BACKGROUND The off-label use of various devices has been reported for the transcatheter closure of perimembranous ventricular septal defects(PmVSD) because of serious complications, such as heart block and tricuspid r...BACKGROUND The off-label use of various devices has been reported for the transcatheter closure of perimembranous ventricular septal defects(PmVSD) because of serious complications, such as heart block and tricuspid regurgitation(TR),associated with conventional ventricular septal defect devices. However, whether certain defects such as PmVSD with abnormally attached tricuspid are fit for interventional treatment is still disputable.AIM To explore the feasibility and safety of transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae using an improved patent ductus arteriosus(PDA) occluder.METHODS We retrospectively analyzed 20 patients diagnosed with PmVSD with abnormally attached tricuspid chordae tendineae who underwent interventional treatment using an improved PDA occluder at our center from January 2012 to January 2016. Baseline characteristics and procedural and follow-up data were analyzed.RESULTS All 20 patients achieved procedure success. No heart block occurred during the operation. One patient had a transient complete right bundle branch block within48 h post-procedure and reverted to normal rhythm after intravenous injections of dexamethasone for 3 d. For all 20 patients, no residual shunt was observed by transthoracic echocardiography post-procedure. During the average follow-up period of 2.4 years, no severe TR was observed.CONCLUSION Using of the improved PDA occluder for the transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae is a safe and promising treatment option. However, long-term follow-up in a large group of patients is still warranted.展开更多
Objectives To evaluate feasibility, safety and clinical significance of the modified method for trans-catheter closure of patent ductus arteriosus (PDA) with Amplatzer duct occluders. Methods Sixty children with PDA w...Objectives To evaluate feasibility, safety and clinical significance of the modified method for trans-catheter closure of patent ductus arteriosus (PDA) with Amplatzer duct occluders. Methods Sixty children with PDA were divided into 2 groups. Group A consisted of 27 children (12 males, 15 females, aged at 4.6±2.9 years), and group B 33 children (13 males, 20 females, aged at 4.9±3.3 years). The duct closure was completed with the modified method during initial phase in group A and after well-experienced phase in group B. All the technical procedures during PDA occluding including measurement展开更多
Isolated levocardia with situs inversus is an extremely rare type of situs anomaly with an estimated incidence of 1 per 22,000 in the general population. This autosomal recessive situs anomaly has been described as no...Isolated levocardia with situs inversus is an extremely rare type of situs anomaly with an estimated incidence of 1 per 22,000 in the general population. This autosomal recessive situs anomaly has been described as normal levo position of the heart with dextro position of the abdominal viscera. In this case report, we describe accidental diagnosis of isolated levocardia with situs inversus in pediatric patient while evaluating for heart murmur. Systematic examination of the patient identified the presence of patent ductus arteriosus, anomalous course of inferior vena cava and bovine aortic arch. We shared our experience of successful transcatheter closure of patent ductus arteriosus. This case report is worth reporting both, for demonstrating the possibility of the percutaneous device closure of the patent ductus arteriosus in patient with this unusual situs anomaly to interventional cardiologists and because of scanty of literature.展开更多
Background:Persistent patent ductus arteriosus(pPDA)is a common condition in preterm infants.This metaanalysis aimed to assess the safety and efficacy of transcatheter closure(TC)when compared to surgical ligation(SL)...Background:Persistent patent ductus arteriosus(pPDA)is a common condition in preterm infants.This metaanalysis aimed to assess the safety and efficacy of transcatheter closure(TC)when compared to surgical ligation(SL)in preterm infants with pPDA.Methods:A literature search of Ovid Cochrane Library,Medline,Embase,Epub,Scopus,PMC Preprints,and ClinicalTrials.Gov was conducted from inception to May 06,2022.Eligible studies reported infants diagnosed with pPDA born at≤2000 g birth weight or at≤37 weeks’who underwent TC or SL as treatment.This review was registered in