Background: Perimembranous ventricular septal defect combined with right coronary cusp bulge generally should be treated with surgical thoracotomy, owing to the potential aortic regurgitation. However, the minimally i...Background: Perimembranous ventricular septal defect combined with right coronary cusp bulge generally should be treated with surgical thoracotomy, owing to the potential aortic regurgitation. However, the minimally invasive method of transcatheter closure has always attracted the attention of cardiologists and patients. The present study aimed to apply transcatheter occlusion in treating ventricular septal defect with right coronary cusp bulge and further evaluate the clinical effect through follow-up. Materials and methods: A total of 40 children diagnosed as having a ventricular septal defect with right coronary cusp bulge, examined using transthoracic echocardiography and cardiovascular angiography, were enrolled in this study. The ventricular septal defects were closed by placing occluders through transcatheter occlusion treatment. During the operation process, the children underwent angiography and transthoracic echocardiography examinations to check the position of the occlude and the extent of aortic regurgitation. The influence of occlusion on the conduction system was evaluated using a surface electrocardiogram. The children were followed up after their procedures. Results: All 40 patients were immediately and successfully occluded. Three patients with filament residual shunts were observed during the operations. No major surgical complications occurred during the perioperative period. During the follow-up period, the positions of all the occluders were good, the residual shunts in the three patients disappeared, and no new or aggravated aortic regurgitation occurred. Electrocardiogram did not reveal any atrioventricular blocks. Only one patient suffered from an incomplete right bundle branch block. Conclusions: Children diagnosed with ventricular septal defect combined with right coronary cusp bulge could be considered for transcatheter occlusion. With appropriate indications and methods, the effect may be favorable.展开更多
Idiopathic monomorphic ventricular tachycardia and premature ventricular complexes (PVCs) commonly arise from the right and left ventricular outflow tracts (VOT). Their mechanism is most commonly triggered activity fr...Idiopathic monomorphic ventricular tachycardia and premature ventricular complexes (PVCs) commonly arise from the right and left ventricular outflow tracts (VOT). Their mechanism is most commonly triggered activity from delayed after-depolarizations and successful ablation is performed at the site of earliest endocardial activation. Re-entrant mechanisms have been rarely described. We report a case of an otherwise healthy patient who ultimately underwent six electro-physiology studies (EPS) and suffered numerous implantable cardiac defibrillator (ICD) discharges prior to the successful radiofrequency ablation (RFA) of two idiopathic VOT tachycardias. During the sixth EPS, a proximal aortogram demonstrated a left aortic sinus of valsalva (LASV) aneurysm. Subsequntly, a novel and successful RFA strategy of aneurysm isolation was undertaken. The presence of multiple clinical or inducible VT morphologies and the characterization of a VT as re-entrant should raise concerns that a complex arrhythmogenic substrate is present and defining the anatomy with angiography or an alternative imaging modality is essential in achieving a successful ablation strategy.展开更多
目的通过比较在CARTO3指导下零射线与常规在X线指导下对特发性主动脉窦内室性早搏(ASC-PVCs)导管射频消融来评价其治疗安全性、有效性及可行性。方法分析2013年4月~2015年10月于南方医院因特发性主动脉窦内室早行射频消融(RFCA)治疗的患...目的通过比较在CARTO3指导下零射线与常规在X线指导下对特发性主动脉窦内室性早搏(ASC-PVCs)导管射频消融来评价其治疗安全性、有效性及可行性。方法分析2013年4月~2015年10月于南方医院因特发性主动脉窦内室早行射频消融(RFCA)治疗的患者52例,其中零射线组23例,即运用Carto3系统重建主动脉窦三维模型后在零射线下行导管消融。另29例在X线下常规标测和消融,为常规消融组。比较两组的靶点标测时间、总放电次数、手术即时成功率、手术总时间、X线曝光时间、随访观察疗效(复发率)及并发症。结果零射线组手术即时成功率看似高于常规组,但两组患者即时成功率差异无统计学意义[22/23(96%)vs 24/29(83%),P=0.21];两组患者术中均无并发症发生。与常规组相比,零射线组靶点标测时间明显缩短(4.3±1.7 vs 7.8±2.6 min,P<0.01),零射线组与常规组手术总时间差异无统计学意义(79.6±8.8 vs 77.4±7.2 min,P=0.332)。与零射线组比较,常规组放电次数明显较多(7.9±3.2 vs 4.8±1.1,P<0.01),零射线组整个手术过程完全零射线,而常规组X线曝光时间为23.1±6 min,随访5~20个月,常规组复发4例,零射线组1例复发。结论 CARTO3指导下零射线导管射频消融治疗特发性主动脉窦频发室性期前收缩是一种安全、有效、可行的方法。CARTO3指导零射线射频消融相对常规消融方法;其靶点标测时间缩短、总放电次数减少且不延长手术总时间,而且全手术过程为零射线。展开更多
