Interventional treatment for congenital heart disease and its severe complications

Background To approach the incidence, cause and possible treatment of severe complications induced during or after congenital heart disease interventions. Methods Interventional procedures of congenital heart disease were performed in 654 patients from January 2003 to October 2009, which were divided into four groups, i.e. patent ductus arteriosus （PDA）, atrial septum defect （ASD）, pulmonary stenosis（PS）, ventricular septum defect（VSD）, among them 32 patients with severe complications were retrospectively analyzed. Results A total of 654 cases accepted the treatment of intrusion. There was one death in all the patients, ten patients failed in the operation. The overall severe complication rate was 4.89% （32/654）, in which 2.29%（4/175） in PDA group, 5.26%（10/190） in ASD group, 5.77% （3/52） in PS group, 6.33%（15/237） in VSD group, respectively. Conclusions The severe complication rates of interventional therapy for congenital heart disease are low, it is a relatively safe interventional method, and careful supervision is necessary during or after procedure.     

Tetralogy of Fallot with Absent Pulmonary Valve and Pulmonary Artery Aneurysm： A Case Report of Surgical Cure

Absent pulmonary valve is a rare congenital anomaly, characterized with a dysplastic or absent pulmonary valve tissue and severe pulmonary regurgitation. It is usually associated with tetralogy of Fallot （TOF）. A 7-year-old girl with absent pulmonary valve, pulmonary artery aneurysm and tetralogy of Fallot without cyanosis was operated and 10 months followed up result was reported     

“Treat and repair” therapy for giant patent ductus arteriosus complicated with pulmonary embolism

<正>Patent ductus arteriosus(PDA) is one of the most common congenital heart defects, accounting for 5%–10% of congenital heart diseases.^[1] Its combination with pulmonary embolism(PE) is extremely rare, and there are few relevant reports.     

Transcatheter closure of aortopulmonary window in children:Case reports and literature review

INTRODUCTION Aortopulmonary(AP) window is an uncommon congenital anomaly,accounting for approximately 0.2 % of all congenital heart abnormalities 1.It is usually nonrestrictive and is conventionally treated surgically at an early age to prevent the development of pulmonary vascular obstructive disease.In 10 % of this lesion,it is restrictive and case reports of its percutaneous closure are mostly limited to these patients.     

New concepts on development of the second heart field

Background Congenital heart diseases（CHDs） account for the majority of life-threatening congenital anomalies at birth. CHDs are outcomes of developmental disorders of heart during embryogenesis. Here, we reviewed the development of cardiac progenitors, called the second heart field（SHF）. And it is also the major origin of the outflow tract（OFT）, right ventricle and most of the atria.     

Rare case of coronary to pulmonary vein fistula with coronary steal phenomenon

Coronary artery fistulas are abnormal connections between coronary artery territories and cardiac chambers or major vessels,most of them are congenital.Patients with coronary artery fistula can be asymptomatic or present with different symptoms like angina.Cardiac computed tomography(CT)is one of the best modalities for diagnosis.We present an elderly patient that presented with angina symptoms,non invasive stress test was positive for ischemic heart disease,coronary angiogram could not reveal any obstructive lesions,but an abnormal branch of the left descending coronary artery(LAD),cardiac CT showed fistula that connect left anterior descending coronary artery to left superior pulmonary vein.Our case is extremely rare as most of the reported cases were fistulas between LAD and pulmonary artery,but in our case the fistula between LAD and left superior pulmonary vein.In addition,our patients’symptoms resolved with anti-ischemic medical treatment without any surgical intervention.     

