Introduction: Ventricular septal defect (VSD) is the most common congenital heart disease of all congenital heart defects. The aim of this study was to investigate the echographic, therapeutic and evolutionary aspects...Introduction: Ventricular septal defect (VSD) is the most common congenital heart disease of all congenital heart defects. The aim of this study was to investigate the echographic, therapeutic and evolutionary aspects of ventricular septal defects (VSD) in the general cardiology department of the Hôpital National Ignace Deen. Methods: A retrospective data collection was carried out from January 2018 to December 2023 including 85 cases of isolated IVC was performed. The variables studied were epidemiological, clinical, paraclinical, therapeutic and evolutionary. Results: Of the 320 patients seen during the study period for congenital heart disease, 85 (26.556%) were isolated IVCs. Age at diagnosis ranged from 3 months to 16 years, with an average age of 3.59 years. The most represented ethnic group was the Fulani (50.58%). The 8.24% came from consanguineous marriage versus 22.35%. 91.76% of children had a history of bronchitis. The most common clinical signs found were systolic murmur (90.58%), growth retardation (51.76%). Only 4 cases (4.70%) had a malformation associated with IVC represented by DiGeorges disease (2.35%) and trisomy 21 (2.35%). Nearly half the patients had type IIb VIC (44.71%). The other half were represented by type 1 (18.82%), type IIa (20%), type III (10.59%) and type IV (5.88%). According to site more than two-thirds of VICs (71.64%) were perimembranous in location, followed by infundibular (16.47%) and muscular (11.76%) VICs. In our study 55.29% presented an indication for both surgical intervention and medical treatment, while 16.47% required only medical treatment. In contrast, 28.23% were placed under exclusive surveillance. Of the 47 patients for whom surgery was indicated, 29 (61.17%) underwent surgical repair, while 18 (38.83%) were awaiting confirmation for surgery. Conclusion: VIC is the most common congenital heart disease. An early detection strategy and the establishment of specialized centers could improve the outcome of these children.展开更多
Speckle tracking imaging (STI) was employed to investigate the effect of right ventricular (RV) volume and pressure overload on left ventricular (LV) rotation and twist in 35 patients with atrial septal defect ...Speckle tracking imaging (STI) was employed to investigate the effect of right ventricular (RV) volume and pressure overload on left ventricular (LV) rotation and twist in 35 patients with atrial septal defect (ASD), 18 of which with pulmonary hypertension, and 21 healthy subjects serving as controls. The peak rotations of 6 segments at the basal and apical short-axises and the average peak rotation and interval time of the 6 segments in the opposite direction during early systolic phase were measured respectively. LV twist versus time profile was drawn and the peak twist and time to peak twist were calculated. LV ejection fraction (EF) was measured by Biplane Simpson. Compared to ASD patients without pulmonary hypertension and healthy subjects, the peak rotations of posterior, inferior and postsept walls at the basal level were lower (P〈0.05), and the average counterclockwise peak rotation of 6 segments at the basal level during early systolic phase was higher (P〈0.05), and the average interval time was delayed (P〈0.05). LV peak twist was also lower (P〈0.05), and had a significant negative correlation with pulmonary arterial systolic pressure (r=-0.57, P=0.001). No significant differences were found in LVEF among the three groups. It was suggested that although RV volume overload due to ASD has no significant effects on LV rotation and twist, LV peak twist is lower in ASD patients with pulmonary hypertension. Thus LV twist may serve as a new indicator of the presence of pulmonary hypertension in ASD patients.展开更多
Objectives To improve experience of procedure and success rate of interventional treatment of atrial septal defect (ASD) in children, applying the technique of controlling release of devices in the pulmonary vein (...Objectives To improve experience of procedure and success rate of interventional treatment of atrial septal defect (ASD) in children, applying the technique of controlling release of devices in the pulmonary vein (controlling two disc of device opening for subsequence) in children cases with ASD who can not be occluded by regularly interventional treatment. Methods Since 2000 year 182 child cases (male 70 and 112 female) underwent the procedure of controlling release of devices in the pulmonary vein. The patients' age was from 2 to 14 years old (average 3.77±1.55). The body weight was from 9 to 48 Kg (average 21.53±10.63). When the devices were placed on the right position with difficulty and