PROSPERO(CRD42022325944).Results:From 97 studies screened,8 studies met the eligibility criteria,with a total of 756 preterm infants undergoing either TC(n=366)or SL(n=390).Compared to TC,SL had higher mortality rates(OR=0.32,95%CI:0.16,0.66,I^(2)=0%).No difference was seen in post-procedural complication rate(OR=0.90,95%CI:0.18,4.44,I^(2)=79%),mean duration of post-procedural mechanical ventilation(MD=−2.21 days,95%CI:−4.88,0.47,I^(2)=60%),hospital stay length(MD=−8.30 days,95%CI:−17.03,0.44,I^(2)=0%)or neonatal intensive care unit stay length(MD=−3.50 days,95%CI:−10.27,3.27,I^(2)=0%).Conclusion:Our meta-analysis demonstrated TC as a viable alternative option in managing preterm infants with pPDA in the context of SL.Despite the promising trends demonstrated in this meta-analysis,further studies with larger sample size and controlled baseline characteristics are needed to evaluate the safety and efficacy of TC and SL for preterm infants with pPDA.展开更多
Background:Closure of large patent ductus arteriosus(PDA)in older children has been accomplished using surgical and percutaneous techniques with remarkable outcomes.However,outcomes amongst infants have been variable ...Background:Closure of large patent ductus arteriosus(PDA)in older children has been accomplished using surgical and percutaneous techniques with remarkable outcomes.However,outcomes amongst infants have been variable with several drawbacks.Here we describe a novel minimally invasive technique,a product of mini-thoracotomy and traditional percutaneous technique skills,accomplished exclusively under echocardiography guidance.Methods:Symptomatic infants with a significant left-to-right shunt from PDA measuring more than 4 mm were selected.The symptoms were varying degrees of tachypnea,tachycardia,heart failure,failure to thrive,recurrent respiratory tract infections,or intensive care unit treatment for a longer duration.Through a left parasternal mini-thoracotomy,two parallel purse-string sutures were placed on the pulmonary trunk.After purse-string circle puncture,under exclusively transesophageal echocardiography guidance,a device secured to the safety-suture was implanted on the ascending aorta via pulmonary trunk using a specially designed set.The safety-suture prevented device migration in case of dislocation.The basic demographics,PDA size,device size and type,intrapulmonary manipulation time,operation time,PDA parameters(length,diameter,type of duct),redeployment of the device,residual shunt,and retention of safety-suture were all recorded and analyzed.The follow-up was done with transthoracic echocardiography on the 2^(nd)postoperative day,1,3,6,and 12 months,and yearly thereafter.Results:Fifty-two infants with a mean age of 8 months±2.8 months(Interquartile range=0)underwent Perpulmonary device closure of PDA.Successful PDA occlusion was accomplished event-free in all subjects.The mean PDA,mean device,and mean operation time were 5.6 mm±1.4 mm,7.9 mm±1.7 mm,and 61.2 min±12.9 min,respectively.The immediate acceptable residual shunt was noted among 3 subjects and disappeared at a 1-month follow-up.Eighteen infants had retained safety-suture for added safety.There were no reports of the device or procedure-related complications.Conclusion:Perpulmonary device closure is an effective and safe approach to PDA with a diameter measuring>4 mm among infants.The safety-suture,in case of dislocation,prevents migration and associated complications.展开更多
Purpose: The feasibility and validity of simultaneous transcatheter interventions for patients with atrial septal defect(ASD) complicated with patent ductus arteriosus(PDA) has not been systematically evaluated. Mater...Purpose: The feasibility and validity of simultaneous transcatheter interventions for patients with atrial septal defect(ASD) complicated with patent ductus arteriosus(PDA) has not been systematically evaluated. Materials and Methods: A retrospective analysis was conducted in patients who received transcatheter procedures for ASD complicated with PDA concurrently. The indications and treatment protocols were in accordance with the current guidelines. The sequence of therapy for ASD complicated with PDA was determined by clinical experience. Patients were followed up for at least 6 months after therapy Results: Overall, 22 patients received simultaneous transcatheter interventional therapy, and the success rate was a 100%. No severe complications transpired during the procedure or follow-up stage. Conclusion: Simultaneous transcatheter intervention is feasible and effective for patients who have concurrent complications for both ASD and PDA.展开更多