Differential effects of atrial and brain natriuretic peptides on human pulmonary artery:An in vitro study

BACKGROUND The prevalence of cardiovascular diseases, especially heart failure, continues to rise worldwide. In heart failure, increasing levels of circulating atrial natriuretic peptide(ANP) and brain natriuretic peptide(BNP) are associated with a worsening of heart failure and a poor prognosis.AIM To test whether a high concentration of BNP would inhibit relaxation to ANP.METHODS Pulmonary arteries were dissected from disease-free areas of lung resection, as well as pulmonary artery rings of internal diameter 2.5–3.5 mm and 2 mm long,were prepared. Pulmonary artery rings were mounted in a multiwire myograph,and a basal tension of 1.61 gf was applied. After equilibration for 60 min, rings were pre-constricted with 11.21 μmol/L PGF_(2α)(EC_(80)), and concentration response curves were constructed to vasodilators by cumulative addition to the myograph chambers.RESULTS Although both ANP and BNP were found to vasodilate the pulmonary vessels,ANP is more potent than BNP.pEC50 of ANP and BNP were 8.96 ± 0.21 and 7.54± 0.18, respectively, and the maximum efficacy(E_(max)) for ANP and BNP was-2.03 gf and-0.24 gf, respectively. After addition of BNP, the E_(max) of ANP reduced from -0.96 gf to-0.675 gf(P=0.28).CONCLUSION BNP could be acting as a partial agonist in small human pulmonary arteries, and inhibits relaxation to ANP. Elevated levels of circulating BNP could be responsible for the worsening of decompensated heart failure. This finding could also explain the disappointing results seen in clinical trials of ANP and BNP analogues for the treatment of heart failure.     

Percutaneous closure of congenital Gerbode defect using Nit-Occlud~? Lê VSD coil

We present a case report about percutaneous closure of a congenital Gerbode defect using Nit-Occlud~? Lê VSD coil. The patient was referred to our hospital with a diagnosis of ventricular septal defect(VSD) and severe pulmonary arterial hypertension. But transthoracic echocardiography revealed a communication between the left ventricle(LV) and the right atrial(RA), called Gerbode defect. Catheterization confirmed the shunt from the LV to the RA. We successfully closed the defect with a VSD coil. After uneventful 6 mo follow-up, the patient was out of dyspnea, the symptom urged him to have medical attention. This case report is to discuss the diagnosis and percutaneous treatment approach for this rare congenital heart disease.     

The application of aortopulmonary shunt in cyanotic congenital heart disease with severe pulmonary hypoplasia in adolescents and adults

Background Pulmonary arterial hypoplasia is a common complication in complex cyanotic congenital heart disease. For extreme stenosis of the branch pulmonary arteries,which is not feasible for complete repair,palliative systemic-pulmonary shunt is needed to increase pulmonary blood flow and pulmonary tree growth as early as beyond 2 years old. Unfortunately,due to poor medical setting in local hospitals,there are still a small number of patient with severe hypoplastic pulmonary arteries in developing area who have failed to undergo appropriate surgical intervention till to teenagers even adults. In order to explore the resolution of the dilemma for these notable cyanotic patients,hence we began to utilize three-dimensional computed tomography(CT)to reconstruct pulmonary artery anatomy and to simulate virtual palliative systemic pulmonary shunt conduit module,to facilitate and improve the intraoperative aortopulmonary shunt performance. Methods FromApril 2011 to August 2018,13 consecutive patients undergoing aortopulmonary shunt with older age(13-35 years old)who missed the optimal timing for surgery were identified from 196 cases involving palliative systemic pulmonary shunt. An individually pre-designed prosthetic expanded poly tetra fluoroethylene(ePTFE)conduit was utilized based on the threedimensional enhanced computed tomography reconstruction and simulation. The post-operative recovery courses and complications were documented. Blood gas analysis,electrocardiogram,echocardiography were performed routinely prior to discharge and compared with the preoperative data. Re-evaluation of finger pulse saturation(SpO2),echocardiography and electrocardiogram was performed in clinical follow-up in 1 st month,6 th month,12 th month and every year postoperatively. A retrospective analysis of operative data,postoperative outcomes and complications were performed. Results All the 13 consecutive patients underwent successfully non-cardiopulmonary bypass systemic-pulmonary shunt with ePTFE conduits via median sternotomy. Postoperative thirtyday mortality was 1 in 13 due to pulmonary hemorrhage. During the follow-up,no more mortality was documented but a re-intervention for ePTFE conduit revision. For the 12 survivors,the postoperative SpO2,and arterial partial oxygen pressure(PaO2)on room air significantly increased from 68.0±2.42% to 88.46±4.67%(P0.01),and from 42.61±3.94 mmhg to 49.62±1.76 mmhg(P0.01),respectively. While the postoperative hematocrit and hemoglobin significantly decreased from 72.01±3.12% to 61.03±3.21%(P0.01),and from 196.77±10.56 g/dL to 171.76±6.52 g/dL(P0.01),respectively. Conclusions Appropriate systemic-pulmonary shunt based on threedimensional reconstruction and simulation can significantly alleviate the hypoxia with elevated oxygen saturation for severe cyanotic adolescent or adult patient with extreme pulmonary hypoplasia and unrepairable complex congenital heart disease,so as to improve their clinical symptoms and life quality,although it cannot promote secondary pulmonary artery development directly.[S Chin J Cardiol 2020;21(2):104-111]     

