Objective A meta-analysis was performed for a comparison of outcomes between transcatheter closure and transthoracic closure for simple congenital heart diseases (CHD). Methods Electronic databases, including PubMed, EMbase, Scopus, CNKI, Wanfang Data and Weipu Data were searched systematically for the literature aimed mainly at comparing the therapeutic effects for CHD administrated by transcatheter closure and transthoracic closure. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality. The meta-analysis was conducted with Revman 5.3. Results Twelve studies meeting the inclusion criteria were included, involving 8 studies regarding to atrial septal defect (ASD), 2 studies regarding to ventricular septal defect (VSD) and 2 studies with regard to patent ductus arteriosus (PDA). A total of 1 423 patients were included. It was observed that compared with transthoracic closure, transcatheter closure entailed a lower complication rate (OR=5.62, 95%CI 2.78 to 11.36, P<0.001). However, meta-analysis of operative success rate(OR=1.65, 95%CI 0.92 to 2.98, P=0.09), instantly (OR=0.75, 95%CI 0.40 to 1.41, P=0.37) and long-term (OR=0.72, 95%CI 0.25 to 2.05, P=0.54) persistent shunt after surgery showed no significant differences between two approaches. No publication bias was found according to the funnel plot of complication rate and operative success rate. Conclusion In the treatment of simple CHD such as ASD, VSD and PDA, compared with transthoracic closure, a lower complication rate were associated with transcatheter closure. Meanwhile, operative success rate, instantly and long-term persistent shunt after surgery were not statistically different between the two surgical approaches. However, this study was based on retrospective studies, the level of evidence remained low. More large sample size randomized controlled trials should be designed to explore the safety and effectiveness of these two approaches in the treatment of CHD.
ObjectiveTo explore the method and feasibility of establishing patent ductus arteriosus (PDA) model in Bama miniature pig by using autologous jugular vein, and to provide a large animal model for the development of PDA occluder and the study of pulmonary hypertension associated with congenital heart disease. MethodsFive male Bama miniature pigs weighing about 45 kg were selected to gain the PDA model of the autogenous jugular vein, which was fixed by glutaraldehyde and anastomosed between the ascending aorta and the main pulmonary artery. The patency of PDA was confirmed by echocardiography and angiocardiography immediately and one week after the operation. Two animals were selected to undergo transcatheter closure of PDA via femoral vein 1 week after the operation, and the rest were euthanized to obtain PDA and lung tissue for pathological examination. ResultsThe PDA model was successfully established in all five animals with a success rate of 100.0%. Immediately and 1 week after the operation, echocardiography and angiography showed that PDA blood flow was unobstructed, and hematoxylin-eosin staining showed that PDA endothelialization was good. One week after the operation, two animals were successfully treated with transcatheter femoral vein occlusion. The pathological examination of lung tissue showed thickening of the intima and muscular layer of pulmonary arterioles, thickening of pulmonary interstitium and infiltration of neutrophils. ConclusionIt is safe and feasible to establish a large animal model of PDA by using autogenous jugular vein anastomosis between the ascending aorta and the main pulmonary artery. The model can be used for the development of PDA interventional occlusive devices and the pathophysiological study of congenital heart disease-related pulmonary hypertension.