Purpose To improve the method of PDA closuremanipulation for occluding larger PDAs with the diameter】5mm Method:For 3 patients after perforating the femoral artery,a guiding wire wasintroduced into the aortic atery a...Purpose To improve the method of PDA closuremanipulation for occluding larger PDAs with the diameter】5mm Method:For 3 patients after perforating the femoral artery,a guiding wire wasintroduced into the aortic atery and past through the PDA.Along the wirea balloon catheter was adopted to explore the real internal eiameter and thedistensibility of the PDA.Using a multi-usable catheter which remade fromthe coronary angiographic catheter and had a relative larger cavity was easyto push the coil.Result:The diameters of 3 patients were 6.0,6.3 and40 minutes.A small shunt existed in only one case and disappeared onemonth late.Conclusion:The improved method is safe and valuable forclmical application.展开更多
Background: Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases and began to get treated by transcatheter occlusion since 1997 in China. Since then, several devices have been invented...Background: Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases and began to get treated by transcatheter occlusion since 1997 in China. Since then, several devices have been invented for occluding PDA. This study aimed to evaluate the technical feasibility, safety, and efficacy of transcatheter occlusion of PDA with different devices. Methods: One thousand five hundred and twenty-six patients (537 boys, 989 girls) with PDA from January 1997 to September 2014 underwent descending aortogram and transcatheter occlusion procedure. We retrospectively analyzed data of these patients, including gender, age, weight, size and morphology of PDA, and devices used in transcatheter occlusion, outcomes, and postoperational complications. Results: Median age and median weight were 4.0 years (range: 0.3 5-2.0 years old) and 15.3 kg (range: 4.5-91.0 kg), respectively. Mean ductal diameter, aortic ductal diameter, ductal length, and pulmonary artery pressure were 3.50 ± 2.15 mm, 10.08 ± 2.46 ram, 7.49 ± 3.02 mm, and 30.21 ± 17.28 mmHg, respectively. Morphology of PDA assessed by descending aortogram was of type A in 1428 patients, type B in 6 patients, type C in 79 patients, type D in 4 patients, and type E in 9 patients according to the classification of Krichenko. Of all the 1526 patients, 1497 patients underwent transcatheter PDA closure, among which 1492 were successful. Devices used were Amplatzer duct occluder I (ADO I, 1280, 85.8%), Cook detachable coils (116, 7.8%), ADO II (ADO II, 68, 4.6%), muscular VSD occluder (12, 0.8%), and Amplatzer vascular plug (16, 1.0%). Conclusions: Excellent occlusion rates with low complication rates were achieved with all devices regardless of PDA types. With transcatheter occlusion technique and devices developing, more patients with PDA can be treated with transcatheter closure both safely and efficiently.展开更多
文摘BACKGROUND The off-label use of various devices has been reported for the transcatheter closure of perimembranous ventricular septal defects(PmVSD) because of serious complications, such as heart block and tricuspid regurgitation(TR),associated with conventional ventricular septal defect devices. However, whether certain defects such as PmVSD with abnormally attached tricuspid are fit for interventional treatment is still disputable.AIM To explore the feasibility and safety of transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae using an improved patent ductus arteriosus(PDA) occluder.METHODS We retrospectively analyzed 20 patients diagnosed with PmVSD with abnormally attached tricuspid chordae tendineae who underwent interventional treatment using an improved PDA occluder at our center from January 2012 to January 2016. Baseline characteristics and procedural and follow-up data were analyzed.RESULTS All 20 patients achieved procedure success. No heart block occurred during the operation. One patient had a transient complete right bundle branch block within48 h post-procedure and reverted to normal rhythm after intravenous injections of dexamethasone for 3 d. For all 20 patients, no residual shunt was observed by transthoracic echocardiography post-procedure. During the average follow-up period of 2.4 years, no severe TR was observed.CONCLUSION Using of the improved PDA occluder for the transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae is a safe and promising treatment option. However, long-term follow-up in a large group of patients is still warranted.
