Gaili Guo

Percutaneous Closure of Atrial Septal Defects Under Transthoracic Echocardiography Guidance Without Fluoroscopy or Intubation in Children

OBJECTIVEnDemonstrate the benefits of percutaneous atrial septal defect (ASD) closure under guidance of transthoracic echocardiography (TTE) without fluoroscopy.nnnMETHODSnFrom February 2013 to April 2014, 127 consecutive patients with an isolated type II ASD were recruited to undergo percutaneous closure under either TTE (n = 60, TTE group) or TEE (n = 67, TEE group) guidance. The TTE group received local anesthesia or sedation with propofol, and the TEE group received general anesthesia with endotracheal intubation. Follow-up examinations were performed for both groups at 1 month, 3 months, 6 months, and 1 year after discharge and annually thereafter.nnnRESULTSnThe TTE group had a significantly shorter procedure time and respirator ventilation duration than the TEE group. The dose of propofol required, the cost, and the pharyngeal complication rate were significantly lower in the TTE group than in the TEE group. The median follow-up of 11.6 months was uneventful in all patients.nnnCONCLUSIONSnPercutaneous ASD closure with TTE guidance as the only imaging tool avoids fluoroscopy, endotracheal intubation, and probe insertion and is associated with a satisfactory procedural success rate and lower costs. This procedure is a safe and reliable treatment for ASD.

Hybrid Balloon Valvuloplasty for the Treatment of Severe Congenital Aortic Valve Stenosis in Infants

BACKGROUNDnSurgical or percutaneous interventional treatment of severe congenital aortic valve stenosis (CAS) in early infancy remains challenging. This single-center, retrospective study analyzed midterm outcomes of a hybrid balloon valvuloplasty procedure through the ascending aorta by way of median sternotomy, including cases with improved technique.nnnMETHODSnIncluded were 45 consecutive infants (aged <90 days) with CAS and selected for biventricular repair who underwent hybrid balloon valvuloplasty in a hybrid or ordinary operating room from October 2010 to March 2016. Patients were assessed at 1, 3, 6, and 12 months and yearly thereafter.nnnRESULTSnHybrid balloon valvuloplasty was successful in all patients, with the last 8 treated in an ordinary operating room under only echocardiography guidance with a new sheath. Thirty-two patients were successfully rescued from low heart rate or left ventricular systolic dysfunction, or both, by cardiac massage under direct visualization; none required cardiopulmonary bypass. The degree of new aortic insufficiency was mild in 7 patients and changed from mild to moderate in 1 patient. Aortic valve pressure gradient decreasedxa0from 70.6 ± 17.5 mm Hg preoperatively to 15.2 ± 4.2xa0mm Hg immediately postoperatively (p < 0.001). Fluoroscopyxa0time was 4.8 ± 2.3 minutes. At a median of 32.1 months (range, 1 to 68 months) follow-up, all patients were alive and healthy. Aortic valve pressure gradient remained low (19.1 ± 5.2 mm Hg). Left ventricular ejection fraction increased fromxa00.515 ± 0.134 (range, 0.21 to 0.70) preoperatively to 0.633 ± 0.035 (range, 0.58 to 0.75; p < 0.001). No aortic insufficiency developed, and no patient required reintervention.nnnCONCLUSIONSnFor infants with severe CAS, hybrid balloon valvuloplasty through the ascending aorta by way of a median sternotomy appears efficacious and safe up to midterm follow-up.

Transcatheter perimembranous ventricular septal defect closure under transthoracic echocardiographic guidance without fluoroscopy

BackgroundnTranscatheter device closure has become an alternative therapy for ventricular septal defect (VSD). This study aimed to investigate the feasibility and safety of transcatheter perimembranous VSD (pm-VSD) closure under transthoracic echocardiography (TTE) guidance alone.nnnMethodsnBetween October 2012 and July 2016, 118 patients with pm-VSD underwent an attempt of transcatheter device closure for pm-VSD through the femoral artery under TTE guidance alone. Patients were followed-up at 1, 3, 6, and 12 months after the procedure and yearly after discharge.nnnResultsnThe mean age was 11.7±12.5 years (range, 1.0-53.0 years) and the mean body weight was 32.2±21.6 kg (range, 11.5-102.0 kg). The mean diameter of the VSD was 4.0±1.1 mm (range, 3.0-8.0 mm). Transcatheter device closure under TTE guidance alone was successful in 111 patients. The average procedural time was 44.9±7.3 minutes (range, 29.0-65.0 minutes). All 111 patients were followed-up for 3.4±2.3 years. At the last follow-up, two patients had a residual shunt smaller than 2 mm, seven patients had right bundle branch block (RBBB) including one patient with complete RBBB, six patients had mild or less tricuspid regurgitation, and two patients still had trivial aortic regurgitation including one patient that had it before the procedure. Occluder malposition, complete atrioventricular block, or other complications were not observed.nnnConclusionsnTranscatheter pm-VSD closure can be successfully performed under TTE guidance alone with outcomes similar to those achieved with fluoroscopic guidance in selected patients with weight more than 10 kg and VSD smaller than 8 mm. However, long-term follow-up in a large number of patients would be necessary.

A Novel Wire Is Effective for Echo-Guiding Percutaneous Atrial Septal Defect Closure: A Preclinical Study

Objective To assess the effectiveness of a novel ultrasound wire for echo-guiding percutaneous atrial septal defect (ASD) closure in a sheep model. Methods After right lateral thoracotomy, ASDs were created in 20 sheep by transseptal needle puncture followed by balloon dilatation. Animals were evenly randomized into 2 groups to undergo ASD closure using echography as the only imaging tool with either COOK wire (control group) or new ultrasound wire (study group). The total procedural time, passing time (time needed for the guide wire to enter the left atrium), frequency of delivery sheath dropping into the right atrium, frequency of arrhythmias, and 1-week rate of complications were compared between the two groups. Results All animals survived defect creation procedures uneventfully. ASD devices were successfully implanted in all sheep. Compared with the control group, the study group had significantly (P < 0.05) lower mean procedure time (15.36u2009±u20094.86 versus 25.82u2009±u20097.85u2009min), lower mean passing time (2.69u2009±u20090.82 versus 5.58u2009±u20093.34u2009min), lower frequency of the guide wire dropping into the right atrium (0% versus 40%), and lower frequency of atrial (4.41u2009±u20092.61 versus 9.60u2009±u20093.68) or ventricular premature contractions (0.75u2009±u20090.36 versus 1.34u2009±u20090.68), respectively, without serious complications up to one week. Conclusion The novel ultrasound specialized guide wire was effective in echo-guiding percutaneous ASD closure.

Feasibility and effectiveness of percutaneous balloon mitral valvuloplasty under echocardiographic guidance only

Percutaneous balloon mitral valvuloplasty (PBMV) is the treatment of choice in patients with isolated mitral stenosis. This study aimed to assess the feasibility of PBMV under echocardiography guidance only of isolated mitral stenosis (MS).