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1.
Transcatheter closure of coronary artery fistula in children   总被引:4,自引:0,他引:4  
Background Transcatheter closure of coronary artery fistula (CAF) has emerged as a successful alternative to surgery. We described our experiences in 10 children patients who were accepted for transcatheter closure of CAF. Methods Ten children were 3-10 years old (seven males) with CAF who underwent percutaneous transcatheter closure between October 1995 and April 2008. Sites of origin of these fistulas were: right coronary artery in seven, left anterior descending coronary artery in two, and left circumflex coronary artery in one patient. Drainage sites of these fistulas were: right atrium in seven, right ventricle in two and left ventricle in one patient. All of these fistulas were congenital and had only one orificium fistula.Results A Cook coil was used in four patients and an Amplatzer patent ductus arteriosus (PDA) occluder was used in six patients. Checking the angiogram after the procedure revealed complete occlusion in nine patients (90%) and minimal residual flow in one (10%) patient. Technical success was achieved in all patients. Follow-up studies at short term showed complete abolition of shunt in all patients with no evidence of recanalization leading to recurrence of shunt. Conclusions Transcatheter therapy using either Cook coil or Amplatzer PDA occluder is suggested to be a safe and effective method of occlusion. The midterm outcome of the intervention for CAF is satisfactory.  相似文献   

2.
Background Transcatheter closure of patent foramen ovale (PFO) is a promising alternative to surgical closure or anticoagulation therapy to prevent paradoxical embolic events in patients with PFO. Several different devices have been used for transcatheter PFO closure. The aim of the present study was to evaluate the safety and feasibility for closure of PFO with a new PFO occluder, the Spider~(TM) PFO occluder. Methods The device was implanted in the PFO patients under fluoroscopy and transthoracic echocardiography (TTE) using a 10 French delivery sheath employing a femoral vein approach. Aspirin was administered at 100 mg/d for six months after occlusion. The clinical and echocardiographic follow-up of patients were performed at the 24th hour, 1st month, 3rd month, 6th month, and 12th month after occlusion, and yearly thereafter. Results The device was implanted successfully in all 55 patients. No major complications occurred during the perioperative period, such as thromboembolism, occluder dislodgement, infection or myocardial infarction. No residual shunt of the atrial level was shown by transesophageal echocardiography, and no latent arrhythmia or cerebral vesselevents occurred in any cases during follow-up ((35±9) months, range 6-51 months).Conclusion Transcatheter closure of a PFO with the Spider~(TM) PFO occluder is a safe and effective therapeutic option for the secondary prevention of presumed paradoxical embolism. However, randomized trials comparing this device with other devices and therapies have to be performed.  相似文献   

3.
Objective To evaluate the safety and efficacy of the Amplatzer septal occluder for transca theter closure in patients with secundum atrial septal defect (ASD Ⅱ). Methods Patients with clinically confirmed ASD Ⅱ were recommended for transcatheter clo sure of ASD Ⅱ. Results 30 ASD Ⅱ patients (20 females) underwent transcatheter closure at a median age of 18.4 years(5-55 years). Both the stretched diameters of ASDs and the sizes o f the devices were from 18 to 34 mm (25±7 mm). The successful placement rate was 100%. The rest shunt documented by color Doppler, was immediately after im plantation in 40% of patients, in 9.9% after 24 hours, and in 3.3% trace at 3 months. No serious complications were observed. There was improvement in symp toms and in cardiac size. Septal motion abnormalities normalized in all patient s after 3 months follow- up. Conclusion The Amplatzer septal occluder is a safe and effective device for transcatheter c losure of ASD Ⅱ. Long- term follow- up is still required before widespread cli nical use can be recommended.  相似文献   