failure in some cases with short and soft rims of the defect and large defect and the angle between the device and the interval atrial septal (IAS), It could be helpful to put the device into the left upper pulmonary vein, and to make right atrium (proximal) disc opened before the left atrium (distal) disc naturally fall down. At the end the double disc of the device clamped and stood up at the right position of the IAS. After closure of ASD, patients were followed up regularly by echocardiography, X-ray and ECG in the 1,3,6,12 month and 3,5 years. Results The successful rate of device implantation in the improving group (98.4%) was obviously higher than that in the regularly group (68%). The techniques improved in this group with the smaller age, the lighter weight, the larger defect and the larger device comparing with the regularly group. The velocity of the pulmonary vein before occlusion procedure was (0.54±0.15)m/s; after procedure was (0.56±0.16)m/s, P 〉 0.05,there were no significant difference. All cases couldn't found pulmonary congestion by follow up. Conclusions The method of controlling release of device in the pulmonary vein has been used more than 5 years in the occlusion of ASD with double disc device. It is feasible and safety. The aim of the improvement is for overcoming the problem with larger ASD and the rim deficiency in the interventional procedure in children with ASD. In summary: 1. The performance of the procedure must be careful; 2. To avoid complication when put the sheath into the pulmonary vein; 3. To avoid to put the left disc into pulmonary vein too long and pull the device too much; 4. When the procedure have to operate repeatedly, the device can not be released before the position satisfactory. The improvement of the technique is needed to carry on long-term follow-up in the clinical trials.展开更多
BACKGROUND Transcatheter device closure of atrial septal defect(ASD) guided by fluoroscopy and/or transesophageal echocardiography is a mature technology. Little study has focused on whether the technology can be guid...BACKGROUND Transcatheter device closure of atrial septal defect(ASD) guided by fluoroscopy and/or transesophageal echocardiography is a mature technology. Little study has focused on whether the technology can be guided totally by transthoracic echocardiography(TTE),even in pregnant women with ASD.AIM To evaluate the safety and efficacy of totally TTE guided transcatheter device closure of ASD in pregnant women.METHODS Six pregnant women(gestational age 20-26 wk) with ASD underwent transcatheter device closure totally guided by TTE at our cardiac center from January 2015 to August 2017. A routine transcatheter procedure without fluoroscopy or intubation and a domestic occluder were used in this study.RESULTS All patients had successful closure with good clinical results,and the overall immediate complete closure rate was 100%. The size of the occluder deployed ranged from 20 to 32 mm(26.7 ± 4.3 mm),the procedure time ranged from 30 to50 min(41.7 ± 7.5 min),and the length of hospital stay was 2-3 d(mean 2.2 ± 0.4 d). There were no serious cardiovascular related complications,and transient arrhythmias occurred in one patient during the procedure. During the follow-up period(3 mo to 2 years),no occluder dislodgement,residual fistulas,or thromboses occurred. All of the patients underwent vaginal delivery between 36 and 38 wk of gestation.CONCLUSION Totally TTE guided transcatheter device closure of ASD in pregnant women may be safe and effective.展开更多
Background: There is a need for data on epidemiological, clinical and therapeutic aspects of ventricular septal defect among children in?Sub-Saharan Africa. Objective: The aim of this study was to determine the preval...Background: There is a need for data on epidemiological, clinical and therapeutic aspects of ventricular septal defect among children in?Sub-Saharan Africa. Objective: The aim of this study was to determine the prevalence, epidemioclinical, echocardiographic, therapeutic and evolutionary aspects of ventricular septal defects (VSD) in the pediatric department of the University Hospital Center (CHUSS) of Bobo-Dioulasso. Methods: This study was a descriptive cross-sectional study, conducted from November 2013 to December 2016. All children aged 1 to 179 months seen at the pediatric consultation in CHUSS were included. CIV was confirmed with Doppler echocardiography. Results: Out of 36,240 children who received consultation in the pediatric ward of CHUSS during the study period, one hundred (100) cases of them had congenital heart disease representing a hospital prevalence of 2.76%. This was diagnosed with Doppler echocardiography. Of these, 88% were VSD isolated or associated with other cardiac malformations. Isolated form was reported in 54.3% of cases. The average?age at diagnosis was 39.6 months. The sex ratio was 1.05. Perimembranous topography and hemodynamic type 2 were the highest, representing 56.8% and 35.2% respectively. The indication for surgical repair was recommended for 81.8% of the cases, but only 9.7% of these cases benefited from cardiac surgery. The rest were for medicalcare with a high proportion of lost to follow-up (48.9%). Conclusion: VSD is the most common congenital heart disease. Its care is mainly surgical. This cardiac surgery is non-existent in Burkina Faso. The design of multidisciplinary strategies associated with an optimization of the means of the countries of Sub-Saharan Africa could improve the management of this cardiopathy.展开更多