Neurohumoral,cardiac and inflammatory markers in the evaluation of heart failure severity and progression

Heart failure is common in adult population,accounting for substantial morbidity and mortality worldwide.The main risk factors for heart failure are coronary artery disease,hypertension,obesity,diabetes mellitus,chronic pulmonary diseases,family history of cardiovascular diseases,cardiotoxic therapy.The main factor associated with poor outcome of these patients is constant progression of heart failure.In the current review we present evidence on the role of established and candidate neurohumoral biomarkers for heart failure progression management and diagnostics.A growing number of biomarkers have been proposed as potentially useful in heart failure patients,but not one of them still resembles the characteristics of the"ideal biomarker."A single marker will hardly perform well for screening,diagnostic,prognostic,and therapeutic management purposes.Moreover,the pathophysiological and clinical significance of biomarkers may depend on the presentation,stage,and severity of the disease.The authors cover main classification of heart failure phenotypes,based on the measurement of left ventricular ejection fraction,including heart failure with preserved ejection fraction,heart failure with reduced ejection fraction,and the recently proposed category heart failure with mid-range ejection fraction.One could envisage specific sets of biomarker with different performances in heart failure progression with different left ventricular ejection fraction especially as concerns prediction of the future course of the disease and of left ventricular adverse/reverse remodeling.This article is intended to provide an overview of basic and additional mechanisms of heart failure progression will contribute to a more comprehensive knowledge of the disease pathogenesis.     

Pulmonary Artery Sarcoma：A Case Report of Surgical Cure and 1- Year Follow-up

Pulmonary artery sarcoma is a rare tumor that is frequently misdiagnosed as chronic pulmonary embolism. With heightened clinical awareness and advancing technology, the diagnosis is now increasingly being made preoperatively. Previous literature has described the surgical resection as the single most effective modality for short-term disease palliation. We present the case of a patient in whom pulmonary artery sarcoma was diagnosed preoperatively and who underwent surgical resection as main and left pulmonary artery tumor decollement and fight pneumonectomy with extracorporeal circulation. During 1 year follow-up, the patient was doing well without any symptoms in the first 7 months after operation, then recurred after 8 months and died 1 year later. Also it suggests that early identification and aggressive surgical intervention has the possibility to be curative.     

急性ST段抬高型心肌梗死经皮冠状动脉介入治疗患者预后与平均血小板体积相关性研究

目的探讨术前平均血小板体积(MPV)与急性ST段抬高型心肌梗死(STEMI)行急诊经皮冠脉介入治疗(PCI)患者预后的关系。方法选择STEMI行急诊PCI患者335例,根据入院时MPV水平分为A组(≤9.9 fl,123例)和B组(MPV>9.9 fl,212例)。对患者进行随访1年,观察主要心脏不良事件(MACE)发生率。根据MACE的发生,分为MACE(+)组和MACE(-)组,对两组数据进行分析。并对各因素采用Logistic回归分析。结果 MACE发生率B组[53例(25.0%)]高于A组[16例(13.0%)](χ2=6.844,P=0.01),主要表现在再发心绞痛[37例(17.4%)比9例(7.3%),χ2=6.751,P<0.01]和再次住院[40例(18.7%)比12例(9.7%),χ2=4.928,P=0.03]。MACE(+)组中MPV>9.9 fl病例比例高于MACE(-)组[54例(78.2%)比165例(62%),χ2=6.376,P=0.02]。多因素Logistic回归分析示MPV>9.9 fl(OR:2.05,P=0.03),提示MPV>9.9 fl与STEMI行急诊PCI患者1年预后相关。结论术前MPV>9.9 fl是预测STEMI行急诊PCI患者1年MACE的独立危险因素。     