4.
Background Cardiac resynchronization therapy (CRT) with biventricular pacing has demonstrated cardiac function improvement for treating congestive heart failure (HF). It has been documented that the placement of the left ventricular lead at the longest contraction delay segment has the optimal CRT benefit, This study described follow-up to surgical techniques for CRT as a viable alternative for patients with heart failure. Methods Between April 2007 and June 2012, a total of 14 consecutive heart failure patients with New York Heart Association (NYHA) Class Ill-IV underwent left ventricular epicardial lead placements via surgical approach. There were eight males and six females, aged 36 to 79 years ((59.6±9.2) years). The mean left ventricular ejection fraction (LVEF) was (33.6±7.4)%. All patients were treated with left ventricular systolic dyssynchrony and underwent left ventricular epicardial lead placements via a surgical approach. Tissue Doppler imaging (TDI) and intraoperative transesophageal echocardiography were used to assess changes in left heart function and dyssynchronic parameters. Also, echo was used to select the best site for left ventricular epicardial lead placement. Results Left ventricular epicardial leads were successfully implanted in the posterior or lateral epicardial wall without serious complications in all patients. All patients had reduction in NYHA score from Ⅲ-Ⅳ preoperatively to Ⅱ-Ⅲ postoperatively. The left ventricular end-diastolic diameter (LVEDD) decreased from (67.9±12.7) mm to (61.2±7.1) mm (P〈0.05), and LVEF increased from (33.6±7.4)% to (42.2±8.8)% (P〈0.05). Left ventricular intraventricular dyssynchrony index decreased from (148.4±31.6) ms to (57.3±23.8) ms (P〈0.05). Conclusions Minimally invasive surgical placement of the left ventricular epicardial lead is feasible, safe, and efficient. TDI can guide the epicardial lead placement to the ideal tar qet location.  相似文献   

5.
Background Pulmonary atresia with ventricular septal defect (PA-VSD) and major aortopulmonary collateral arteries (MAPCAs) remains a challenging complex congenital heart disease nowadays. In the present study, we aimed to develop a two-stage surgical method and to evaluate outcomes of this method in managing PA-VSD and MAPCAs. Methods Between December 2003 and December 2008, 7 female and 4 male patients between the age of 5 and 10 years who were suffering from PA-VSD and MAPCAs were selected and recruited. The native pulmonary artery trunks were absent in all patients; the lungs were solely supplied by major aortopulmonary collaterals, and the numbers of supplied lung segments ranged from 15 to 20 (17.9±1.6). There were a total of 43 MAPCAs in all the patients (3-5 (3.9~0.7) MAPCAs per patient). The accumulated Nakata index was (222.9+_29.9) mm2/m2 (ranged from 182 to 272). All the patients underwent two sequential operations. Stage one included left major aortopulmonary collateral unifocalization and modified Blalock-Taussig shunt from left posterior lateral thoracotomy; stage two comprised right unifocalization, ligation of the shunt, followed by ventricular septal defect closure and right ventricular outflow tract reconstruction assisted with cardiopulmonary bypass from midline sternotomy. Results All the patients survived the initial surgery, but one of them died of low cardiac output syndrome on the third day after the second operation. Postoperative complications included pneumonia in one case and capillary leak syndrome in another. Postoperative oxygen saturation maintained about 95%-100%, which was significantly higher than pre-operation (P 〈0.01). During the follow-up period of 3-51 (25.4±15.2) months, there were no late death and no need for reintervention. All the patients enjoyed their lives with good conditions. Conclusions This two-stage complete repair strategy was well-tolerated and effective with good outcome, thus offering an alternative surgical approach in the treatment of PA-VSD and MAPCAs.  相似文献   

