内的心动图指标。结果所有患者都顺利完成手术,且术后恢复顺利,无死亡病例;54例患者有50例患者在手术后无瓣膜反流,有4例患者存在轻度反流。手术后患者的心动图各项情况明显较手术前改善(P<0.01),有统计学意义。结论改良edge-to-edge二尖瓣成形术可恢复二尖瓣前叶脱垂患者的瓣膜功能,控制二尖瓣反流,明显改善患者的心脏指标,临床有推广价值。

Crystallography of Zr poisoning of Al-Ti-B grain refinement using edge-to-edge matching model

The mechanism of zirconium poisoning on the grain-refining efficiency of an Al-Ti-B based grain refiner was studied. The experiment was conducted by melting Al-5Ti-1B and Al-3Zr master alloys together. The edge-to-edge matching model was used to investigate and compare the orientation relationships between the binary intermetallic compounds present in the Al-Ti-B-Zr system. The results show that the poisoning effect probably results from the combination of Al3 Zr with Al3 Ti and the decreased amount of Ti solute, for Al3 Ti particles have good crystallographic relationships with Al3 Zr. Totally six orientation relationships may present between them, while they play vital roles in grain refinement. TiB2 particles appear to remain unchanged because of a bit large misfit. Only one orientation relationship may present between them to prevent Al3 Zr phase from forming on the surface of TiB2, though TiB2 is agglomerated. The theoretical calculation agrees well with the experimental results. The edge-to-edge matching model is proved to be a useful tool for discovering the orientation relationships between phases.

Association of edge-to-edge valve repair with artificial ring annuloplasty for severe tricuspid insufficiency

Objective To analyze whether association of edge to edge valve repair with artificial ring annuloplasty would result in better results in patients with severe tricuspid regurgitation (TR) . Methods From April,2001 to May, 2010,41 patients underwent tricuspid valve repair to treat severe TR were studied. Twenty-one patients were done artificial ring annuloplasty alone (group R) and twenty patients were done artificial ring annuloplasty associated with edge to edge valve repair (group E) . All the

Utilization of edge-to-edge valve plastic technique to correct severe tricuspid regurgitation in patients with congenital heart disease

Objective Tricuspid regurgitation is often associated in patients with congenital heart disease. Significant morbidity and mortality are related to tricuspid valve replacement. Tricuspid valve plasty is still a preferred choice. This report deals with our surgical experience in using edge-to-edge valve plasty technique to correct severe

Thirty-day Outcomes of First-in-man Implantation of a Novel Transcatheter Edge-to-edge Mitral Repair System in Patients With Severe Mitral Regurgitation

Objectives:The aim of this multicenter,prospective,single-arm pilot study(ClinicalTrials.gov number:NCT05040074)was to observe the procedural and 30-day results of the novel transcatheter mitral valve repair system,SQ-Kyrin■-M Clip(Shenqi Medical,Shanghai,China),in patients with severe mitral regurgitation(MR).Methods:The heart team considered patients from 5 centers in China with clinically significant functional mitral regurgitation≥3+despite optimal medical therapy or degenerative mitral regurgitation≥3+with high surgical risk as candidates for transcatheter repair.All patients received transcatheter edge-to-edge mitral valve repair under general anesthesia.The primary outcome was technical success,which included all of the following measured at the exit from the catheterization laboratory:(1)absence of procedural mortality;(2)successful access,delivery,and retrieval of the device delivery system;(3)successful deployment and correct positioning of the frst intended device;and(4)no emergency surgery or reintervention related to the device or access procedure.The secondary outcomes included all-cause mortality,serious adverse events,device success,and procedural success 30 d after the intervention.Results:From June 2021 to December 2021,18 patients were enrolled in this study with age(75.7±7.4)years.Fifteen patients had MR 4+,while 3 had MR 3+.Technical success was achieved in all patients,including 6 degenerative mitral regurgitation and 12 functional mitral regurgitation patients.There was no all-cause mortality at 30 d.One patient had single leaflet device attachment within 30 d,which was regarded as a serious adverse event,and the patient was successfully treated with reintervention by implanting another clip.Another patient's transmitral gradient was 6 mmHg(>5 mmHg),with an effective orifice area of 2.57 cm^(2) after the procedure.Sixteen patients had device success and procedural success at 30 d postoperation.Fourteen patients had MR 1+,3 had MR 2+,and only 1 patient had MR 3+30 d after the procedure.Conclusions:The results of this feasibility study showed the efficacy and safety of the SQ-Kyrin■-M device in the Chinese population with severe MR,laying a solid foundation for a subsequent large-scale confirmatory study.

