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

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

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The Impact of a Prior Norwood Procedure on Cardiac Transplantation in Failed Fontan Physiology

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congenital heart disease 2024年第3期19卷 257-266页

作者： Ryan G.McQueen Nikki M.Singh Ronald K.Woods Medical College of Wisconsin Herma Heart Institute at Children’s WisconsinMilwaukeeUSA Division of Pediatric Cardiology Medical College of WisconsinHerma Heart Institute at Children’s WisconsinMilwaukeeUSA Division of Pediatric Cardiothoracic Surgery Medical College of WisconsinHerma Heart Institute at Children’s WisconsinMilwaukeeUSA

Objective:The objective of this study was to compare cardiac transplant operative and postoperative courses of patients with failed Fontan physiology who were initially palliated with a Norwood(FFN)to those without a prior Norwood(FF).Methods:A single-institution retrospective review of all patients with Fontan failure who under-went cardiac transplantation from 2003–2021 was completed-22 underwent prior Norwood(FFN)and 11 did not(FF).Descriptive and inferential statistics were calculated for operative course and patient ***:The operative course of the FFN cohort appeared to be more complex(not statistically significant,but clinically relevant)-this group exclusively experienced sternal re-entry events(3 of 22 patients)and concomitant neo-aor-tic reconstruction(6 patients),had a longer duration of surgery(median of 682 min vs.575.5 min),more time on circulatory arrest(median of 25.5 min vs.12.5 min),and more frequent use of open sternal management[50%of patients(11/22)vs.27.3%of patients(3/11)].Postoperatively,these patients underwent more mediastinal explora-tions[other than sternal closure;40.9%of patients(9/22)vs.18.2%of patients(2/11)],spent more time on mechanical ventilation(median of 5 days vs.2 days),had a longer length of stay(median of 30 days vs.19 days),and required more catheter-based re-interventions[22.7%of patients(5/22)vs.9.1%of patients(1/11)].Conclu-sion:Although underpowered,our results suggest that the operative course of FFN patients is more challenging,based mostly on neo-aortic arch *** turn,this likely leads to a more complex postoperative *** are currently collaborating with other institutions to increase the cohort size and power of the study.

关键词： Fontan Fontan failure Norwood cardiac transplantation

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Interaction between ozone and paternal smoking on fetal congenital heart defects among pregnant women at high risk a multicenter maternal-fetal medicine study

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World Journal of Pediatrics 2024年第6期20卷 621-632页

作者： Huan Wang Yan-Ping Ruan Sheng Ma Ya-Qi Wang Xiao-Yu Wan Yi-Hua He Jing Li Zhi-Yong Zou Institute of Child and Adolescent Health School of Public HealthNational Health Commission Key Laboratory of Reproductive HealthPeking UniversityNo.38 Xueyuan RdHaidian DistrictBeijing 100191China Echocardiography Medical Center Beijing Anzhen Hospital.Capital Medical UniversityMaternal-Fetal Medicine center in Fetal Heart DiseaseBeijing Anzhen HospitalNo.2 Anzhen RdChaoyang DistrictBeijing 100029China

Background Evidence remains limited on the association between maternal ozone(O,)exposure and congenital heart defects(CHDs)in offspring,and few studies have investigated the interaction and modification of paternal smoking on this *** Using a sample including pregnant women at high risk of fetal CHD(with metabolic disease,first-trimester viral infection,family history of CHD,etc.)from a maternal-fetal medicine study covering 1313 referral hospitals in China during 2013-2021,we examined the associations between maternal O_(3)exposure during 3-8 weeks of gestational age and fetal CHD in offspring and investigated the interaction and modification of paternal smoking on this *** was diagnosed by fetal echocardiograms,maximum daily 8-hour average O,exposure data at a 10 km×10 km spatial resolution came from the Tracking Air Pollution in China dataset,and paternal smoking was collected using *** regression models were used to estimate adjusted odds ratios(ORs)and 95%confidence intervals(CIs).Results Among 27,834 pregnant women at high risk of fetal CHD,17.4%of fetuses were diagnosed with *** 10μg/m^(3)increase in maternal O_(3)exposure was associated with a 17%increased risk of CHD in offspring(OR=1.17,95%CI=1.14-1.20).Compared with paternal nonsmoking and maternal low O_(3)exposure,the ORs(95%CI)of CHD for smoking and low O_(3)exposure,nonsmoking and high O_(3)exposure,and smoking and high O_(3)exposure were 1.25(1.08-1.45),1.81(1.56-2.08),and 2.23(1.84-2.71),*** smoking cessation seemingly mitigated the increased risk of *** Maternal O_(3)exposure and paternal smoking were interactively associated with an increased risk of fetal CHD in offspring,which calls for effective measures to decrease maternal exposure to O_(3)pollution and secondhand smoke for CHDprevention.