6.
Objective To evaluate the safety and feasibility of transcatheter closure of large secundum atrial septal defects ( ASDs ) with Amplatzer septal occluder ( ASO ) . Methods A total of 26 patients ( age 16 to 67 years, median 43 years; body weight 52 to 102 kg, median 67 kg ) with large ASDs underwent an attempted transcatheter closure using ASO. Large ASD was defined as those with a balloon-stretched diameter of ≥ 30 mm. Another 81 patients with small-to-moderate ASD during same period who underwent closure served as controls. Results In patients with large ASDs, the ASD dimension means were ( 22.1 ± 3. 2 ) mm ( range from 16 to 30 mm) and (23. 8 ± 2. 6) mm( range from 18 to 31 ram) assessed by transesophageal echocardiography ( TEE ) and transthoracic echocardiography ( TIE), respectively. The mean balloon-stretched diameter of the ASD was (31.9 ± 2. 1 ) mm ( range from 30 to 37mm ). The size of device was (32. 0 ±1.9 )mm ( range from 30 to 36mm). The transcatheter procedure was successful in all patients ( 100% ). Seventeen deployments were performed using the conventional left atrium approach, and remaining 9 patients required the right upper pulmonary vein approach. Immediately after deployment, TEE revealed that complete closure rate was 73%. Procedure-related complications were recorded in 3 patients (12%), including device embolization in one patient, pericardial effusion in one patient, and large hematoma at puncture site in one patient. During follow-up, the complete closure rate increased to 88% at 24 h after procedure and 100% at 6 months. The procedural success rates, immediate TEE results and TTE results at 24 h and 6 months after procedure, were not significantly different between patients with large ASDs and those with small-to-moderate ASDs. Conclusion Transcatheter closure of large ASDs using ASO is technical feasible and relatively safe. Proper care selection and specific technique modification such as the right upper pulmonary vein approach is vital for the implantation success.  相似文献   

7.
Objective To evaluate the efficacy of minimally invasive perventricular device closure of ventricular septal defect(VSD). Methods Between September 2011 and February 2013, we collected 40 patients who underwent perventricular closure via a small lower sternal incision(minimally invasive group), aged 15.5±3.5 years(12 months to 32 years) with a body weight of 24.2±7.5 kg(10.8-58.0 kg). The mean size of VSD was 5.6±0.5 mm(2-14 mm). Another 40 patients were included as the surgical group, receiving the conventional surgical repair of VSD. The device of the minimally invasive group was released under the guidance of transesophageal echocardiography. Success rate, cardiac indicators, and clinical outcomes of the 2 groups were compared. Results The patients in the surgical group and those in the minimally invasive group showed similar results in success rate(both 97.5%). The procedure time, intensive care unit stay, hospital stay, and postoperative recovery time in the minimally invasive group were significantly shorter than those in the surgical group(58±21 minutes versus 145±26 minutes, 2±1 days versus 8±3 days, 5±1 days versus 16±6 days, 3±1 days versus 90±20 days, all P〈0.05). The minimally invasive group had a higher incidence of conduction anomalies(17.5% versus 2.5%, P〈0.05). In the follow-up period of 3-12 months, there was no new residual shunt, noticeable aortic regurgitation, significant arrhythmias, or device failure except for new complications in the surgical group. Conclusions The success rate of minimally invasive perventricular device closure of VSD under transesophageal echocardiography guidance is similar to that of conventional surgical repair, but the short-term outcomes of the minimally invasive approach is much better. Long-term follow-up is necessary to confirm the effectiveness of this technique.  相似文献   

8.
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.  相似文献   

9.
Surgical treatment of double outlet ventricle   总被引:1,自引:0,他引:1  
Objective To study the results of surgical treatment for double outlet ventricle. Methods The results of 72 cases of double outlet ventricle were retrospectively analyzed. Results There were 71 cases of double outlet right ventricle, including 64 cases of type SDD, 3 type ILL, 3 type SDL, 1 type IDD. Only one case was double outlet left ventricle type ILD. Surgical procedures included left ventricle-aorta intraventricular tunnel connection in 61 patients,total cava-pulmonary artery connection in 2,left ventricle-aorta intraventricular tunnel and right ventricle-pulmonary artery extracardial tube repaired in 3. Six cases underwent bi-directional Glenn procedure. Two cases died from operation. Residue shunt of VSD was observed in one case and re-operation was done to repair the shunt. There were no long-term death and other complications. Conclusion It is important to choose the right time and proper procedure. Reconstruction left and right ventricle is the essential factor to the surgical success. 6 refs  相似文献   