文摘Objectives To evaluate feasibility, safety and clinical significance of the modified method for trans-catheter closure of patent ductus arteriosus (PDA) with Amplatzer duct occluders. Methods Sixty children with PDA were divided into 2 groups. Group A consisted of 27 children (12 males, 15 females, aged at 4.6±2.9 years), and group B 33 children (13 males, 20 females, aged at 4.9±3.3 years). The duct closure was completed with the modified method during initial phase in group A and after well-experienced phase in group B. All the technical procedures during PDA occluding including measurement
文摘Isolated levocardia with situs inversus is an extremely rare type of situs anomaly with an estimated incidence of 1 per 22,000 in the general population. This autosomal recessive situs anomaly has been described as normal levo position of the heart with dextro position of the abdominal viscera. In this case report, we describe accidental diagnosis of isolated levocardia with situs inversus in pediatric patient while evaluating for heart murmur. Systematic examination of the patient identified the presence of patent ductus arteriosus, anomalous course of inferior vena cava and bovine aortic arch. We shared our experience of successful transcatheter closure of patent ductus arteriosus. This case report is worth reporting both, for demonstrating the possibility of the percutaneous device closure of the patent ductus arteriosus in patient with this unusual situs anomaly to interventional cardiologists and because of scanty of literature.
文摘Background:Persistent patent ductus arteriosus(pPDA)is a common condition in preterm infants.This metaanalysis aimed to assess the safety and efficacy of transcatheter closure(TC)when compared to surgical ligation(SL)in preterm infants with pPDA.Methods:A literature search of Ovid Cochrane Library,Medline,Embase,Epub,Scopus,PMC Preprints,and ClinicalTrials.Gov was conducted from inception to May 06,2022.Eligible studies reported infants diagnosed with pPDA born at≤2000 g birth weight or at≤37 weeks’who underwent TC or SL as treatment.This review was registered in PROSPERO(CRD42022325944).Results:From 97 studies screened,8 studies met the eligibility criteria,with a total of 756 preterm infants undergoing either TC(n=366)or SL(n=390).Compared to TC,SL had higher mortality rates(OR=0.32,95%CI:0.16,0.66,I^(2)=0%).No difference was seen in post-procedural complication rate(OR=0.90,95%CI:0.18,4.44,I^(2)=79%),mean duration of post-procedural mechanical ventilation(MD=−2.21 days,95%CI:−4.88,0.47,I^(2)=60%),hospital stay length(MD=−8.30 days,95%CI:−17.03,0.44,I^(2)=0%)or neonatal intensive care unit stay length(MD=−3.50 days,95%CI:−10.27,3.27,I^(2)=0%).Conclusion:Our meta-analysis demonstrated TC as a viable alternative option in managing preterm infants with pPDA in the context of SL.Despite the promising trends demonstrated in this meta-analysis,further studies with larger sample size and controlled baseline characteristics are needed to evaluate the safety and efficacy of TC and SL for preterm infants with pPDA.
文摘Background:Closure of large patent ductus arteriosus(PDA)in older children has been accomplished using surgical and percutaneous techniques with remarkable outcomes.However,outcomes amongst infants have been variable with several drawbacks.Here we describe a novel minimally invasive technique,a product of mini-thoracotomy and traditional percutaneous technique skills,accomplished exclusively under echocardiography guidance.Methods:Symptomatic infants with a significant left-to-right shunt from PDA measuring more than 4 mm were selected.The symptoms were varying degrees of tachypnea,tachycardia,heart failure,failure to thrive,recurrent respiratory tract infections,or intensive care unit treatment for a longer duration.Through a left parasternal mini-thoracotomy,two parallel purse-string sutures were placed on the pulmonary trunk.After purse-string circle puncture,under exclusively transesophageal echocardiography guidance,a device secured to the safety-suture was implanted on the ascending aorta via pulmonary trunk using a specially designed set.The safety-suture prevented device migration in case of dislocation.The basic demographics,PDA size,device size and type,intrapulmonary manipulation time,operation time,PDA parameters(length,diameter,type of duct),redeployment of the device,residual shunt,and retention of safety-suture were all recorded and analyzed.The follow-up was done with transthoracic echocardiography on the 2^(nd)postoperative day,1,3,6,and 12 months,and yearly thereafter.Results:Fifty-two infants with a mean age of 8 months±2.8 months(Interquartile range=0)underwent Perpulmonary device closure of PDA.Successful PDA occlusion was accomplished event-free in all subjects.The mean PDA,mean device,and mean operation time were 5.6 mm±1.4 mm,7.9 mm±1.7 mm,and 61.2 min±12.9 min,respectively.The immediate acceptable residual shunt was noted among 3 subjects and disappeared at a 1-month follow-up.Eighteen infants had retained safety-suture for added safety.There were no reports of the device or procedure-related complications.Conclusion:Perpulmonary device closure is an effective and safe approach to PDA with a diameter measuring>4 mm among infants.The safety-suture,in case of dislocation,prevents migration and associated complications.