First-in-man Experience of a New Transcatheter Edge-to-edge Repair System Neoblazar in Patients With Severe Tricuspid Regurgitation

objective:Severe tricuspid regurgitation frequently leads to increased mortality and a poor prognosis.Transcatheter edge-to-edge repair(TEER)for tricuspid valve regurgitation has been reported as a safe alternative to traditional open-heart surgery.This study endeavors to assess the efficacy and safety of a newly designed Neoblazar TEER system in this high-risk population.Methods:This investigation was structured as a prospective,single-arm,first-in-man trial in China(ClinicalTrials.gov number:NCT05497141).From August 2022 to October 2022,patients with severe tricuspid regurgitation were enrolled from 3 centers(Xiamen Cardiovascular Hospital,Fuwai Yunnan Cardiovascular Hospital,and Wuhan Union Hospital).The primary endpoint was achieving a minimum 1-grade reduction in tricuspid regurgitation at the 6-month post-TEER intervention,in addition to the pertinent New York Heart Association class.Scheduled echocardiographic evaluations were conducted at the following distinct intervals:baseline,discharge,1 month,and 6 months post-TEER intervention.Results:A total of 10 patients were enrolled in the study.Immediately after the TEER procedure with the Neoblazar system,massive tricuspid regurgitation(grade 5+)at baseline decreased to moderate-severe tricuspid regurgitation(grade 3+)in 2 patients and the optimal tricuspid regurgitation reduction(severe tricuspid regurgitation(grade 4+)to mild tricuspid regurgitation(grade 1+)were achieved in 6 patients.After 6 months of follow-up,tricuspid regurgitation reduction was found to be durable in all enrolled patients,among whom at least 1 grade of tricuspid regurgitation reduction was sustained,even without reintervention.Consistently,the New York Heart Association class among these subjects significantly improved,with the percentage of patients categorized as class I-ll increasing from 0/10 at baseline to 5/10 after 1 month(P=0.015)and 8/10 after 6 months(P<0.001).Conclusion:Tricuspid TEER with the newly designed Neoblazar system appears to be a feasible and safe alternative in treating patients with severe tricuspid regurgitation.However,the implementation of larger and more robust randomized trials is still necessary for further verification of the potential benefits.

Edge-to-edge chordal transfer repair for anterior leaflet prolapse of mitral valve in 21 patients

Background Repair of anterior mitral leaflet （AML） prolapse is still a technical challenge for cardiac surgeons. It is an important issue to find a way to repair the AML prolapse with a reliable and reproducible technique.Methods Between January 2002 and June 2009, the operation of chordal transfer based on the ＂edge-to-edge＂technique was performed in 21 patients with serious mitral valve regurgitation because of prolapse of the anterior leaflet.After the operation, echocardiography was performed in each patient before discharge and at the time of follow-up.Results All patients survived the operation. One patient required mitral valve replacement because of anterior leaflet perforation 3 days after the operation. The other patients were free from reoperation. At the time of follow-up, all these patients were in New York Heart Association （NYHA） functional class I. In all these patients, pre-discharge and follow-up echocardiography showed neither stenosis nor significant regurgitation of the mitral valve： the cross-sectional area of the mitral valve was 3.3-4.8 cm2 （mean （3.78：±0.52） cm2）, the mean regurgitation area was （0.45：±0.22） cm2. At the same time, both dimension of left atrium and left ventricle reduced significantly （left atrium diameter： pre-operation （48.26±11.12） mm, post-operation （37.57±9.56） mm, P 〈0.05; the end-diastolic diameter of the left ventricle：pre-operation （61.43±8.24） mm, post-operation （42.35±10.79） mm, P〈0.01）.Conclusion ＂Edge-to-edge＂ chordal transfer technique is a simple, reliable, and reproducible technique that can provide good results for repair of anterior leaflet prolapse of mitral valve.