ObjectiveTo analyze the cases of cryptogenic cerebral infarction complicated with patent foramen ovale (PFO) treated by interventional occlusion, and evaluate the efficacy and safety of occlusion of PFO on preventing the recurrence of cerebral infarction.MethodsA total of 24 patients with cerebral infarction complicated with PFO who underwent interventional occlusion from January 2015 to August 2018 in Mianyang Central Hospital were retrospectively analyzed. The data of these patients was collected, including relevant medical history, clinical examinations, and treatment processes. Detailed examinations (electrocardiogram, right heart contrast echocardiography, transcranial Doppler ultrasound foaming test, cranial imaging, etc.) were performed and the clinical manifestations were evaluated when patients returned to the outpatient department. Combining with regular telephone calls and outpatient follow-up, the recurrence of cerebral infarction and postoperative complications were evaluated.ResultsAmong the 24 patients, there were 11 males and 13 females, who were aged from 16 to 72 (with an average age of 49); the National Institutes of Health Stroke Scale Score was ≤5 in 19 patients, and was >5 in 5. The preoperative MRI and other examinations of the 24 patients showed that there were 21 cases of unilateral cerebral infarctions and 3 cases of bilateral cerebral infarctions; 10 cases of single lesions and 14 cases of multiple lesions; 9 cases of cortical infarctions and 15 cases of subcortical infarctions; 11 cases of lacunar infarctions and 13 cases of non-lacunar infarctions. Anterior circulation was involved in 14 cases, posterior circulation was involved in 8 cases, and both anterior and posterior circulations were involved in 2 cases. All the 24 patients underwent interventional occlusion successfully. No complications occurred during hospitalization or 3, 6, and 12 months of follow-up visits. No cerebral infarctions reoccurred.ConclusionsInterventional occlusion of PFO is effective on preventing the recurrence of cerebral infarction. And the operation is safe with rare complications.
ObjectiveTo study effect of different surgical treatments for patent ductus arteriosus in children.MethodA total of 38 patients with patent ductus arteriosus who underwent surgical treatment of cardiothoracic surgery between January 2016 and December 2017 in our hospital were as an observation group (12 patients with severing suture, 26 patients with ligation, 14 males and 24 females, aged 0.08–8.67 years). In the same period, 38 patients with patent ductus arteriosus who underwent interventional closure in the Department of Cardiology were as a control group (17 males and 21 females, aged 0.50–5.42 years). The clinical effectiveness of the two groups was compared.ResultsThe operation time, postoperative hospital stay, and blood transfusion rate in the observation group were higher than those in the control group with statistical differences (P<0.05). There was no statistical difference in intraoperative blood loss and complications between the two groups.ConclusionsIn patients with a single patent ductus arteriosus or a small catheter, interventional closure of the patent ductus arteriosus is less trauma and faster recovery. But in patients with lower weigh, premature, other intracardiac malformations, large catheter, moderate or severe pulmonary hypertension, the surgery is better.
ObjectiveTo compare the efficacy of additional tricuspid valve annuloplasty (TVP) and isolated closure for atrial septal defect (ASD) with moderate to severe tricuspid regurgitation (TR). MethodsClinical data of the patients diagnosed with ASD combined with secondary moderate to severe TR and treated in our hospital from January 2009 to June 2020 were retrospectively analyzed. Patients were divided into a TVP group and a non-TVP group based on whether TVP was performed simultaneously. The baseline data of two groups were matched with a ratio of 1∶1 propensity score. ResultsA total of 32 pairs from 257 patients were successfully matched. In the TVP group, there were 24 females and 8 males with an average age of 44.0±13.1 years. In the non-TVP group, there were 28 females and 4 males with an average age of 44.5±11.6 years. The TR area and estimated pulmonary artery pressure in the two groups were significantly decreased compared with preoperation (all P<0.001). The TR area (P=0.001) and the estimated pulmonary artery pressure (P=0.002) were decreased more significantly in the TVP group than those in the non-TVP group. Linear regression analysis showed that age and preoperative TR area had a positive correlation with TR area at follow-up (β=0.045 and 0.259, respectively, both P<0.05), while additional TVP had a negative correlation (β=–1.542, P=0.001). ConclusionAdditional TVP can significantly reduce the TR area and pulmonary artery pressure, and elderly patients with severe TR before surgery should actively receive TVP.
