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Left atrial dysfunction in elderly patients with patent foramen ovale and atrial septal aneurysm

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Journal of Geriatric Cardiology 2009年第4期6卷 195-198页

作者： Gianluca Rigatelli Fabio Dell＇Avvocata Federico Ronco Massimo Giordan Paolo Cardaioli Section of adult congenital and adult heart disease Cardiovascular Diagnosis and Endoluminal Interventions Rovigo GeneralHospital Rovigo 45100 Italy

Objective Recently it has been suggested that, in patients with large patent foramen ovale （PFO） and atrial septal aneurysms （ASA）, a certain amount of left atrial （LA） dysfunction may be active as an alternate mechanism promoting arterial embolism. Following this hypothesis, elderly patients, being more susceptible to atrial chambers stiffness, should present a more severe LA dysfunction profile. We sought to evaluate the grade of LA dysfunction in elderly patients submitted to transcatheter PFO closure. Methods We retrospectively enrolled 28 consecutive patients with previous stroke （mean age 674-12.5 years, 18 females） referred to our centre for catheter-based PFO closure after recurrent stroke. Baseline values of LA passive and active emptying, LA conduit function, LA ejection fraction, and spontaneous echocontrast （SEC） in the LA and LA appendage were compared with those of 50 atrial fibrillation patients, as well as a sex/age/cardiac risk matched population of 70 healthy controls. Results Pre-closure elderly subjects demonstrated significantly greater reservoir function as well as passive and active emptying, with reduced conduit function and LA ejection fraction, when compared to healthy and younger patients. After closure in elderly patients, LAparameters did not return completely to the levels of healthy patients, whereas LA dysfunction in younger subjects returned normal. Conclusions This study suggests that elderly patients have more severe LA dysfunction than younger patients, which affects the LA remodelling after closure.

关键词： patent foramen ovale stroke embolism cardiac anatomy echocardiography

Patent foramen ovale closure in over-60-years old patients with diastolic dysfunction

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Journal of Geriatric Cardiology 2008年第1期5卷 3-6页

作者： Gianluca Rigatelli Fabio Dell'Avvocata Paolo Cardaioli Massimo Giordan Gabriele Braggion Loris Roncon Section of adult congenital and Structural heart disease Cardiovascular Diagnosis and Endoluminal Interventions Rovigo General Hospital Rovigo Italy

Background Patent foramen ovale (PFO)-related stroke is a possible and not easily manageable occurrence in ≤60-years-old patients due to the presence of different comorbidities and in particular of diastolic dysfunction which is considered as a contraindication to PFO *** grade of diastolic dysfunction for which PFO closure is contraindicated and whether there are changes in diastolic dysfunction class after closure have not been investigated in deep *** We prospectively enrolled patients who were referred to our centre over a 12 months period for PFO transcatheter closure having echocardiographic demonstration of diastolic dysfunction (≤Ⅲ class diastolic dysfunction).Echocardiography was scheduled at 1,6 and 12 months in order to assess changes in haemodynamic parameters of left ventricle *** Thirteen out of 80 patients referred to our centre (16.2%,mean age 65 + 6.4 years) over a 24-month period were enrolled in the study (Table 1).Eighteen Amplatzer PFO Occluder 25 mm and one 35 mm,two Amplatzer 25/25 mm Cribriform Occluder and two 25 nun Premere Occlusion System were successfully implanted with no intraoperative *** collateral findings on ICE 8/12 patients (66.7 %) had hypertrophy of the interatrial septum (thickness of the rims ＞ 1.2 mm) probably imputable to hypertensive *** patients developed atrial fibrillation during the first month post-implantation,all successfully treated with antiarrhythmic *** a mean follow-up of 40±4.3 months left ventricle performance indices (ejection fraction and end-diastolic volume) and diastolic dysfunction parameters (E/A,deceleration time,diastolic dysfunction class) did not change *** The present study suggests that PFO transcatheter closure may be safely performed in aged patients with diastolic dysfunction class 1-2.(J Geriatr Cardio12008;5:3-6.)

关键词： patent foramen ovale elderly diastolic dysfunction transcatheter closure

Patent foramen ovale in the elderly:what to do?

