Objective:The aims of this retrospective study were to investigate and evaluate the safety and efficacy of three approaches for closure of secundum atrial septal defect(ASD).Methods:In this study,we reviewed clinical data for transcatheter occlusion(TCO,n=63),transthoracic occlusion(TTO,n=55),and right anterolateral minithoracotomy(RALT,n=60)techniques used for ASD closure.We compared the safety and efficacy of the three approaches.Results:ASD size in the TTO group was similar to that in the RALT group(P=0.645)and significantly larger than that in the TCO group(P
目的总结保留主动脉瓣的 A 型主动脉夹层外科治疗的经验。方法收集、分析2009年6月至2014年6月45例 A 型主动脉夹层患者接受保留主动脉瓣的外科手术治疗病历资料。其中，男30例，女15例；年龄36～57岁，平均（45±10）岁。手术方法包括升主动脉置换＋全弓置换＋支架象鼻手术25例、单片技术＋全弓置换＋支架象鼻手术15例，David 技术＋全弓置换＋支架象鼻手术5例，术后随访12个月。结果术中45例主动脉瓣均获得保留。术后并发症包括胸腔积液、心包积液、肝功能不全、肾功能不全各1例。无住院及随访期死亡，随访期无瓣膜相关并发症发生。随诊12个月超声心动图结果示：主动脉瓣反流程度，40例无反流，4例为少量反流，1例为少中量反流。结论A 型主动脉夹层保留主动脉瓣手术早期效果满意。
Fontan surgery is a widely used palliative procedure that significantly improves the survival period of patients with complex congenital heart disease(CHD). However, it does not decrease postoperative complication rate. Previous studies suggested that elevated mean pulmonary artery pressure(m PAP) and vascular resistance lead to decreased exercise tolerance and myocardial dysfunction. Therapy with endothelial receptor antagonists(Bosentan) has been demonstrated to improve the patients' prognosis. A double-blind, randomized controlled trial was performed to explore the efficacy of Bosentan in treating patients who underwent the Fontan procedure. Eligible participants were randomly divided into Bosentan group and control group. Liver function was tested at a local hospital and the results were reported to the phone inspector every month. If the results suggested abnormal liver function, treatment would be adjusted or terminated. All the participants finished the follow-up study, with no patients lost to follow-up. Unblinding after 2-year follow-up, no mortality was observed in either group. However, secondary end-points were found to be significantly different in the comparable groups. The cardiac function and 6-min walking distance in the Bosentan group were significantly superior to those in the control group(P=0.018 and P=0.027). Bosentan could improve New York Heart Association(NYHA) functional status and improve the results of the 6-min walking test(6MWT) in Fontan patients post-surgery, and no other benefits were observed. Furthermore, a primary meta-analysis study systematically reviewed all the similar clinical trails worldwide and concluded an overall NYHA class improvement in Fontan patients who received Bosentan treatments.
目的使用电导导管测量小鼠右心室压力-容积环,评估健康小鼠及肺动脉高压模型小鼠的血流动力学。方法将16只小鼠随机分为实验组(n=8)和对照组(n=8)。实验组小鼠暴露在常压缺氧的环境中10 d,对照组小鼠被安置在室内空气中。使用1.2 F导管从右颈动脉插至升主动脉,另外再穿刺右心室心尖部,用20号针头导入1.2 F压力-容积导管,获得压力-容积的测量值并计算血流动力学参数。比较两组小鼠血流动力学参数的差异。结果两组小鼠体重、右心房重量/体重、左心房重量/体重、(左心室+室间隔)重量/体重比较,差异均无统计学意义(均P>0.05);实验组小鼠右心室重量/(左心室+室间隔)重量[(0.30±0.03)比(0.23±0.06),P=0.0291]、右心室重量/体重[(1.04±0.13)比(0.74±0.10),P=0.0001]显著高于对照组,差异均有统计学意义。两组小鼠心率、主动脉收缩压、主动脉舒张压、右心室舒张末期容积、心室内最大压力上升速度、右心室收缩末期压力-容积关系的斜率、心室内最大压力下降速度、松弛因子τ比较,差异均无统计学意义(均P>0.05)。实验组小鼠血细胞容积率、右心室收缩压、右心室舒张压、搏出功、压力导数的最大值与右心室舒张末期压力容积关系的斜率、前负荷补充搏功、动脉有效弹性显著大于对照组,差异均有统计学意义;而射血时间[(36±2)ms比(45±1)ms,P=0.0001]、心输出量[(5.2±2.6)ml/min比(8.5±2.3)ml/min,P=0.0026]、心室顺应性[(0.43±0.13)μl/mm Hg比(0.68±0.21)μl/mm Hg,P=0.0030(1 mm Hg=0.133 k Pa)]、射血分数[(28±13)%比(51±11)%,P=0.0008]、耦合效率[(0.36±0.15)比(0.73±0.26),P=0.0001]显著低于对照组,差异亦均有统计学意义。结论本研究验证了电导导管测量小鼠右心室压力-容积数据的可能性,为健康状态或疾病状态下的右心室-肺动脉耦合机制的研究提供了方向。
Nitinol alloy occluders are widely used in the transcatheter intervention treatment of congenital heart diseases like patent ductus arteriosus(PDA).However,nitinol alloy contains high levels of nickel,which can lead to toxic effects in the immune and hematopoietic systems if released in sufficient quantities.A new type of single-rivet occluder coated with nano-film has been developed to limit the release of nickel.In total,23 patients were recruited and randomly assigned to the experimental group(n=12) with the new nano-film single-rivet occluders or the control group(n=11) with the traditional occluders.One case in the control group was lost to follow-up.The remaining 22 cases were followed up at 24 h,7 days,1 month,3 months,and 6 months after the procedure.There were no statistically significant differences in routine blood test,alanine aminotransferase,creatinine,and troponin between the experimental and control groups.Serum nickel concentration in both two groups increased at 24 h after the procedure,peaked at 1 month,and returned to preoperative levels at 6 months.Serum nickel levels in the experimental group were significantly lower than in the control group at 24 h,7 days,1 month,and 3 months after the procedure.These data suggested that the nano-film coating effectively prevented nickel release from the new occluders,and therefore has a preferable safety profile.
Pentalogy of Cantrell is a rare congenital abnormality.Even with high-quality medical care and staged corrective surgeries in professional hospitals,the mortality rate is still very high and long-term prognosis is poor.Survival is largely determined by the complexity and severity of cardiac abnormalities,the efficiency of abdominal wall closure and postoperative complications.A 24-year-old male patient with complete pentalogy of Cantrell was diagnosed.One-stage surgical repair of all abnormalities were completed.The patient recovered well and had been follow-up for 7 years.He has a good cosmetic outcome,with no signs of cardiac dysfunction.No complications were noted.
Hao HongNianguo DongMingxing XieLin LiSi ChenWengang SunXiaoqing Hu