心血管疾病戒烟干预中国专家共识

吸烟是心血管疾病的独立危险因素,并且也是患者唯一能够自我控制的致病因素。许多心血管医生已经认识到吸烟的危害和戒烟干预的重要性,但尚缺乏相应的戒烟知识和戒烟技巧。本共识通过全面总结吸烟的危害和戒烟的益处,     

Stanford B型主动脉夹层的腔内隔绝治疗体会

随着影像学的发展,主动脉夹层的病例越来越多,应用覆膜支架腔内隔绝术已成为治疗Stanford B型主动脉夹层的首选方法。我院于2006年1月至2009年10月应用腔内隔绝术治疗Stanford B型主动脉夹层26例,效果良好,现报道如下。     

心血管疾病合并无症状高尿酸血症诊治建议(第二版)

高尿酸血症（Hyperuricemia,HUA）常与传统的代谢性心血管危险因素伴发,长期以来被认为是代谢异常的一种标记。近30年来,多项大规模观察性研究,共有约40余万例以上的观察对象,采用多因素回归和COX风险回归分析,一致证实HUA是心血管疾病发病和预后的危险因素。目前尚没有大规模临床研究证实,降低血尿酸与心血管风险下降有关,但鉴于高尿酸与血管、心脏、肾脏不良预后密切相关,HUA的防治受到关注。     

心绞痛患者PCI术前大剂量阿托伐他汀对围手术期心肌损伤的影响

经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）是所有采用经皮穿刺方法减轻冠状动脉狭窄的各种心导管技术的总称,早期PCI术主要是指经皮冠状动脉内血管成形术（percutaneous transluminal coronary angioplasty,PTCA）.自从1977年Gruzentig在瑞士完成世界上第一例PTCA后,心血管造影的临床应用日趋广泛,成为临床上判断冠状动脉病变部位和程度的＂金标准＂.     

Plasma N-terminal pro-Brain natriuretic peptide levels after hybrid therapy with pulmonary vein isolation and amiodarone for atrial fibrillation

Background The purpose of this study was to investigate the effect of hybrid therapy and the relationship between the plasma N-terminal pro-Brain natriuretic peptide (NT-pro BNP) levels and the recurrence rate of the atrial fibrillation (AF) patients underwent pulmonary vein isolation (PVI) with or without amiodarone. Methods There were two groups in this study: control group and hybrid group. In the control group, 54 patients (36 males, 54±13 years) including paroxysmal (PAF) 22, persistent (Pers-AF) 15, and permanent AF (perm-AF) 17, respectively, underwent the PVI procedure only; In the hybrid, 63 AF patients (41 males, 53±12 years) including PAF 24, Pers-AF 18, and perm-AF 21, respectively,underwent the PVI procedure and used amiodarone to enhance the effect of PVI. Blood samples were collected before and 3 months after PVI. NT-pro BNP concentrations were determined by immunoassays. Results In the control group, AF recurred in 29 patients (PAF 5 in 22, Pers-AF 11 in 15, and perm-AF 13 in 17) after the initial PVI procedure; And in the hybrid group, AF recurrred in 20 patiens (PAF 3 in 24, Pers-AF 7 in 18, and perm-Af 11 in 21 ). The average recurrent rate decreased significantly in the hybrid group (53.7% vs 31.7%, P0.01). While the NT pro- BNP level (pg/mL) was significantly different between the 2 groups (PAF 294.34±54.4 versus 241.69±17.6 pg/mL, P=0.047; Pers-AF 487.51±47.9 versus 248.76±19.4, P=0.001; Perm-AF 490.91±38.3 versus 300.86±31.8, P=0.032), While the NT pro- BNP level was also much lower in hybird group than control group in total (263.43±26.1 versus 409.88±49.7, P=0.02). Conclusions Sinus rhythm(SR)following AF ablation is associated with a dramatic decrease in NT-pro BNP. The hybrid group which had the administration of amiodarone after PVI would significantly decrease the plama NT pro-BNP levels and the recurrent rate of AF.     

