ObjectiveTo evaluate the efficacy and safety of a novel wire for echo-guiding percutaneous atrial septal defect (ASD) closure.MethodsTwenty sheep were randomly divided into two groups, an experimental group and a control group (n=10 in each group). In both groups, an animal model of ASD was established by transthoracic balloon dilatation, and percutaneous closure of atrial septal defect was finished only by echography guiding. The total procedure time, passing time (time needed for the guide wire to enter the left atrium), frequency of delivery sheath dropping into right atrium, frequency of arrhythmias and rate of complications were compared between the two groups.ResultsASD model was uneventfully established in all animals. ASD devices were successfully implanted in all sheep. Compared with the control group, the experimental group had significantly less mean procedure time and mean passing time, lower frequency of guide wire dropping into right atrium and frequency of atrial and ventricular premature contractions, respectively (15.36±4.86 min vs. 25.82±7.85 min, 2.69±0.82 min vs. 5.58±3.34 min, 0% vs. 40.0%, 4.41±2.61 vs. 9.60±3.68, 0.75±0.36 vs. 1.34±0.68; all P<0.05) . Two groups did not have serious complications within postoperative one week.ConclusionThe novel wire system is not only safe and effective in the treatment of ASD occlusion, but also easy to operate.
ObjectiveTo assess the feasibility and safety of percutaneous transcatheter closure of atrial septal defect (ASD) guided by transthoracic echocardiography (TTE) in outpatients.MethodsFrom December 2016 to June 2018, 50 simple ASD patients underwent TTE-guided transcatheter closure in the outpatient operating room of our hospital (a TTE group) including 22 males and 28 females at the age of 16-48 (27.40±6.95) years. Fifty patients with simple ASD treated with the guidance of conventional fluoroscopy during the same period were treated as a control group, including 22 males and 28 females at the age of 15-48 (28.58±6.96) years. Both groups were re-examined by TTE during follow-up at 1 month, 3 months, 6 months and 1 year.ResultsThe mean age, body weight, the size of ASD and occluder and success rate had no statistical difference between the two groups (P>0.05). Compared with the control group, the TTE group had significantly lower mean operation time (P<0.01) and less cost (P<0.01) since patients need not to be hospitalized. No related complications were found in the TTE group during follow-up.ConclusionPercutaneous transcatheter closure of ASD guided by TTE appears safe and effective for outpatients, and can significantly reduce the cost.
Objective To investigate the effects of different types of tricuspid regurgitation, implantation positions, and device models on the treatment outcomes of K-Clip for tricuspid regurgitation using numerical simulations. Methods Three-dimensional reconstruction of the heart model was performed based on CT images. Two different regurgitation orifices were obtained by modifying the standard parameterized tricuspid valve leaflets and chordae tendineae. The effects of different K-Clip models at different implantation positions (posterior leaflet midpoint, anterior-posterior commissure, anterior leaflet midpoint, posterior septal commissure) were simulated using commercial explicit dynamics software Ls-Dyna. Conclusion For the two types of regurgitation in this study, clipping at the posterior leaflet midpoint resulted in a better reduction of the regurgitation orifice (up to 75% reduction in area). Higher clamping forces were required for implantation at the anterior leaflet midpoint and posterior septal commissure, which was unfavorable for the smooth closure of the clipping components. There was no statistical difference in the treatment outcomes between the 18T and 16T K-Clip components, and the 16T component required less clamping force. Therefore, the use of the 16T K-Clip component is recommended.
Objective To assess the efficacy and safety of percutaneous closure of patent ductus arteriosus (PDA) solely under echocardiography guidance. Methods We retrospectively analyzed the clinical data of 200 patients who received the percutaneous closure of PDA under echocardiography guidance in Fuwai Hospital from August 2013 to April 2016. According the different approach, they were divided into 2 groups: a femoral artery approach group (n=143) and a femoral vein approach group (n=57). In the femoral artery approach group, there were 42 males and 101 females aged 3.20±5.63 years. In the femoral vein group, there were 10 males and 47 females aged 7.30±11.36 years. All Patients were treated by percutaneous PDA closure solely under echocardiography guidance. The follow-up was performed at one month after the operation by echocardiography, chest radiograph and electrocardiogram. Results All 200 patients were successfully treated with percutaneous closure of PDA. The patients’ gender, in-hospital stay, rates of occluder detachment were similar between the two groups (P>0.05). Compared with the femoral vein approach group, the femoral artery approach group had a younger age (3.20±5.63 yearsvs. 7.30±11.36 years, P<0.001), less body weight (14.25±11.54 kgvs. 24.25±19.14 kg, P<0.001) and shorter diameter of PDA (3.06±0.79 mmvs. 5.93±0.68 mm, P<0.001) and PDA occluders (5.43±1.00 mmvs. 12.14±0.54 mm, P<0.001), but had higher hospitalization expenses (32 108.2±3 100.2 yuanvs.25 120.7±3 534.1 yuan, P<0.001). In the femoral vein approach group, one patient was closed under radiation guidance because guide wires could not pass through PDA. One patient in the femoral artery approach group suffered from occluder detachment at one day after operation and was cured by transthoracic minimally invasive PDA occlusion. There were no complications of occluder detachment, residual shunt, pericardial effusion or left pulmonary stenosis during the follow-up. Conclusion Echocardiography-guided percutaneous PDA closure is safe and effective, while the proper interventional approach should be chosen by the anatomical features of PDA.