10.
Background The RhoA/Rho kinase pathway may participate in the pathogenesis of hypoxia and monocrotaline induced pulmonary hypertension. This study tested whether RhoA/Rho kinase pathway is involved in the pathogenesis of high flow induced pulmonary hypertension in rats. Methods Male Wistar rats (4 weeks) were randomly divided into 4 shunt groups, 4 treated groups and 4 control groups. Shunt and treated groups underwent left common carotid artery/external jugular vein shunt operation. Control groups underwent sham operation. Treated groups received fasudil treatment and the others received same dose of saline. At weeks 1, 2, 4 and 8 of the study, nght ventricular systolic pressure was measured and blood gases were analysed to calculate Qp/Qs. The weight ratio of right ventricle to left ventricle plus septum and the mean percentage of medial wall thickness in moderate sized pulmonary arteries were obtained. RhoA activity in pulmonary arteries was detected using Rho activity assay reagent. Rho kinase activity was quantified by the extent of MYPT1 phosphorylation with Western blot. Proliferating cells were evaluated using proliferating cell nuclear antigen immunohistological staining, Results Carotid artery/jugular vein shunt resulted in high pulmonary blood flow, both an acute and a chronic elevation of right ventricular systolic pressure, significant medial wall thickening characterized by smooth muscle cells proliferation, nght ventricular hypertrophy and increased activation of RhoA and Rho kinase. Fasudil treatment lowered pulmonary artery systolic pressure, suppressed pulmonary artery smooth muscle cells proliferation, attenuated pulmonary artery medial wall thickening and inhibited right ventricular hypertrophy together with significant suppression of Rho kinase activity but not Rho activity. Conclusions Activated RhoNRho kinase pathway is associated with both the acute pulmonary vasoconstriction and the chronic pulmonary artery remodelling of high flow induced pulmonary hypertension. Fasudil treatment could improve pulmonary hypertension by inhibiting Rho kinase activity.  相似文献   

11.
R啨sum啨   Objectif Explorerl efficacit啨delafermeturetranscath啨t啨riennedelapersistanceducanalart啨riel (PCA )aveclaspire (coil)d啨tachableetaveclebloqueurAmplatzer (Amplatzerductoccluder,ADO) ,discuterlesfacteursimpliqu啨s . M啨thodes Lafermeturetranscath啨t啨rienne…  相似文献   

12.
应用Amplatzer封堵器治疗先天性心脏病68例   总被引:1,自引:0,他引:1  
曾智  张庆  饶莉  梁玉佳  张立 《四川医学》2002,23(3):223-226
目的:评价Amplatzer封堵器在继发也型房间隔缺损(OSD)和动脉导管未闭(PDA)的介入治疗中的可靠性、安全性和疗效。方法:采用Amplatzer封堵器治疗38例OSD与30例PDA患者,术后24小时,1,3,6月及1年行超声心动图检查,观察封堵效果及无并发症。结果:37例(97.4%)OSD患者成功置入Amplatzer封堵器,其中34例(91.9%),显示即刻封堵完全,3例(8.1%)存在微-少量残余分流。1例28岁男性术后第4天发生无Q波心肌梗死。随访中,未见封堵器移位及再通,右心房、室有不同程度缩小,2例残余分流消失;PDA最窄处直径为2.5-12(平均5.3)mm。29例用PDA封堵器,1例有重度肺动脉高压的粗大PDA采用Amplatzer房封堵器治疗。19例(63.3%)显示即刻封堵完全,所有病例术后24小时(1例48小时)的彩色多普勒检查均未见残余分流。1例发生机械性溶血。随访期中,未出现封堵器移位,、残余分流及再通。结论:用Amplatzer封堵器治疗OSD和PDA是一种安全有效的非外科手术方法,操作简便,创伤小,成功率高。超声心动图在术前、术中、术后均发挥了重要作用。近期疗效满意,远期效果尚需进一步观察。  相似文献   