Orientation Relationships between Ferrite and Cementite by Edge-to-edge Matching Principle

The crystallographic features of pearlite were investigated by experiments and edge-to-edge matching principle. Two new orientation relationships between ferrite and cementite were determinated by selected area electron diffraction and then explained by our modified edge-to-edge matching method. The consistence of the experimental results with theoretical prediction confirms the practicability of the modified edge-to-edge matching model.

Nucleation potency prediction of LaB_6 with E2EM model and its influence on microstructure and tensile properties of Al-7Si-0.3Mg alloy

The edge-to-edge matching(E2EM)crystallographic model was used to predict the orientation relationships(ORs)between LaB6 and Al.Three different possible ORs can be predicted between LaB6 and Al,which are(100)Al||(100)LaB6,[001]Al||[001]LaB6;(110)Al||(110)LaB6,[001]Al||[001]LaB6;and(111)Al||(111)LaB6,[011]Al||[011]LaB6.The prediction results are perfectly confirmed through TEM analysis and prove the nucleation potency of LaB6.The refining efficacy of Al-2La-1B refiner and its influence on the tensile properties were investigated in the as-cast Al-7Si-0.3Mg alloy.According to the results,LaB6 has higher nucleation potency than TiB2,leading to better grain refining efficacy of Al-2La-1B refiner in the as-cast Al-7Si-0.3Mg alloy.Regarding the mechanical performances,tensile properties of the as-cast Al-7Si-0.3Mg casting alloy are prominently improved after addition of Al-2La-1B refiner,due to the refined microstructures.

Effect of Ca addition on grain refinement of Mg–9Li–1Al alloy

The as-cast and as-extruded Mg–9Li–1Al–xCa alloys(x=0,0.2;wt%)were prepared by a simple alloying process followed by hot extrusion with an extrusion ratio of 28.2.The microstructures of the as-cast and as-extruded Mg–9Li–1Al–xCa alloys were observed to investigate the effect of calcium(Ca)element on the Mg–9Li–1Al(LA91)alloy,and the crystallographic calculations between Al_(2)Ca and the matrix(α-Mg andβ-Li phases)were examined on the basis of the edge-to-edge matching model.The experimental results indicate that the addition of 0.2 wt%Ca into LA91 alloy reduce the size of theα-Mg phases in the as-cast alloy and that ofβ-Li phases in the as-extruded alloy due to the Al_(2)Ca particles distributed inside the matrix.Crystallographic calculation results suggested that there is a good crystallographic matching between the matrix and Al_(2)Ca,which confirmed that Al_(2)Ca particles can act as a heterogeneous nucleation site for bothα-Mg andβ-Li phases and were effective grain refiners for LA91 alloy.

E2EM’s prediction of LaB_(6) as nucleation substrate for primary Mn-rich phase in Al-Si-Cu-Mn heat-resistant alloy and its refining effect

Edge-to-edge matching(E2EM)model was used to predict the potency of LaB_(6) as the heterogeneous nucleation substrate for primary Al_(13)Mn_(4)Si_(8) phase formed during the solidification of Al−Si−Cu−Mn heat-resistant alloy.There are five pairs of orientation relationships(ORs)between LaB_(6) and Al_(13)Mn_(4)Si_(8) phases which meet the criteria of E2EM model.One pair of plane ORs((110)LaB_(6)//(110)Al_(13)Mn_(4)Si_(8))are demonstrated by TEM observation.This strongly indicates that the LaB_(6) phase can act as the heterogeneous nucleation substrate for the primary Al_(13)Mn_(4)Si_(8) phase.1.0 wt.%of Al−2La−1B master alloy was also added into Al−12Si−4Cu−2Mn alloy to evaluate the refining effect by microstructure observation and tensile test.Experimental results show that addition of Al−2La−1B master alloy can significantly refine the primary Al_(13)Mn_(4)Si_(8) phase,supporting the prediction accuracy of E2EM model.However,such refinement of primary Al_(13)Mn_(4)Si_(8) phase does not lead to an improvement in strength.This is due to the larger difference in elastic modulus between the finally formed Al_(13)Mn_(4)Si_(8) phase and aluminum matrix than that of Al_(15)Mn_(3)Si_(2) phase.