Objectives To evaluate the therapeutic effect of transcatheter Amplatzer device on the closure of ventricular septal defect (VSD). Methods Among 143 patients with VSD, 135 patients with perimembrane VSD and 2 wit...Objectives To evaluate the therapeutic effect of transcatheter Amplatzer device on the closure of ventricular septal defect (VSD). Methods Among 143 patients with VSD, 135 patients with perimembrane VSD and 2 with muscular VSD aged 2.5 -28 years old, were successfully closed with Amplatzer oeeluder device by the pereutaneous guidwire through femoral artery-VSD-femoral vein route under the guidance of fluoroscopy, ventrieulography and transthoracic echocardiography (TIE). The diameters of the VSDs were 2.3-15.7 (6.90±2.76)mm by left ventriculography. Results The success rate of transcatheter closure of VSD with Amplatzer devices was 96%(137/143). Minimal residual amount of shunts were found in one patient, although the shunts was decreased one month after the procedure. There were one patient who had respiratory arrest during the procedure, 7 patients(5%)had conduction disturbance, 3 patients had complete left bundle branch block, 2 patients had complete right bundle branch block, 1 patient had Ⅰ degree atrial-ventricular block and 1 patient had Ⅲ degree atr/al-ventricular block during hospitalization. The diameters of the occluder ranged from 4 to 23 (9.13±3.31)mm and were symmetrical in 122 patients and asymmetrical in 15 patients. Conclusions Transcatheter closure of the perimembranous ventrieular septal defect using Amplatzer VSD occluder device is an efficient method for patients with the perimembranous VSD. The operation is simple with a high success rate and a good effect.展开更多
Objectives To investigate the causes, theraputic and preventive methods of com- plications associated with transcatheter occlusion of at- rial septal defect ( ASD) using the Amplatzer septal oc- cluder (ASO) in childr...Objectives To investigate the causes, theraputic and preventive methods of com- plications associated with transcatheter occlusion of at- rial septal defect ( ASD) using the Amplatzer septal oc- cluder (ASO) in children. Methods 289 cases un- derwent transcatheter closure of ASD with ASO. Com- plications occurred in 9 cases. The complications in procedure included systemic circulatory systemic air embolism in 2, pulmonary air embolism in 1, pericar- dial tamponade in 1, ASO malposition requiring emer- gency surgical removal in 1, transient atrial extrasysto- les in 1 and sizing balloon rupture in 1 case. 2 cases with postoperative complications were found in the fol- low-up studies. These included perforation of mitral valve and ASO partially dislodged. In this study, 5 children with intraoperative complication received e- mergency therapy including surgical intervention, and others needed only follow-up, as the complications were transient or asymptomatic. Results There were no children death in this study. The 5 cases who re- ceived treatment were completely healing, and the oth- ers with intra - procedure complications were also had no sequela existed. Cases with mitral valve and ASO partially dislodged were still in follow-up studies, as the 2 patients having no symptoms. Conclutions Air embolism were occurred easily in atrial septal defect cases who received ASO therapy. Complications mainly caused by inappropriate operative procedure and some complications needed emergency treatments. Follow-up studies were important to cases with transcatheter oc- clusion therapy.展开更多