13.
儿童动脉导管未闭介入堵闭术的临床疗效评价   总被引:1,自引:0,他引:1  
目的评价分别运用弹簧圈(Coil)和Amplatzer封堵器(ADO)堵闭小型和中一大型动脉导管未闭(PDA)的临床疗效。方法对1998年5月至2006年1月在我院接受介入封堵术的112名PDA患儿进行回顾性队列研究。结果植入Coil和ADO的患儿分别为19例和93例。AIX)组患儿PDA最窄处直径为1.7~11.0mm,(平均3.53mm),显著高于Coil组患儿1.0~3.3mm(平均1.76mm),P〈0.001。全部患儿均成功完成介入封堵术(100%)。1年随访期中,残余分流率在不同随访时间点分别为Coil组31.6%(即刻)、26.3%(24h)、5.3%(1~3月)、5.3%(9~12月)和ADO组21.5%、6.5%、2.2%和1.2%。近期并发症2例,溶血1例,心律失常1例。远期随访中无溶血、PDA再通和左肺动脉或降主动脉狭窄;无患儿因残余分流需要再次接受介入治疗。结论选择合适的堵闭器经导管介入封堵治疗儿童PDA疗效确切,安全性好。  相似文献   

14.
目的 应用Amplatzer封堵器治疗动脉导管未闭 (patentductusarteriosus ,PDA)并评价其临床疗效。 方法  7例患者 ,女 2例 ,男 5例 ,年龄 2 .5~ 5 6岁 ,体重 10 .0~ 73 .5kg ,均经超声心动图确诊。术中行右心导管测压后 ,进行主动脉弓降部造影 ,以确定PDA的位置、形状及最窄直径。选择大于所测PDA最窄直径 3~ 6mm的封堵器 ,于透视下经输送鞘管将其封堵于PDA处。 10分钟后重复造影 ,若封堵器形状、位置满意 ,无或仅有微~少量残余分流时 ,可释放封堵器。术后 1周 ,1~ 6个月行超声心动图、心血管摄片检查 ,观察残余分流情况、封堵器位置及心脏大小的变化。结果 主动脉弓降部造影显示PDA均呈管型 ,PDA最窄直径平均为 5 .5± 3 .1mm ( 3 .0~ 11.8mm )。均有肺动脉高压 ,其中轻度 6例 ,重度 1例。 7例封堵器均放置成功。造影示 6例即刻完全封堵 ,1例有微量残余分流 ,此患者术后 18小时发生急性溶血 ,经内科保守治疗治愈 ,术后 1个月彩色多普勒超声心动图示残余分流消失 ,随访 6个月 7例患者心脏均有不同程度缩小。结论 应用Amplatzer封堵器治疗PDA是一种方法简便 ,成功率高 ,近期疗效可靠的介入方法  相似文献   

15.
评价五种不同介入性心导管堵闭术治疗小儿动脉导管未闭 (PDA)的应用价值。方法  1989年 3月 - 1999年 12月 ,354例PDA患儿分别用五种不同介入堵闭术进行治疗 ,男 135例 ,女 2 19例 ,年龄 0 4 - 15(3 2± 0 8)岁 ,体重 4 8- 4 9(2 0 6± 3 2 )Kg ,Qp Qs为 1 2 - 4 4 (2 2± 0 5)。其中Porstmann海绵法 2 5例 ,Rashkind双面伞器法 78例 ,Sideris纽扣式补片法 4 3例 ,Cook及PFM弹簧圈器法 6 9例 ,Amplatzer蘑菇伞器法139例。单纯PDA351例 ,其中 3例为PDA结扎后残余分流 ;2例合并轻度主动脉狭窄 ,1例合并轻度肺动脉瓣狭窄。所有PDA患儿术后 1天 ,1个月 ,3个月 ,6个月均用彩色多普勒超声心动图随诊。结果 总成功率 98 6 % (351 354) ,其中Porstmann法 92 % (2 3 2 5) ,Rashkind法 98 7% (71 78) ,Sideris法 10 0 % (43 4 3) ,Coil法 10 0 % (6 9 6 9) ,Amplatzer法 10 0 % (139 139)。具体见表。五种方法残余分流分别是 :Porstmann法无残余分流 ;Rashkind法 17 9% (2 4小时 ) ,7 7% (6个月 ) ;Sideris法 18 6 % (2 4小时 ) ,15% (6个月 ) ;Coil法 5 8% (2 4小时 ) ,2 8% (6个月 ) ;Amplatzer法 8 6 % (2 4小时 ) ,1 4 % (6个月 )。五种方法的X线透视时间分别是 :Porstmann法 54 0± 13 0分钟 ,Rash  相似文献   

