Extravascular lung water in children immediately after operative closure of either isolated atrial septal defect or ventricular septal defect

Extravascular lung water (EVLW) was measured in 16 patients with congenital heart disease by the cold green dye, double indicator dilution technique. Five patients with optimally corrected tetralogy of Fallot served as controls, and EVLW in this group was 4.7 +/- 0.5 ml/kg (111 +/- 13 ml/m2) (mean +/- standard deviation). In 5 asymptomatic patients with atrial septal defect (ASD), normal pulmonary artery (PA) pressure and increased pulmonary blood flow, EVLW was 5.7 +/- 2.8 ml/kg (132 +/- 63 ml/m2), which was not significantly different from the value of control patients. However, in 6 patients with ventricular septal defect, PA hypertension, normal left atrial pressure and an equivalent left-to-right shunt to ASD patients, EVLW was 15.9 +/- 3.8 ml/kg (270 +/- 60 ml/m2). This was significantly different from values in both control and ASD patients (p less than 0.01). It is concluded that in the face of normal pulmonary vascular resistance, PA pressure is transmitted to the microvasculature, causing hydrostatic pulmonary edema. Other factors that may be implicated in the pathogenesis of pulmonary edema, such as increased pulmonary blood flow and relative lymphatic insufficiency in infants, cannot be excluded.     

Assessment of ventricular septal defect closure by intraoperative epicardial ultrasound

Intraoperative epicardial two-dimensional echocardiographic imaging, color flow mapping and contrast echocardiography were used in 31 patients after patch closure of a ventricular septal defect to determine their respective values in the assessment of residual shunting after cardiopulmonary bypass and for the prediction of long-term results. Epicardial imaging showed no incidence of patch dehiscence. Residual shunting detected by color flow mapping or contrast echocardiography was graded into one of four categories (0 to III). Real time analysis of color flow mapping studies suggested no shunting (grade 0) in 2 patients, grade I shunting in 20, grade II in 8 and grade III in 1; contrast studies suggested grade 0 in 15, grade I in 6, grade II in 8 and grade III in 2. Interobserver variation in real time encoding of grade I or II shunting was 25% by color flow mapping and 6% by contrast echocardiography. Subsequent frame by frame analysis revealed that both diastolic and early systolic right ventricular turbulence gave rise to false positive results during real time analysis of color flow mapping studies. Color flow mapping allowed exact localization of residual shunting, whereas contrast echocardiography allowed better semiquantification. Postbypass results were correlated in 30 patients with late postoperative precordial studies (mean interval 7.5 months). Persistent shunts were found in 6 (20%) of 30 patients. No patient required reoperation for residual shunting. The predictive value of immediate grade I or II shunting as a marker for persistent long-term shunting was poor, whereas both patients with immediate grade III shunting had shunt persistence, indicating that immediate revision should be considered in such patients. Intraoperative epicardial ultrasound is valuable for the immediate exclusion of important residual shunting after ventricular septal defect closure. Maximal information is obtained when color flow mapping and contrast echocardiography are used in combination.     

介入治疗膜周部室间隔缺损后早期的心律失常

目的探讨介入治疗膜周部室间隔缺损后早期心律失常的特点。方法回顾性分析膜周部室间隔缺损273例心电图资料，了解介入封堵术后早期发生的各种类型心律失常。分析封堵器类型、缺损大小及有无膜部瘤对心律失常发生的影响。结果心律失常发生率33．0％（90／273），其中传导阻滞占68．9％（62／90）。国产和进口封堵器组的心律失常差异无统计学意义（P〉0．05）；室间隔缺损小于5mm组和不小于5mm组的心律失常发生率分别为25．8％、49．4％（P〈0．05）。结论膜周部室间隔缺损介入治疗后早期心律失常发生率较高，以传导阻滞为主。室间隔缺损大小和有无膜部瘤是影响术后早期心律失常的重要因素。     

室问隔缺损介入术后并发三度房室阻滞

目的分析国内室间隔缺损患者介入封堵术后三度房室阻滞的发生特点和原因。方法通过中国生物医学文献数据库和清华同方医学期刊数据库文献检索系统,以“室间隔缺损”和“传导”为任意字段进行检索,在纳入的文献中,重点对患者年龄、性别、术后三度房室阻滞的发生时间、恢复时间、处理措施等进行总结分析。结果总计纳入23篇文献,共报道了73例术后出现三度房室阻滞的患者,女性和儿童多见。88％的三度房室阻滞发生于术后3～7d。80％的病例均在症状出现后的7—15d恢复窦性心律。有3例患者植入了永久起搏器。结论室间隔缺损介入术后的三度房室阻滞有其发生发展的规律,多数为一过性,需植入永久性起搏器的患者极少。     

介入治疗膜周部室间隔缺损后早期的心律失常

目的探讨介入治疗膜周部室间隔缺损后早期心律失常的特点。方法回顾性分析膜周部室间隔缺损273例心电图资料，了解介入封堵术后早期发生的各种类型心律失常。分析封堵器类型、缺损大小及有无膜部瘤对心律失常发生的影响。结果心律失常发生率33．0％（90／273），其中传导阻滞占68．9％（62／90）。国产和进口封堵器组的心律失常差异无统计学意义（P〉0．05）；室间隔缺损小于5mm组和不小于5mm组的心律失常发生率分别为25．8％、49．4％（P〈0．05）。结论膜周部室间隔缺损介入治疗后早期心律失常发生率较高，以传导阻滞为主。室间隔缺损大小和有无膜部瘤是影响术后早期心律失常的重要因素。     