<strong>Background:</strong> <span style="font-family:;" "="">Children presenting with physical features of chondro-ectodermal</span><span style="font-family:;&...<strong>Background:</strong> <span style="font-family:;" "="">Children presenting with physical features of chondro-ectodermal</span><span style="font-family:;" "=""> dysplasia (Ellis-Van Creveld syndrome) such as skeletal and joint abnormalities often have concomitant congenital cardiac anomalies. Presence of cardiorespiratory symptoms in children with Ellis-Van Craved syndrome warrants a thorough cardiologic evaluation to recognize and treat underlying congenital heart anomaly. <b>Aim:</b> A child with physical stigmata of Ellis-Van-Creveld syndrome is evaluated to detect an associated congenital cardiac anomaly and <span>accomplish successful repair of the underlying cardiac lesion to reduce the cardiac</span> related morbidity and improve the patient survival. <b>Case Presentation:</b> Ten year</span><span style="font-family:;" "="">s</span><span style="font-family:;" "=""> old boy with chondroectodermal dysplasia (dental anomalies, genu valgum and other skeletal abnormalities) presented with dyspnea and cyanosis. Cardiac evaluation by 2D echo revealed an atrioventricular (AV) canal septal defect with AV valve regurgitation and a common atrium. Angiocardiography showed a goose neck deformity of the left ventricular outflow tract. <span>The Qp/Qs was 3.4: 1, with systemic arterial oxygen desaturation (SaO<sub>2</sub> of 0.7) </span>and O<sub>2</sub> saturation in the common atrium was 0.7. The pulmonary venous connections to the common atrium were anomalous. Atriotomy on cardiopulmonary bypass and on a cardioplegic arrest discerned a partial AV canal septal defect with a common bridging leaflet, clefts in septal leaflets of tricuspid and mitral vlalves, an incompletely closed interventricular communication, and a common atrium with highly anomalous pulmonary venous insertions well anterior (8</span><span style="font-family:;" "=""> </span><span style="font-family:;" "="">cm) to vena caval orifices. Intracardiac repair was performed with two patches of Goertex to partition the common atrium into the pulmonary and systemic venous chambers after repair of the partial AV canal septal defect. Patient required only a temporary afterload reduction with enalapril;otherwise patient had an uneventful postoperative course. At a 2</span><span style="font-family:;" "="">-</span><span style="font-family:;" "="">year follow-up, the child was well without AV valve regurgitation and had normal <span>biventricular function. <b>Conclusion:</b> A child with Ellis-Van-Creveld syndrome</span> with skeletal abnormalities and dental anomalies had manifested with cardio-respiratory symptoms. Preoperative cardiac and intraoperative evaluation showed a common atrium with severely anomalous pulmonary venous connection and partial AV canal septal defect. Successful biventricular repair was accomplished by repairing the partial AV canal septal defect and partitioning <span>the common atrium into left and right atrium by a complex atrial routing tech<span>nique with two patches of Gore-Tex. On a follow-up at 2 years</span></span></span><span style="font-family:;" "="">, </span><span style="font-family:;" "="">the patient had</span><span style="font-family:;" "=""> adequate biventricular function without AV valve regurgitation.</span> <div class="__kindeditor_paste__" style="position:absolute;width:1px;height:1px;overflow:hidden;left:-1981px;top:0px;white-space:nowrap;"> <table width="100%" border="0" cellpadding="0" cellspacing="1" bgcolor="#cacfd2" style="border:0px solid #CCCCCC;line-height:25px;width:1041px;color:#000000;font-family:宋体, Arial, sans-serif;"> <tbody> <tr style="background-color:#FAFBFD;"> <td style="text-align:center;font-size:14px;vertical-align:middle;"> <div align="center"> 114264<strong></strong> </div> </td> </tr> </tbody> </table> </div>展开更多
Objective To research the expression of endothelin-1 (ET-1) in vascular of lung, endocardium and myocardial vascular of congenital heart disease (CHD) ventricular septal defect (VSD) with pulmonary hypertension (PH...Objective To research the expression of endothelin-1 (ET-1) in vascular of lung, endocardium and myocardial vascular of congenital heart disease (CHD) ventricular septal defect (VSD) with pulmonary hypertension (PH). Methods The Streptavidin-peroxidase (SP) immunoassay was used to measure the expression of ET-1 in pulmonary arteriola, pulmonary veinlet, endocardium and endangium of vasa coronary of 20 cases VSD of CHD with PH, and contrast the expression level of these 20 cases VSD of CHD with PH. Results The expression of ET-1 PH patients in pulmonary arteriola, endocardium, and endangium of vasa coronary was much higher than that of the control group (P<0.05), but there was no significance variance in expression level of pulmonary veinlet between two groups (P>0.05). Conclusion If VSD of CHD was accompany with PH, the degree of PH has a positive correlation with the amount of ET-1 in pulmonary arteriola, ET-1 may be the cause of dynamic PH, and also the acceleration factor of the PH. However, the amount of ET-1 in endocardium and endangium of vasa coronary, may have significant connection with the myocardium hypertrophy in dynamic PH.展开更多