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Journal of Geriatric Cardiology 2007年第4期4卷 254-256页

作者： Gianluca Rigatelli Fabio Dell’Avvocata Section of adult congenital and Structural heart disease Cardiovascular Diagnosis and Endoluminal Interventions Rovigo General Hospital Rovigo Italy

The increase in life expectance makes the diagnosis of PFO a possible and not easily manageable event in patients > 60-years-old due to the presence of different comorbidities and in particular of diastolic dysfunction which is considered as a contraindication to PFO closure. The literature review suggests that aged patients with PFO cannot be excluded"a priori"from PFO closure that should evaluated as therapeutic options in presence of anatomical and functional indications. Moreover in the elderly many other syndromes than paradoxical stroke mediated by PFO required full assessment and, if needed, transcather PFO closure:deoxygenating in obstructive sleeping apnoea, unexplained increased dyspnoea associated with hypoxemia after lung surgery, paralysis of the hemidiaphragm, and platypnea orthodeoxia. Differently from in the young and middle age, the management of PFO in aged patients should obligatory include the careful evaluation of potential comorbidities and eventual contraindications, such as severe diastolic dysfunction due to for example to hypertensive cardiomyopathy and coronary heart disease, the main causes of diastolic dysfunction.(J Geriatr Cardiol 2007;4:254-256.)

关键词： stroke patent foramen ovale elderly transcatheter closure

Delayed cardiac tamponade after simultaneous transcatheter atrial septal defect closure and left atrial appendage closure device implantation: a particular case report

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Journal of Geriatric Cardiology 2019年第12期16卷 898-901页

作者： Jian-Ming WANG Qi-Guang WANG Xian-Yang ZHU Department of congenital heart disease General Hospital of Northern Theater Command

Percutaneous left atrial appendage(LAA)occlusion evolved as an alternative treatment to the patients who are contraindicated or cannot tolerate oral anticoagulants with nonvalvular atrial fibrillation(AF)at risk of stroke or systemic embolism.[1]Abnormal hemodynamic changes in elder atrial septal defect(ASD)patients cause remodeling of the left atrium,which eventually leads to right heart failure.[2]As the ASDs elderly are associated with a higher incidence of AF,simultaneous transcatheter ASD and LAA closure has become a new effective therapeutic ***,only a limited number of articles involving cardiac tamponade complications have been published in the ***’s more,previous studies involving early hemodynamically irrelevant pericardial effusion after the procedure attribute to multiple repositioning attempts of LAA occluder or delivery sheath injured the atrial wall.

关键词： Atrial fibrillation Atrial septal defect Cardiac catheterization Cardiac tamponade Left atrial appendage

Simultaneous Transcatheter Closure of the Left Atrial Appendage and congenital Interatrial Communication Closure

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congenital heart disease 2022年第1期17卷 61-70页

作者： Jianming Wang Xianyang Zhu Xiaotang Sheng Jingsong Geng Jiawang Xiao Qiguang Wang Department of congenital heart disease General Hospital of Northern Theater CommandShenyangChina

Background:Left atrial appendage closure(LAAC)with simultaneous interventional occlusion therapy for congenital interatrial communication has become a new focus of patients with nonvalvular atrial *** is known about the results of mid-and long-term ***:The aim of this study was to evaluate the midand long-term safety and effectiveness of simultaneous transcatheter closure of the left atrial appendage(LAA)and congenital interatrial communication closure in atrial fibrillation(AF)***:From Jan 2016 to June 2017,27 patients with AF were treated with simultaneous transcatheter closure of the LAA and atrial septal defect(ASD,n=22),patent foramen ovale(PFO,n=5).Results:The perioperative closure success rate was 96.3%,except for cardiac tamponade occurred in one ASD *** the median 37.6-month follow-up period,no cases of cerebrovascular or peripheral vascular embolism,bleeding,infective endocarditis or thrombosis along the occluders were *** the 21 patients with NYHA Class III,nineteen had significant improvements to NYHA Classes I or II,and 81.5%of patients were free from major or minor adverse events during midand long-term ***:Simultaneous closure of the LAA and congenital interatrial communication closure is a viable option for patients with nonvalvular atrial fibrillation who are at risk of stroke or systemic embolism,and it is effective and yields excellent mid-and long-term results.

关键词： Left atrial appendage atrial fibrillation interatrial communication cardiac catheterization

Effectiveness and Safety of Transcatheter Closure of Various Ventricular Septal Defects Using Second-Generation Amplatzer Duct Occluders

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congenital heart disease 2023年第2期18卷 183-195页

作者： Jianming Wang Qiguang Wang Xiaotang Sheng Jingsong Geng Jiawang Xiao Xianyang Zhu Department of congenital heart disease General Hospital of Northern Theater CommandShenyangChina