关键词： congenital heart defects Fetal heart development Ozone exposure Tobacco smoking

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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

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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

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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

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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

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Past and present of cardiocirculatory assist devices: a comprehensive critical review

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Journal of Geriatric Cardiology 2012年第4期9卷 389-400页

作者： Gianluca Rigatelli Francesco Santini Giuseppe Faggian Section of adult congenital heart disease Cardiovascular Diagnosis and Endoluminal Interventions Rovigo General Hospital Viale Tre Martiri 45100 Rovigo Italy Division of Cardiac Surgery University of Verona Medical School Verona Italy

During the last 20 years, the management of heart failure has significantly improved by means of new pharmacotherapies, more timely invasive treatments and device assisted therapies. Indeed, advances in mechanical support, namely with the development of more efficient left ventricular assist devices (LVADs), and the total artificial heart have reduced mortality and morbidity in patients awaiting transplantation, so much so, that LVADs are now approved of as a strategy for destination therapy. In this review, the authors describe in detail the current basic indications, functioning modalities, main limitations of surgical LAVDs, total artificial heart development, and percutaneous assist devices, trying to clarify this complex, but fascinating topic.

关键词： Cardiac surgery Cardiocirculatory support Devices heart failure heart transplant

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Atrial tachyarrhythmia in adult congenital heart disease

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World Journal of Cardiology 2017年第6期9卷 496-507页

作者： Arsha Karbassi Krishnakumar Nair Louise Harris Rachel M Wald S Lucy Roche Toronto congenital Cardiac Center for adults Peter Munk Cardiac Center University Health Network Division of Cardiology 5N-521 Toronto General Hospital

The adult congenital heart disease (ACHD) population continues to grow and most cardiologists, emergency room physicians and family doctors will intermittently come into contact with these patients. Oftentimes this may be in the setting of a presentation with atrial tachyarrhythmia; one of the commonest late complications of ACHD and problem with potentially serious implications. Providing appropriate initial care and ongoing management of atrial tachyarrhythmia in ACHD patients requires a degree of specialist knowledge and an awareness of certain key issues. In ACHD, atrial tachyarrhythmia is usually related to the abnormal anatomy of the underlying heart defect and often occurs as a result of surgical scar or a consequence of residual hemodynamic or electrical disturbances. Arrhythmias significantly increase mortality and morbidity in ACHD and are the most frequent reason for ACHD hospitalization. Intra-atrial reentrant tachycardia and atrial fibrillation are the most prevalent type of arrhythmia in this patient group. In hemodynamically unstable patients, urgent cardioversion is required. Acute management of the stable patient includes anticoagulation, rate control, and electrical or pharmacological cardioversion. In ACHD, rhythm control is the preferred management strategy and can often be achieved. However, in the long-term, medication side-effects can prove problematic. Electrophysiology studies and catheter ablation are important treatments modalities and in certain cases, surgical or percutaneous treatment of the underlying cardiac defect has a role. ACHD patients, especially those with complex CHD, are at increased risk of thromboembolic events and anticoagulation is usually required. Female ACHD patients of child bearing age may wish to pursue pregnancies. The risk of atrial arrhythmias is increased during pregnancy and management of atrial tachyarrhythmia during pregnancy needs specific consideration.

关键词： congenital heart disease Arrhythmia adult Ablation

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“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

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