文摘Purpose: The feasibility and validity of simultaneous transcatheter interventions for patients with atrial septal defect(ASD) complicated with patent ductus arteriosus(PDA) has not been systematically evaluated. Materials and Methods: A retrospective analysis was conducted in patients who received transcatheter procedures for ASD complicated with PDA concurrently. The indications and treatment protocols were in accordance with the current guidelines. The sequence of therapy for ASD complicated with PDA was determined by clinical experience. Patients were followed up for at least 6 months after therapy Results: Overall, 22 patients received simultaneous transcatheter interventional therapy, and the success rate was a 100%. No severe complications transpired during the procedure or follow-up stage. Conclusion: Simultaneous transcatheter intervention is feasible and effective for patients who have concurrent complications for both ASD and PDA.
文摘Purpose To improve the method of PDA closuremanipulation for occluding larger PDAs with the diameter】5mm Method:For 3 patients after perforating the femoral artery,a guiding wire wasintroduced into the aortic atery and past through the PDA.Along the wirea balloon catheter was adopted to explore the real internal eiameter and thedistensibility of the PDA.Using a multi-usable catheter which remade fromthe coronary angiographic catheter and had a relative larger cavity was easyto push the coil.Result:The diameters of 3 patients were 6.0,6.3 and40 minutes.A small shunt existed in only one case and disappeared onemonth late.Conclusion:The improved method is safe and valuable forclmical application.
文摘Background: Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases and began to get treated by transcatheter occlusion since 1997 in China. Since then, several devices have been invented for occluding PDA. This study aimed to evaluate the technical feasibility, safety, and efficacy of transcatheter occlusion of PDA with different devices. Methods: One thousand five hundred and twenty-six patients (537 boys, 989 girls) with PDA from January 1997 to September 2014 underwent descending aortogram and transcatheter occlusion procedure. We retrospectively analyzed data of these patients, including gender, age, weight, size and morphology of PDA, and devices used in transcatheter occlusion, outcomes, and postoperational complications. Results: Median age and median weight were 4.0 years (range: 0.3 5-2.0 years old) and 15.3 kg (range: 4.5-91.0 kg), respectively. Mean ductal diameter, aortic ductal diameter, ductal length, and pulmonary artery pressure were 3.50 ± 2.15 mm, 10.08 ± 2.46 ram, 7.49 ± 3.02 mm, and 30.21 ± 17.28 mmHg, respectively. Morphology of PDA assessed by descending aortogram was of type A in 1428 patients, type B in 6 patients, type C in 79 patients, type D in 4 patients, and type E in 9 patients according to the classification of Krichenko. Of all the 1526 patients, 1497 patients underwent transcatheter PDA closure, among which 1492 were successful. Devices used were Amplatzer duct occluder I (ADO I, 1280, 85.8%), Cook detachable coils (116, 7.8%), ADO II (ADO II, 68, 4.6%), muscular VSD occluder (12, 0.8%), and Amplatzer vascular plug (16, 1.0%). Conclusions: Excellent occlusion rates with low complication rates were achieved with all devices regardless of PDA types. With transcatheter occlusion technique and devices developing, more patients with PDA can be treated with transcatheter closure both safely and efficiently.