Four new orientation relationships of Mg_(17)Al_(12) phase with magnesium matrix in Mg-8Al-0.5Zn alloys

Although the non-basal precipitates, those not parallel to the basal plane, are more effective to block basal slip in Mg-Al alloys, the crystallographic orientation relationship(OR) between these precipitates and the α-Mg matrix has not been well established. In this work, the crystallography of the non-basal Mg_(17)Al_(12) precipitates in AZ80 alloy was systematically investigated by transmission electron microscopy(TEM). By tilting to a suitable electron beam direction, different kinds of non-basal precipitates were recognized in TEM, and the following four new ORs between the non-basal Mg_(17)Al_(12) precipitates and the matrix were revealed: ■, and ■.Furthermore, these ORs and their habit planes were explained using the edge-to-edge matching model. The findings in this work can provide some guidelines for designing the microstructure of Mg-Al alloys to enhance their precipitation hardening potential.

First-in-human Results of the Novel Transcatheter Mitral Valve Repair System for Severe Mitral Regurgitation

Objective:To evaluate the feasibility,safety,and effectiveness of a novel edge-to-edge mitral valve repair system(the NovoClasp system)in patients with severe mitral regurgitation.Methods:In this prospective,single-arm,first-in-human study conducted at Beijing Anzhen Hospital,data were collected from patients undergoing transcatheter edge-to-edge repair using the NovoClasp system.The study candidates were patients exhibiting a mitral regurgitation severity of 3+or more and were at high-risk or contraindicated for surgical intervention.Technical success and device success according to the Mitral Valve Academic Research Consortium definitions were used as primary outcomes.Other safety and efficacy outcomes were prospectively assessed at device implantation,discharge,and 30 d,6 months,and 12 months post-procedure.Results:Between October 1,2021,and January 31,2022,11 patients were treated for moderate-to-severe(grade 3+)or severe(grade 4+)mitral regurgitation using the NovoClasp system.All patients had a baseline New York Heart Association functional class oflll-lIV,with 7/11 exhibiting complex mitral valve disease.All patients achieved the primary endpoints of technical and device success,with a post-operative 30-d mitral regurgitation grade reduction to 2+or lower,which was maintained at 12 months.One patient had minor bleeding and hematoma at the access site before discharge,and 2 patients were readmitted due to fast atrial fibrillation within 12 months post-discharge.No additional cases of death,adverse cerebral or cardiovascular events,or device-related complications was observed during the follow-up.Conclusion:This study suggested the potential feasibility and safety of the NovoClasp system,showing a promising technical and device success rate,along with a decrease in mitral regurgitation severity.A further pivotal study is needed to assess the procedural and long-term outcomes.

Topological Landau–Zener nanophotonic circuits

Topological edge states(TESs),arising from topologically nontrivial phases,provide a powerful toolkit for the architecture design of photonic integrated circuits,since they are highly robust and strongly localized at the boundaries of topological insulators.It is highly desirable to be able to control TES transport in photonic implementations.Enhancing the coupling between the TESs in a finite-size optical lattice is capable of exchanging light energy between the boundaries of a topological lattice,hence facilitating the flexible control of TES transport.However,existing strategies have paid little attention to enhancing the coupling effects between the TESs through the finite-size effect.Here,we establish a bridge linking the interaction between the TESs in a finite-size optical lattice using the Landau–Zener model so as to provide an alternative way to modulate/control the transport of topological modes.We experimentally demonstrate an edge-to-edge topological transport with high efficiency at telecommunication wavelengths in silicon waveguide lattices.Our results may power up various potential applications for integrated topological photonics.