Objective:This study was designed to determine the long-term safety and efficacy of using the Amplatzer Duct Occluder II(ADO II)for the closure of various ventricular septal defects(VSDs).Methods:From January 2011 to December 2019,selected VSD patients were treated through transcatheter intervention using ADO II *** closure results and complications from 188 patients,involving 167 perimembranous ventricular septal defects(pmVSDs),9 intracristal VSDs,11 post surgery residual shunts and 1 post closure residual shunt with the mean outlet diameter3.1±0.8 mm under angiography,were enrolled in this ***:The success rate was 98.9%for all *** the median 77-month follow-up period,no cases of complete atrioventricular block(cAVB),infective endocarditis or death *** major adverse event(0.5%)was recorded:cerebrovascular accident occurred 1 day after the procedure in one patient who was transferred to the neurology *** residual shunt rate was 44.6%,which was the most common minor adverse *** cardiac conduction block rate was 4.3%.Specifically,one pmVSD patient developed intermittent LBBB during the 28-month *** were 3 patients(1.6%)with new-onset mild tricuspid insufficiency,and the insufficiency degree was stable during *** was no new-onset aortic insufficiency that ***:Transcatheter closure of pmVSDs,some intracristal VSDs,some postsurgery or postclosure residual shunts using ADO II occluders were both safe and effective and yielded excellent long-term results in selected patients.

关键词： Ventricular septal defects Amplatzer Duct Occluder II long-term follow-up transcatheter closure

Treatment for hemoptysis after percutaneous closure of a large intralobar pulmonary sequestration in elderly patient

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Journal of Geriatric Cardiology 2020年第9期17卷 585-588页

作者： Jian-Ming WANG Qi-Guang WANG Duan-Zhen ZHANG Xian-Yang ZHU Department of congenital heart disease General Hospital of Northern Theater CommandShenyangChina

Pulmonary sequestration is a rare congenital cardiovascular malformation.[1,2]Open surgical excision is the usual treatment,although thorascopic intervention and transcatheter embolization have been ***,only a limited number of articles involving percutaneous closure the rare pulmonary malformations have been published in the literature.[3]What’s more,previous studies involving percutaneous pulmonary sequestration closure with repeated respiratory symptoms at the very young age suggested that the optimal therapeutic strategy has yet to be determined.[4]We hereby describe a particular case of percutaneous closure of a large intralobar pulmonary sequestration at elderly age.

关键词： Cardiac catheterization Hemoptysis Interventional embolization Pulmonary sequestration

Transcatheter Closure of Postoperative Residual Atrial or Ventricular Septal Shunts in Patients with congenital heart disease

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congenital heart disease 2024年第3期19卷 293-303页

作者： Jiawang Xiao Jianming Wang Zhongchao Wang Lili Meng Ming Zhao Qiguang Wang Department of congenital heart disease General Hospital of Northern Theater CommandShenyang110016China

Background:Transcatheter closure(TCC)has emerged as the preferred treatment for selected congenital heart disease(CHD).While TCC offers benefits for patients with postoperative residual shunts,understanding its mid-and long-term efficacy and safety remains ***:This study aims to assess the mid-and long-term safety and efficacy of TCC for patients with residual atrial or ventricular septal shunts following CHD ***:In this consecutive retrospective study,we enrolled 35 patients with residual shunt who underwent TCC or surgical repair of CHD between June 2011 to October *** candidacy was determined based on established *** and electrocardiogram were conducted during the perioperative period and continued as part of long-term ***:Among the patients,5(14.3%)exhibited interatrial shunt-ing,while 30(85.7%)had interventricular *** was successfully implemented in 33 of 35 patients,with exceptions in two cases of post-ventricular septal defect repair due to anatomical challenges involving the shape and aortic *** resulted in a TCC success rate of 94.3%.Trace residual shunt was detected in two interventricular shunting cases and a mild residual shunt in one interventricular shunting case;all resolved by the three-month follow-up after *** complications included one hematoma at the puncture site and one transient junctional rhythm during the perioperative *** a median follow-up of 73 months,there were no instances of residual shunt,device embolization,occluder displacement,valve insufficiency,malignant arrhythmia,infective endocarditis,death,or other serious ***:TCC is an effective and safe therapy for patients with residual atrial or ventricular septal shunts following CHD *** support the consideration of TCC as the preferred treatment option for appropriate patient populations.

关键词： congenital heart disease residual shunt transcatheter closure surgical repair

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

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Journal of Geriatric Cardiology 2023年第12期20卷 890-894页

作者： Jian-Ming WANG Li-Li MENG Jia-Wang XIAO Zhong-Chao WANG Jing-Song GENG Qi-Guang WANG Department of congenital heart disease General Hospital of Northern Theater CommandShenyangChina

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 *** giant PDA complicated with PE is prone to pulmonary hypertension(PH),which will significantly increase the right heart load,right ventricle hypertrophy,and result in clinical escape diagnosis or misdiagnosis.

关键词： ductus diagnosis congenital