Surgical intervention for post-infarct ventricular septal defect (VSD) is a challenging procedure due to patients’ complex preoperative conditions. While percutaneous VSD closure can be considered as an alternative t...Surgical intervention for post-infarct ventricular septal defect (VSD) is a challenging procedure due to patients’ complex preoperative conditions. While percutaneous VSD closure can be considered as an alternative to surgical repair, complete closure of the defect remains difficult and is associated with various procedural complications. We report a rare case of a patient with postoperative residual shunts who experienced recurrent stroke episodes, requiring surgical intervention for repair. The patient, a 71-year-old female, developed acute anterior myocardial infarction and post-infarct VSD. Percutaneous closure with a 14-mm Amplatzer VSD occluder device was performed, yet the closure was incomplete. Following discharge, she developed multiple embolic stroke episodes, likely stemming from the residual VSD, which led to the surgical extraction of the device and VSD repair. Fibrous tissue was found to be solely attached to the core and right ventricle side of the device, whilst no fibrous tissue was observed on the side of the left ventricle. The patient has not experienced new neurological symptoms at an 18-month follow-up. Thus, it is paramount to keep in mind that an embolic stroke may occur in the setting of percutaneous post-infarct VSD closure. Surgical repair of VSD with device removal should be considered as a treatment option to such a complex case.展开更多
文摘Introduction: Ventricular septal defect (VSD) is the most common congenital heart disease of all congenital heart defects. The aim of this study was to investigate the echographic, therapeutic and evolutionary aspects of ventricular septal defects (VSD) in the general cardiology department of the Hôpital National Ignace Deen. Methods: A retrospective data collection was carried out from January 2018 to December 2023 including 85 cases of isolated IVC was performed. The variables studied were epidemiological, clinical, paraclinical, therapeutic and evolutionary. Results: Of the 320 patients seen during the study period for congenital heart disease, 85 (26.556%) were isolated IVCs. Age at diagnosis ranged from 3 months to 16 years, with an average age of 3.59 years. The most represented ethnic group was the Fulani (50.58%). The 8.24% came from consanguineous marriage versus 22.35%. 91.76% of children had a history of bronchitis. The most common clinical signs found were systolic murmur (90.58%), growth retardation (51.76%). Only 4 cases (4.70%) had a malformation associated with IVC represented by DiGeorges disease (2.35%) and trisomy 21 (2.35%). Nearly half the patients had type IIb VIC (44.71%). The other half were represented by type 1 (18.82%), type IIa (20%), type III (10.59%) and type IV (5.88%). According to site more than two-thirds of VICs (71.64%) were perimembranous in location, followed by infundibular (16.47%) and muscular (11.76%) VICs. In our study 55.29% presented an indication for both surgical intervention and medical treatment, while 16.47% required only medical treatment. In contrast, 28.23% were placed under exclusive surveillance. Of the 47 patients for whom surgery was indicated, 29 (61.17%) underwent surgical repair, while 18 (38.83%) were awaiting confirmation for surgery. Conclusion: VIC is the most common congenital heart disease. An early detection strategy and the establishment of specialized centers could improve the outcome of these children.
文摘Speckle tracking imaging (STI) was employed to investigate the effect of right ventricular (RV) volume and pressure overload on left ventricular (LV) rotation and twist in 35 patients with atrial septal defect (ASD), 18 of which with pulmonary hypertension, and 21 healthy subjects serving as controls. The peak rotations of 6 segments at the basal and apical short-axises and the average peak rotation and interval time of the 6 segments in the opposite direction during early systolic phase were measured respectively. LV twist versus time profile was drawn and the peak twist and time to peak twist were calculated. LV ejection fraction (EF) was measured by Biplane Simpson. Compared to ASD patients without pulmonary hypertension and healthy subjects, the peak rotations of posterior, inferior and postsept walls at the basal level were lower (P〈0.05), and the average counterclockwise peak rotation of 6 segments at the basal level during early systolic phase was higher (P〈0.05), and the average interval time was delayed (P〈0.05). LV peak twist was also lower (P〈0.05), and had a significant negative correlation with pulmonary arterial systolic pressure (r=-0.57, P=0.001). No significant differences were found in LVEF among the three groups. It was suggested that although RV volume overload due to ASD has no significant effects on LV rotation and twist, LV peak twist is lower in ASD patients with pulmonary hypertension. Thus LV twist may serve as a new indicator of the presence of pulmonary hypertension in ASD patients.