选择性胆固醇吸收抑制剂临床应用中国专家共识(2011版)

血脂与心血管疾病密切关联。过去十余年中,国内外先后完成了一系列里程碑式的血脂干预研究,这些研究结果有力证实,积极降低胆固醇水平可以显著降低心血管病高危人群的心血管事件发生率,因而降胆固醇达标被视为防治心血管疾病的核心策略。虽然确凿证据表明,     

Ministernotomy for minimally invasive coronary artery bypass grafting

Background Through a ministernotomy ＂J shaped approach, left internal mammary artery （LIMA） bypass grafting to the left anterior descending artery （LAD） can be performed safely off-pump. To achieve a complete revascularization, percutaneous coronary interventions （PCI） with drug eluting stent implantation to other coronary arteries was used. We reported outcomes of the treatment of multivessel coronary artery disease with minimally invasive coronary artery bypass （MICAB） and PCI. Methods Between January 2009 and Dec 2012, 14 patients （11 males, 3 females, mean age was 64.8 _ 10.1 years. Two-vessel disease account for 35.7% （5/14） of these patients, three-vessel disease 64.2% （9/14） （Table 1）. All patients underwent a minimally invasive coronary artery bypass grafting via mini-sternotomy ＂J＂ shaped approach. Seven patients were followed by PCI, 7 for obtuse marginal circumflex, 5 for right coronary artery （RCA）. Angiographic assessment of graft patency was performed in all patients during the PCI procedure. The clinical follow-up period lasts from 11-24 months. Results The in-hospital mortality was 0%. There was neither conversion to a full median sternotomy nor intraoperative complications. Ventilation time was 6.6 ＋_ 4.1 h. Blood loss ranged 341 ＋_ 78.8 mL. ICU stay ranged 22.3 _ 12.8 h. Hospital postoperative stay lasted for 6.5 ＋ 1.6 days. Prior to PCI patients showed 100% patent left internal mammary artery. One patient had mediastinitis （Tables 2-3）. Rate of freedom from cardiac reintervention during the follow-up period was 92.8% （13/14）. Conclusions The inferior J-shaped sternotomy is simple, reproducible, and the safest technique for performing minimally invasive coronary bypass surgery. MICAB ＋ PCI is also safe, feasible and efficacious.     

Correlation of carotid artery atherosclerosis with C-reactive protein and adiponectin in patient with metabolic syndrome

Background Metabolic Syndrome(MS) is a group of conditions included hypertension,hyperlipidemia,central obesity,impaired glucose tolerance and insulin resistance,which may contribute to risk factors for atherosclerosis syndrome.Insulin resistance is the core mechanism? while the underlying mechanism is not clear.This article aims to study the correlation of carotid atherosclerosis with C-reactive protein and adiponectin in metabolic syndrome(MS) patients.Methods According to bilateral carotid artery atherosclerosis echocardiography,226 patients with metabolic syndrome were randomized to three groups,of which were non-carotid atherosclerosis plaque group(MS-1 group,n = 94),carotid artery atherosclerosis plaque group(MS-2 group,n = 132),and normal control group(n = 36).Determination of serum insulin,high sensitivity C-reactive protein,adiponectin and bilateral carotid artery atherosclerosis ultrasonography and other indicators,semi-quantitative estimates of the extent and severity of plaque.Results ①In two MS groups,carotid artery atherosclerosis,intima-media thickness(IMT),insulin resistance index(HOMA-IR) and high sensitive C-reactive protein(hs-CRP) were significantly higher than the control group(P 0.01),while adiponectin was lower than the control group(P 0.01);When MS-2 group was compared to MS-1 group,there were significant differences(P 0.01).②IMT was positively correlated with HOMA-IR and hs-CRP(P 0.01) while negatively correlated with adiponectin(P 0.01).Conclusions C-reactive protein and adiponectin in MS patients were correlated with carotid atherosclerosis and insulin resistance,which may be used as the assessment of MS patients.