Abstract： Objective To investigate videoassisted thoracoscopic surgery (VATS) and percutaneous catheter occlusion (PCO) in interruption of patent ductus arteriosus (PDA), in order to achieve minimally invasive surgical injuries and better clinical results. Methods From November 1995 to September 2009, 312 cases of PDA were treated in Fujian provincial hospital, among whom 252 patients were interrupted with VATS(VATS group) and 60 patients with PCO technique(PCO group). For the VATS group, there were 78 males and 174 females aged from 7 d to 31 years old (9.16±8.91 years), while there were 17 males and 43 females aged from 4 to 57 years old (25.55±14.10 years) in the PCO group. We used titanium clip to interrupt PDA under videoassisted thoracoscope for patients in the VATS group, and adopted Amplatzer method for patients in the PCO group. The clinical results, complications and hospital cost in the two groups were compared in this study. Results In the VATS group, all the PDA were successfully interrupted with no residual shunt. In the PCO group, 5% (3/60) of the patients had minor residual shunt after the procedure. No mortality occurred in both groups. Time of the procedure and hospital stay in the PCO group were shorter than that in the VATS group (70.20±31.20 min vs. 112.50±16.30 min, t=6.344,P=0.002; and 4.70±2.20 d vs. 6.50±2.80 d, t=3.241, P=0.022, respectively). However, the hospital cost for each patient in the PCO group was much higher than that in the VATS group (23 222.00±4 333.40 yuan RMB vs. 8 904.50±2 634.60 yuan RMB,t=25.360, P=0.000). Conclusion Compared with PCO, VATS in interrupting PDA can achieved not only excellent clinical results, especially in the newborn and baby cases, but also very satisfying cost which is just a little more than one third of the PCO cost.
ObjectiveTo explore the safety and effectiveness of different interventional approaches for the treatment of patent ductus arteriosus (PDA) in children.MethodsThe children (≤7 years) who underwent interventional treatment for PDA from 2019 to 2020 in our hospital were retrospectively included. The patients were divided into 3 groups according to the procedures: a conventional arteriovenous approach group, a simple venous approach group, and a retrograde femoral artery approach group. The clinical efficacy of the patients was compared. Results A total of 220 patients were included. There were 78 males and 142 females, with an average age of 3.21±1.73 years, weight of 14.99±5.35 kg, and height of 96.19±15.77 cm. The average diameter of the PDA was 3.35±1.34 mm. A total of 85 patients received a conventional arteriovenous approach, 104 patients received a simple venous approach, and 31 patients received a retrograde femoral artery approach. The diameter of PDA in the retrograde femoral artery group was smaller than that in the other two groups (3.44±1.43 mm vs. 1.99±0.55 mm; 3.69±1.17 mm vs. 1.99±0.55 mm, P<0.001); the contrast medium usage [40 (30, 50) mL vs. 20 (20, 30) mL; 35 (25, 50) mL vs. 20 (20, 30) mL, P≤0.001] and operation time [32 (26, 44) min vs. 25 (23, 30) min; 29 (25, 38) min vs. 25 (23, 30) min, P<0.05] in the simple venous approach group were significantly less or shorter than those in the other two groups; the length of hospital stay of the conventional arteriovenous group was longer than that in the other two groups [3 (3, 5) d vs. 4 (3, 6) d; 4 (3, 5) d vs. 4 (3, 6) d, P<0.05]. There was no significant difference in postoperative complications.ConclusionIt is safe and effective to close PDA through simple venous approach. The retrograde femoral artery approach has the advantage of simplifying the surgical procedure for PDA with small diameters.
Objective Tho evaluate the outcomes of early percutaneous occlusion of these residual major aortopulmonary collateral arteries after heart surgery. Methods This was a retrospective review of children undergoing early percutaneous embolization of major aortopulmonary collateral arteries after cardiac surgery. From January 2013 to February 2017, 52 consecutive patients with postoperative residual major aortopulmonary collateral arteries were treated with percutaneous embolization (38 males, 14 females; median age of 10.0 months, interquartile range 14.0 months; median weight 8.6 kg, interquartile range 4.4 kg). Fifty-one patients were cyanotic and 1 patient was acyanotic. Forty-nine patients underwent corrective surgery and 3 patients underwent B-T shunt. Results Typical symptoms and signs of major aortopulmonary collateral arteries included: elevated left atrial pressure; focal lung infiltration, pink or blood-stained frothy sputum. The median time interval from cardiac surgery to percutaneous occlusion of major aortopulmonary collateral arteries was 5 (9) d, median duration of mechanic ventilation support since occlusion was 72 (159) h, mechanic ventilation support was 239 (480) h and median duration of intensive care unit was 19 (29) d. There was no death in this group. Conclusion Angiocardiography could be able to demonstrate the existence of postoperative major aortopulmonary collateral arteries. The early percutaneous occlusion appears to be simple, safe and effective.