文摘Objectives To improve experience of procedure and success rate of interventional treatment of atrial septal defect (ASD) in children, applying the technique of controlling release of devices in the pulmonary vein (controlling two disc of device opening for subsequence) in children cases with ASD who can not be occluded by regularly interventional treatment. Methods Since 2000 year 182 child cases (male 70 and 112 female) underwent the procedure of controlling release of devices in the pulmonary vein. The patients' age was from 2 to 14 years old (average 3.77±1.55). The body weight was from 9 to 48 Kg (average 21.53±10.63). When the devices were placed on the right position with difficulty and failure in some cases with short and soft rims of the defect and large defect and the angle between the device and the interval atrial septal (IAS), It could be helpful to put the device into the left upper pulmonary vein, and to make right atrium (proximal) disc opened before the left atrium (distal) disc naturally fall down. At the end the double disc of the device clamped and stood up at the right position of the IAS. After closure of ASD, patients were followed up regularly by echocardiography, X-ray and ECG in the 1,3,6,12 month and 3,5 years. Results The successful rate of device implantation in the improving group (98.4%) was obviously higher than that in the regularly group (68%). The techniques improved in this group with the smaller age, the lighter weight, the larger defect and the larger device comparing with the regularly group. The velocity of the pulmonary vein before occlusion procedure was (0.54±0.15)m/s; after procedure was (0.56±0.16)m/s, P 〉 0.05,there were no significant difference. All cases couldn't found pulmonary congestion by follow up. Conclusions The method of controlling release of device in the pulmonary vein has been used more than 5 years in the occlusion of ASD with double disc device. It is feasible and safety. The aim of the improvement is for overcoming the problem with larger ASD and the rim deficiency in the interventional procedure in children with ASD. In summary: 1. The performance of the procedure must be careful; 2. To avoid complication when put the sheath into the pulmonary vein; 3. To avoid to put the left disc into pulmonary vein too long and pull the device too much; 4. When the procedure have to operate repeatedly, the device can not be released before the position satisfactory. The improvement of the technique is needed to carry on long-term follow-up in the clinical trials.
基金Supported by Chinese National and Fujian Provincial Key Clinical Specialty Construction Programs
文摘BACKGROUND Transcatheter device closure of atrial septal defect(ASD) guided by fluoroscopy and/or transesophageal echocardiography is a mature technology. Little study has focused on whether the technology can be guided totally by transthoracic echocardiography(TTE),even in pregnant women with ASD.AIM To evaluate the safety and efficacy of totally TTE guided transcatheter device closure of ASD in pregnant women.METHODS Six pregnant women(gestational age 20-26 wk) with ASD underwent transcatheter device closure totally guided by TTE at our cardiac center from January 2015 to August 2017. A routine transcatheter procedure without fluoroscopy or intubation and a domestic occluder were used in this study.RESULTS All patients had successful closure with good clinical results,and the overall immediate complete closure rate was 100%. The size of the occluder deployed ranged from 20 to 32 mm(26.7 ± 4.3 mm),the procedure time ranged from 30 to50 min(41.7 ± 7.5 min),and the length of hospital stay was 2-3 d(mean 2.2 ± 0.4 d). There were no serious cardiovascular related complications,and transient arrhythmias occurred in one patient during the procedure. During the follow-up period(3 mo to 2 years),no occluder dislodgement,residual fistulas,or thromboses occurred. All of the patients underwent vaginal delivery between 36 and 38 wk of gestation.CONCLUSION Totally TTE guided transcatheter device closure of ASD in pregnant women may be safe and effective.
文摘Background: There is a need for data on epidemiological, clinical and therapeutic aspects of ventricular septal defect among children in?Sub-Saharan Africa. Objective: The aim of this study was to determine the prevalence, epidemioclinical, echocardiographic, therapeutic and evolutionary aspects of ventricular septal defects (VSD) in the pediatric department of the University Hospital Center (CHUSS) of Bobo-Dioulasso. Methods: This study was a descriptive cross-sectional study, conducted from November 2013 to December 2016. All children aged 1 to 179 months seen at the pediatric consultation in CHUSS were included. CIV was confirmed with Doppler echocardiography. Results: Out of 36,240 children who received consultation in the pediatric ward of CHUSS during the study period, one hundred (100) cases of them had congenital heart disease representing a hospital prevalence of 2.76%. This was diagnosed with Doppler echocardiography. Of these, 88% were VSD isolated or associated with other cardiac malformations. Isolated form was reported in 54.3% of cases. The average?age at diagnosis was 39.6 months. The sex ratio was 1.05. Perimembranous topography and hemodynamic type 2 were the highest, representing 56.8% and 35.2% respectively. The indication for surgical repair was recommended for 81.8% of the cases, but only 9.7% of these cases benefited from cardiac surgery. The rest were for medicalcare with a high proportion of lost to follow-up (48.9%). Conclusion: VSD is the most common congenital heart disease. Its care is mainly surgical. This cardiac surgery is non-existent in Burkina Faso. The design of multidisciplinary strategies associated with an optimization of the means of the countries of Sub-Saharan Africa could improve the management of this cardiopathy.