三种不同左房室瓣修复策略治疗肥厚型梗阻性心肌病合并左房室瓣关闭不全的远期疗效对比研究

背景肥厚型梗阻性心肌病(HOCM)常合并左房室瓣关闭不全(MI),左房室瓣修复比左房室瓣置换疗效更好,并发症更少。常用的左房室瓣修复技术中,“Sliding”左房室瓣成形术联合左房室瓣成形环植入术效果确切,但操作复杂;“Edge-to-Edge”左房室瓣成形术操作简单,但疗效尚不确定。目的对比三种不同左房室瓣修复策略治疗HOCM合并MI的远期疗效。方法回顾性选取2005—2012年在俄罗斯巴库列夫心血管外科研究中心进行心脏手术的HOCM合并MI患者58例为研究对象,根据手术方式,将其分为Morrow组(行单纯Morrow手术,24例)、Morrow-E组(行Morrow手术联合“Edge-to-Edge”左房室瓣成形术,18例)、Morrow-S组(行Morrow手术联合“Sliding”左房室瓣成形术及左房室瓣成形环植入术,16例)。统计患者围术期指标〔包括术中永久性起搏器植入情况、体外循环时间、主动脉阻断时间,术后早期(术后住院期间)左心室流出道最大压差、左房室瓣反流程度、室间隔厚度、左心室舒张末期内径、左心房直径、左心室射血分数;术后使用呼吸机时间、入住ICU时间、住院天数,围术期死亡情况〕、随访指标{包括随访时间、主要疗效指标(术后1、2、3年左心室流出道最大压差、左房室瓣反流程度、左房室瓣跨瓣压差)、安全性指标〔术后早期与术后远期(术后3年)的死亡情况〕}。结果Morrow-E组、Morrow-S组术中体外循环时间、术中主动脉阻断时间长于Morrow组,术后早期左心室流出道最大压差、术后早期左房室瓣反流程度低于Morrow组,术后早期左心房直径小于Morrow组(P<0.05);Morrow-S组术中体外循环时间、术中主动脉阻断时间长于Morrow-E组(P<0.05)。三组围术期均无死亡患者。三组随访时间比较,差异无统计学意义(P>0.05)。Morrow组、Morrow-E组、Morrow-S组完成1年随访的患者分别有24、18、16例,完成2年随访的患者分别有24、18、16例,完成3年随访的患者分别有21、12、12例。手术方法与时间在左心室流出道最大压差、左房室瓣反流程度、左房室瓣跨瓣压差上不存在交互作用(P>0.05);手术方法在左心室流出道最大压差、左房室瓣反流程度、左房室瓣跨瓣压差上主效应显著(P<0.05);时间在左心室流出道最大压差、左房室瓣反流程度、左房室瓣跨瓣压差上主效应不显著(P>0.05)。Morrow-E组、Morrow-S组术后1、2、3年左心室流出道最大压差均低于Morrow组(P<0.05);Morrow-E组、Morrow-S组术后1、3年左房室瓣反流程度低于Morrow组(P<0.05);Morrow-S组术后1、3年左房室瓣跨瓣压差低于Morrow组、Morrow-E组(P<0.05)。Morrow-S组术后3年左心室流出道最大压差高于本组术后1、2年(P<0.05)。Morrow组术后早期死亡2例患者,其中1例死于心肌梗死,1例死于呼吸衰竭;Morrow-E组和Morrow-S组术后早期无死亡患者。Morrow组术后远期有1例患者死于胆汁性腹膜炎;Morrow-E组术后远期有1例患者死于吸食麻药过量;Morrow-S组术后远期无死亡患者。结论单纯Morrow手术、Morrow手术联合“Edge-to-Edge”左房室瓣成形术、Morrow手术联合“Sliding”左房室瓣成形术及左房室瓣成形环植入术均可有效治疗HOCM合并MI患者,且安全性好;Morrow手术联合“Edge-to-Edge”左房室瓣成形术、Morrow手术联合“Sliding”左房室瓣成形术及左房室瓣成形环植入术的远期疗效优于单纯Morrow手术。