基金supported by the National Science Foundation of China(Grant number 81470443)
文摘Background: Perimembranous ventricular septal defect combined with right coronary cusp bulge generally should be treated with surgical thoracotomy, owing to the potential aortic regurgitation. However, the minimally invasive method of transcatheter closure has always attracted the attention of cardiologists and patients. The present study aimed to apply transcatheter occlusion in treating ventricular septal defect with right coronary cusp bulge and further evaluate the clinical effect through follow-up. Materials and methods: A total of 40 children diagnosed as having a ventricular septal defect with right coronary cusp bulge, examined using transthoracic echocardiography and cardiovascular angiography, were enrolled in this study. The ventricular septal defects were closed by placing occluders through transcatheter occlusion treatment. During the operation process, the children underwent angiography and transthoracic echocardiography examinations to check the position of the occlude and the extent of aortic regurgitation. The influence of occlusion on the conduction system was evaluated using a surface electrocardiogram. The children were followed up after their procedures. Results: All 40 patients were immediately and successfully occluded. Three patients with filament residual shunts were observed during the operations. No major surgical complications occurred during the perioperative period. During the follow-up period, the positions of all the occluders were good, the residual shunts in the three patients disappeared, and no new or aggravated aortic regurgitation occurred. Electrocardiogram did not reveal any atrioventricular blocks. Only one patient suffered from an incomplete right bundle branch block. Conclusions: Children diagnosed with ventricular septal defect combined with right coronary cusp bulge could be considered for transcatheter occlusion. With appropriate indications and methods, the effect may be favorable.
文摘Idiopathic monomorphic ventricular tachycardia and premature ventricular complexes (PVCs) commonly arise from the right and left ventricular outflow tracts (VOT). Their mechanism is most commonly triggered activity from delayed after-depolarizations and successful ablation is performed at the site of earliest endocardial activation. Re-entrant mechanisms have been rarely described. We report a case of an otherwise healthy patient who ultimately underwent six electro-physiology studies (EPS) and suffered numerous implantable cardiac defibrillator (ICD) discharges prior to the successful radiofrequency ablation (RFA) of two idiopathic VOT tachycardias. During the sixth EPS, a proximal aortogram demonstrated a left aortic sinus of valsalva (LASV) aneurysm. Subsequntly, a novel and successful RFA strategy of aneurysm isolation was undertaken. The presence of multiple clinical or inducible VT morphologies and the characterization of a VT as re-entrant should raise concerns that a complex arrhythmogenic substrate is present and defining the anatomy with angiography or an alternative imaging modality is essential in achieving a successful ablation strategy.
文摘目的通过比较在CARTO3指导下零射线与常规在X线指导下对特发性主动脉窦内室性早搏(ASC-PVCs)导管射频消融来评价其治疗安全性、有效性及可行性。方法分析2013年4月~2015年10月于南方医院因特发性主动脉窦内室早行射频消融(RFCA)治疗的患者52例,其中零射线组23例,即运用Carto3系统重建主动脉窦三维模型后在零射线下行导管消融。另29例在X线下常规标测和消融,为常规消融组。比较两组的靶点标测时间、总放电次数、手术即时成功率、手术总时间、X线曝光时间、随访观察疗效(复发率)及并发症。结果零射线组手术即时成功率看似高于常规组,但两组患者即时成功率差异无统计学意义[22/23(96%)vs 24/29(83%),P=0.21];两组患者术中均无并发症发生。与常规组相比,零射线组靶点标测时间明显缩短(4.3±1.7 vs 7.8±2.6 min,P<0.01),零射线组与常规组手术总时间差异无统计学意义(79.6±8.8 vs 77.4±7.2 min,P=0.332)。与零射线组比较,常规组放电次数明显较多(7.9±3.2 vs 4.8±1.1,P<0.01),零射线组整个手术过程完全零射线,而常规组X线曝光时间为23.1±6 min,随访5~20个月,常规组复发4例,零射线组1例复发。结论 CARTO3指导下零射线导管射频消融治疗特发性主动脉窦频发室性期前收缩是一种安全、有效、可行的方法。CARTO3指导零射线射频消融相对常规消融方法;其靶点标测时间缩短、总放电次数减少且不延长手术总时间,而且全手术过程为零射线。