16.
目的:研究小儿复合型先天性心脏病经导管介入治疗的方法及疗效。方法:1994年3月至2003年12月适合经导管介入治疗的复合型先天性心脏病患儿15例,肺动脉瓣狭窄(PS)伴房间隔缺损(A SD)或动脉导管未闭(PDA)者,先行PS瓣膜成形术,再堵塞A SD或PDA;主动脉缩窄(COA)伴PDA者,先行COA血管成形术,4~15个月后再行PDA堵塞术;主动脉瓣狭窄(A S)伴PDA者,先行瓣膜成形术,再行PDA堵塞;室间隔缺损(V SD)伴PDA采用弹簧圈封堵。结果:15例患者经导管介入治疗均获成功。除2例PDA术后即刻有少量紊流,余均无残漏。随访(3.57±2.61)年,跨瓣(或跨缩窄段)压差经超声心动图或导管测压除A S外均正常。围术期机械性溶血、弹簧圈脱落和动脉栓塞各1例。结论:复合型先天性心脏病经导管介入治疗只要恰当掌握指征,操作规范,可获得良好的治疗效果;对合并A S者,适应证的掌握及球囊大小的选择需进一步摸索。  相似文献   

17.
目的:评价Amplatzer封堵器治疗动脉导管未闭(PDA)的疗效。方法:经导管置入Amplatzer封堵器施行PDA封堵术22例,术前均经胸超声心动图(TTE)检查确诊。术后3天、3个月分别行TTE检查以评估疗效。结果:22例均获成功,术后即刻所有患者心前区连续性杂音消失,15min后胸主动脉造影示18例(81.8%)动脉导管完全封闭,4例有微量或少量的残余分流。术后3天TTE检查示9例有由左向右的少量分流(一年后完全消失),3个月后TTE随访检查仅发现1例存在微量分流,所有病例左心室直径均缩小,未发现封堵器移位、动脉导管再通或肺动脉狭窄等;除1例出现少量心包积液外,未发现其他并发症。结论:应用Amplatzer封堵器治疗PDA操作简便、成功率高、适应证广,是一种治疗PDA的理想方法。  相似文献   

18.
目的探讨超声心动图在Amplatzer堵闭器介入治疗动脉导管未闭(PDA)中的应用。方法堵闭术前超声观察PDA形态,测量其最小内径、肺动脉内径、左心腔、左室收缩功能指标。术后超声检测堵闭器位置、有无残余分流、肺动脉及降主动脉是否梗阻狭窄及肺动脉、左心腔等大小。结果与主动脉弓部左侧位造影比较,术前超声检测PDA形态、最小内径测量值等差异无统计学意义(P〉0.05)。15例患者中13例堵闭成功,术后即刻超声检查,10例无分流,3例少量分流。堵闭器位置均正常,降主动脉、肺动脉未见梗阻变窄,左心及肺动脉均较术前缩小。结论超声心动图在PDA堵闭术前病例选择、判断PDA大小形态、选择合适型号的堵闭器及术后疗效评价等方面具有重要的作用。  相似文献   

19.
INTROUUCTIONSincethefirstdescriptionoftheinterventionalo cllusionofthe patentductusarteriousus(PDA )in1967[1] ,variousdeviceshavebeendevelopedandtest edbunoneofthemisfullysatifactory .TheAm palatzeroccluderisanewdevicewitheasyplacement.Itisreportedtohavehighe…  相似文献   

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