文摘Objectives To evaluate the therapeutic effect of transcatheter Amplatzer device on the closure of ventricular septal defect (VSD). Methods Among 143 patients with VSD, 135 patients with perimembrane VSD and 2 with muscular VSD aged 2.5 -28 years old, were successfully closed with Amplatzer oeeluder device by the pereutaneous guidwire through femoral artery-VSD-femoral vein route under the guidance of fluoroscopy, ventrieulography and transthoracic echocardiography (TIE). The diameters of the VSDs were 2.3-15.7 (6.90±2.76)mm by left ventriculography. Results The success rate of transcatheter closure of VSD with Amplatzer devices was 96%(137/143). Minimal residual amount of shunts were found in one patient, although the shunts was decreased one month after the procedure. There were one patient who had respiratory arrest during the procedure, 7 patients(5%)had conduction disturbance, 3 patients had complete left bundle branch block, 2 patients had complete right bundle branch block, 1 patient had Ⅰ degree atrial-ventricular block and 1 patient had Ⅲ degree atr/al-ventricular block during hospitalization. The diameters of the occluder ranged from 4 to 23 (9.13±3.31)mm and were symmetrical in 122 patients and asymmetrical in 15 patients. Conclusions Transcatheter closure of the perimembranous ventrieular septal defect using Amplatzer VSD occluder device is an efficient method for patients with the perimembranous VSD. The operation is simple with a high success rate and a good effect.
文摘Objectives To investigate the causes, theraputic and preventive methods of com- plications associated with transcatheter occlusion of at- rial septal defect ( ASD) using the Amplatzer septal oc- cluder (ASO) in children. Methods 289 cases un- derwent transcatheter closure of ASD with ASO. Com- plications occurred in 9 cases. The complications in procedure included systemic circulatory systemic air embolism in 2, pulmonary air embolism in 1, pericar- dial tamponade in 1, ASO malposition requiring emer- gency surgical removal in 1, transient atrial extrasysto- les in 1 and sizing balloon rupture in 1 case. 2 cases with postoperative complications were found in the fol- low-up studies. These included perforation of mitral valve and ASO partially dislodged. In this study, 5 children with intraoperative complication received e- mergency therapy including surgical intervention, and others needed only follow-up, as the complications were transient or asymptomatic. Results There were no children death in this study. The 5 cases who re- ceived treatment were completely healing, and the oth- ers with intra - procedure complications were also had no sequela existed. Cases with mitral valve and ASO partially dislodged were still in follow-up studies, as the 2 patients having no symptoms. Conclutions Air embolism were occurred easily in atrial septal defect cases who received ASO therapy. Complications mainly caused by inappropriate operative procedure and some complications needed emergency treatments. Follow-up studies were important to cases with transcatheter oc- clusion therapy.
文摘<strong>Background:</strong> <span style="font-family:;" "="">Children presenting with physical features of chondro-ectodermal</span><span style="font-family:;" "=""> dysplasia (Ellis-Van Creveld syndrome) such as skeletal and joint abnormalities often have concomitant congenital cardiac anomalies. Presence of cardiorespiratory symptoms in children with Ellis-Van Craved syndrome warrants a thorough cardiologic evaluation to recognize and treat underlying congenital heart anomaly. <b>Aim:</b> A child with physical stigmata of Ellis-Van-Creveld syndrome is evaluated to detect an associated congenital cardiac anomaly and <span>accomplish successful repair of the underlying cardiac lesion to reduce the cardiac</span> related morbidity and improve the patient survival. <b>Case Presentation:</b> Ten year</span><span style="font-family:;" "="">s</span><span style="font-family:;" "=""> old boy with chondroectodermal dysplasia (dental anomalies, genu valgum and other skeletal abnormalities) presented with dyspnea and cyanosis. Cardiac evaluation by 2D echo revealed an atrioventricular (AV) canal septal defect with AV valve regurgitation and a common atrium. Angiocardiography showed a goose neck deformity of the left ventricular outflow tract. <span>The Qp/Qs was 3.4: 1, with systemic arterial oxygen desaturation (SaO<sub>2</sub> of 0.7) </span>and O<sub>2</sub> saturation in the common atrium was 0.7. The pulmonary venous connections to the common atrium were anomalous. Atriotomy on cardiopulmonary bypass and on a cardioplegic arrest discerned a partial AV canal septal defect with a common bridging