室间隔缺损介入治疗的“中国梦”—写在国产室间隔缺损封堵器临床应用20周年之际

中国室间隔缺损介入治疗始于上世纪90年代,但该方法在中国的快速发展则源于国产室间隔缺损封堵器的研发与临床应用,经过20年的临床验证,中国室间隔缺损介入治疗技术和器械均居世界前列。本文回顾室间隔缺损介入治疗在中国的发展历程和国产器械的研发成果,并对未来发展方向做出展望。     

室间隔缺损封堵术前后的心电图分析

目的:探讨42例室间隔缺损(VSD)封堵术前、后心电图的改变.方法:42例VSD患者在x线透视、经胸超声的监测下建立股动静脉轨道,经右心系统释放封堵器.对所有患者封堵术术前、术后即刻、3、7 d、直至出院后1,2个月的12导联心电图作连续观察和分析.结果:42例患者术后即刻出现Ⅰ度房室传导阻滞(AVB)4例、Ⅱ度AVB 1例、不完全性右束支传导阻滞(IRBBB)3例.3 d出现IRBBB 3例、完全性右束支传导阻滞(CRBBB)2例、Ⅰ度AVB 4例、Ⅱ度AVB 1例;术后7 d出现IRBBB 4例、CRBBB 3例、出现左束支传导阻滞2例、Ⅲ度AVB 2例.所有AVB经治疗后均痊愈.结论:VSD封堵术过程中可能会对房室传导产生一定影响.     

Transcatheter residual ventricular septal defect closure after Rastelli operation.

We report on a 17-year-old patient with a residual ventricular septal defect and a significant pressure gradient across the pulmonary homograft after Rastelli-type operation. Device closure of the defect was associated with a considerable reduction of right ventricular hypertension and of the pressure gradient across the right ventricle-to-pulmonary artery conduit.     

Severe aortic valve regurgitation after percutaneous ventricular septal defect closure

Percutaneous closure of ventricular septal defect is now commonly used. We report a rare case, and especially a rare image of aortic leaflet damage caused by percutaneous ventricular septal device. © 2012 Wiley Periodicals, Inc.     

Spontaneous closure of uncomplicated ventricular septal defect

The charts of 222 patients with a diagnosis of ventricular septal defect (VSD) were reviewed to determine the overall incidence, the prevalence of membranous and muscular defects and the rates of spontaneous VSD closure. VSD diagnosis and location were determined primarily from reports of 2-dimensional and pulsed Doppler echocardiograms. In a 5-year period, VSDs occurred in 3.85/1,000 live full-term births and 7.06/1,000 live premature births. The VSD closed spontaneously in 20 of 44 patients (45%) followed from birth (University Hospital group) during a mean follow-up of 12 months. Of 165 patients not followed from birth (referred group), the VSD closed spontaneously in 37 (22%). Overall, VSD location was determined in 101 of 209 patients (48%) and was distributed as follows: membranous 66 (65%), muscular 32 (32%) and subpulmonic 3 (3%). Rates of spontaneous closure for membranous and muscular VSDs were 37% and 50%, respectively, for the University Hospital group and 9% and 9%, respectively, for the referred group (no significant difference in either case). Surgical closure was required in 30 of 165 referred patients (18%) and only 1 of 44 University Hospital patients (2%). There was no significant difference in rate of closure for premature vs full-term infants or small vs larger defects. Data for patients followed from birth more likely reflect the true natural history of VSD.     

Transatrial closure of postinfarction ventricular septal defect

While operative approaches to postinfarction ventricular septal defect emphasize repair through the infarcted area, we present a case that illustrates the transatrial approach in an acute setting in which no discrete infarct or other abnormality of the free ventricular wall is apparent. In such a setting, transatrial repair of mid-muscular or posterior defects can avert unnecessary compromise of right ventricular function. Avoidance of a right ventriculotomy might also benefit patients with chronic defects complicated by severe lung disease or pulmonary hypertension. However, successful transatrial closure requires full visualization of the defect, avoidance of tricuspid valve damage, thorough débridement of necrotic tissue, and the taking of wide, deep sutures.     

房间隔缺损与室间隔缺损介入治疗失败后外科手术疗效分析

目的:分析房间隔缺损(ASD)和室间隔缺损(VSD)介入治疗失败后外科手术的效果。方法:选择2000年1月至2007年12月在我院接受经导管介入治疗ASD(12例)和VSD(4例)失败后需再行外科手术的16例,其中封堵器脱落7例,心脏穿孔3例,Ⅲ°房室传导阻滞(AVB)2例,瓣膜关闭不全2例(其中1例合并Ⅲ°-AVB),残余漏和封堵失败各1例。手术均在体外循环下进行,取出封堵器,修复心内畸形,术后入ICU监护。结果:ASD介入治疗患者中,手术探查ASD直径平均31 mm,较术前经彩色多普勒超声心动图诊断的平均直径26 mm增大(P0.05)。ASD部位为中央型5例,下腔型7例,与术前诊断相符率41.7%,不相符率58.3%。VSD直径平均5 mm,与术前差异无统计学意义。VSD部位为膜部2例,流出部与肌部各1例。3例Ⅲ°-AVB患者术后均恢复窦性心律。心内畸形修复完善,无手术死亡。结论:及时采取外科手术治疗介入封堵失败后并发症,效果良好,安全可靠,并可避免并发症造成的不良后果。