leaflet, clefts in septal leaflets of tricuspid and mitral vlalves, an incompletely closed interventricular communication, and a common atrium with highly anomalous pulmonary venous insertions well anterior (8</span><span style="font-family:;" "=""> </span><span style="font-family:;" "="">cm) to vena caval orifices. Intracardiac repair was performed with two patches of Goertex to partition the common atrium into the pulmonary and systemic venous chambers after repair of the partial AV canal septal defect. Patient required only a temporary afterload reduction with enalapril;otherwise patient had an uneventful postoperative course. At a 2</span><span style="font-family:;" "="">-</span><span style="font-family:;" "="">year follow-up, the child was well without AV valve regurgitation and had normal <span>biventricular function. <b>Conclusion:</b> A child with Ellis-Van-Creveld syndrome</span> with skeletal abnormalities and dental anomalies had manifested with cardio-respiratory symptoms. Preoperative cardiac and intraoperative evaluation showed a common atrium with severely anomalous pulmonary venous connection and partial AV canal septal defect. Successful biventricular repair was accomplished by repairing the partial AV canal septal defect and partitioning <span>the common atrium into left and right atrium by a complex atrial routing tech<span>nique with two patches of Gore-Tex. On a follow-up at 2 years</span></span></span><span style="font-family:;" "="">, </span><span style="font-family:;" "="">the patient had</span><span style="font-family:;" "=""> adequate biventricular function without AV valve regurgitation.</span> <div class="__kindeditor_paste__" style="position:absolute;width:1px;height:1px;overflow:hidden;left:-1981px;top:0px;white-space:nowrap;"> <table width="100%" border="0" cellpadding="0" cellspacing="1" bgcolor="#cacfd2" style="border:0px solid #CCCCCC;line-height:25px;width:1041px;color:#000000;font-family:宋体, Arial, sans-serif;"> <tbody> <tr style="background-color:#FAFBFD;"> <td style="text-align:center;font-size:14px;vertical-align:middle;"> <div align="center"> 114264<strong></strong> </div> </td> </tr> </tbody> </table> </div>
文摘Objective To research the expression of endothelin-1 (ET-1) in vascular of lung, endocardium and myocardial vascular of congenital heart disease (CHD) ventricular septal defect (VSD) with pulmonary hypertension (PH). Methods The Streptavidin-peroxidase (SP) immunoassay was used to measure the expression of ET-1 in pulmonary arteriola, pulmonary veinlet, endocardium and endangium of vasa coronary of 20 cases VSD of CHD with PH, and contrast the expression level of these 20 cases VSD of CHD with PH. Results The expression of ET-1 PH patients in pulmonary arteriola, endocardium, and endangium of vasa coronary was much higher than that of the control group (P<0.05), but there was no significance variance in expression level of pulmonary veinlet between two groups (P>0.05). Conclusion If VSD of CHD was accompany with PH, the degree of PH has a positive correlation with the amount of ET-1 in pulmonary arteriola, ET-1 may be the cause of dynamic PH, and also the acceleration factor of the PH. However, the amount of ET-1 in endocardium and endangium of vasa coronary, may have significant connection with the myocardium hypertrophy in dynamic PH.
文摘Surgical intervention for post-infarct ventricular septal defect (VSD) is a challenging procedure due to patients’ complex preoperative conditions. While percutaneous VSD closure can be considered as an alternative to surgical repair, complete closure of the defect remains difficult and is associated with various procedural complications. We report a rare case of a patient with postoperative residual shunts who experienced recurrent stroke episodes, requiring surgical intervention for repair. The patient, a 71-year-old female, developed acute anterior myocardial infarction and post-infarct VSD. Percutaneous closure with a 14-mm Amplatzer VSD occluder device was performed, yet the closure was incomplete. Following discharge, she developed multiple embolic stroke episodes, likely stemming from the residual VSD, which led to the surgical extraction of the device and VSD repair. Fibrous tissue was found to be solely attached to the core and right ventricle side of the device, whilst no fibrous tissue was observed on the side of the left ventricle. The patient has not experienced new neurological symptoms at an 18-month follow-up. Thus, it is paramount to keep in mind that an embolic stroke may occur in the setting of percutaneous post-infarct VSD closure. Surgical repair of VSD with device removal should be considered as a treatment option to such a complex case.