Hong Tang

Perventricular Device Closure of Ventricular Septal Defects: Six Months Results in 30 Young Children

BACKGROUNDnBoth surgical repair and transcatheter closure of isolated ventricular septal defects are known to have limitations in children. This report describes the short-term results of perventricular device closure of nonmuscular ventricular septal defects without cardiopulmonary bypass in young children.nnnMETHODSnThirty patients who had nonmuscular ventricular septal defects underwent perventricular closure by minimally invasive technique without cardiopulmonary bypass. A subxiphoid minimally invasive incision was performed. Under the continuous guidance of transesophageal echocardiography, the free wall of the right ventricle was punctured and a guidewire was introduced into the left ventricle through the defect. A delivery sheath was advanced over the wire and through the defect into the left ventricle. The device was released.nnnRESULTSnClosure was successful in 27 patients (90%). There was no mortality or atrioventricular block perioperatively or during the entire follow-up period. Three patients developed incomplete right bundle branch blocks and seven patients developed new trace or mild tricuspid regurgitation after the closure. The mean hospital stay was 3.6 +/- 0.7 days (range, 3 to 5 days) and no patient needed any blood or blood products. Follow-up at 6 months showed that two of the three patients had persistent incomplete right bundle branch block and three of the seven patients had persistent closure-related trace or mild tricuspid regurgitation.nnnCONCLUSIONSnPerventricular device closure of isolated ventricular septal defects without cardiopulmonary bypass appeared to be safe and efficacious in selected young children. The outcomes of short-term follow-up are acceptable.

Perventricular device closure of muscular ventricular septal defects on beating hearts: Initial experience in eight children

OBJECTIVEnThe conventional surgical repair and transcatheter closure of muscular ventricular septal defects are known to have undesirable limitations. This communication describes the short-term results of perventricular device closure of muscular ventricular septal defects with the heart beating in 8 children with 15 muscular ventricular septal defects, with or without other congenital malformations.nnnMETHODSnA subxiphoid minimally invasive incision was used in 3 children with isolated muscular ventricular septal defects whereas standard full median sternotomies were used in the other 5 children who required subsequent correction of coexisting malformations. Under the continuous guidance of transesophageal echocardiography, the free wall of the right ventricle was punctured, and a guidewire was introduced into the left ventricle through the defect. A delivery sheath was advanced over the wire and through the defect into the left ventricle. The device was released.nnnRESULTSnA total of 14 muscular ventricular septal defects were successfully closed perventricularly without cardiopulmonary bypass. There was no mortality perioperatively or during the entire follow-up period. At 6-month follow-up, there was no detectable residual shunt, arrhythmia, or new mitral or tricuspid insufficiency. Other than 5 children with the coexisting malformations, none of the other children required any blood or blood products. The average hospital stay was 7.9 +/- 2.2 days (range, 5-11 days).nnnCONCLUSIONnPerventricular device closure of muscular ventricular septal defects with or without coexisting congenital malformations appeared to be safe and efficacious. The outcomes of short-term follow-up are acceptable.

Causes of Death Following Transcatheter Aortic Valve Replacement: A Systematic Review and Meta‐Analysis

Background Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement in patients at high surgical risk. However, there is little published literature on the exact causes of death. Methods and Results The PubMed database was systematically searched for studies reporting causes of death within and after 30 days following TAVR. Twenty-eight studies out of 3934 results retrieved were identified. In the overall analysis, 46.4% and 51.6% of deaths were related to noncardiovascular causes within and after the first 30 days, respectively. Within 30 days of TAVR, infection/sepsis (18.5%), heart failure (14.7%), and multiorgan failure (13.2%) were the top 3 causes of death. Beyond 30 days, infection/sepsis (14.3%), heart failure (14.1%), and sudden death (10.8%) were the most common causes. All possible subgroup analyses were made. No significant differences were seen for proportions of cardiovascular deaths except the comparison between moderate (mean STS score 4 to 8) and high (mean STS score >8) -risk patients after 30 days post-TAVR (56.0% versus 33.5%, P=0.005). Conclusions Cardiovascular and noncardiovascular causes of death are evenly balanced both in the perioperative period and at long-term follow-up after TAVR. Infection/sepsis and heart failure were the most frequent noncardiovascular and cardiovascular causes of death. This study highlights important areas of clinical focus that could further improve outcomes after TAVR.

Hybrid perventricular device closure of doubly committed subarterial ventricular septal defects: Mid-term results

Doubly committed Subarterial ventricular septal defect (VSD) is a specific anatomic type of VSD located just beneath the aortic valve. The purpose of this study was to evaluate the safety and feasibility of using minimal invasive perventricular device closure in managing this type of VSD.

Transapical transcatheter aortic valve implantation using a new second-generation TAVI system — J-Valve™ for high-risk patients with aortic valve diseases: Initial results with 90-day follow-up ☆

BACKGROUNDnTo evaluate the safety and efficacy of transcatheter aortic valve implantation (TAVI) for patients with aortic stenosis (AS) or pure/dominant aortic regurgitation (AR) using the J-Valve™ system.nnnMETHODSnTwenty patients with isolated aortic valve disease (11 with pure/dominant AR and 9 with AS) at high risk for open-heart surgery were enrolled in this study. The mean Logistic Euro-SCORE I was 27.2±8.2% (mean age 74.5±4.7years). Four sizes of prosthesis were used for annular size up to 21 mm (n=1), 23mm (n=2), 25mm (n=10) and 27mm (n=7). Clinical and echocardiographic evaluations were performed at baseline, post-procedure and follow-up. The primary endpoint was all-cause mortality. Secondary endpoints were procedural success, major adverse events as well as echocardiographic performance.nnnRESULTSnTAVI with the J-Valve™ device was successfully performed in 19 patients (95%). Conversion to surgical valve replacement was necessary in one patient due to prosthesis embolization. No mortality occurred during 90 days follow-up. Pacemaker implantation for new onset conduction disorders was necessary in one patient (5%). For patient with severe AS, post-procedure TAVI resulted in favorable reduction of mean transvalvular gradients (55.3±8.5 vs. 16.4±13.3 mmHg, P<0.01). Mean transvalvular gradient was also favorable in AR patients after valve implantation (6.9±1mmHg). The majority of patients had none or trivial paravalvular regurgitation (17/19) while none had moderate or severe paravalvular regurgitation.nnnCONCLUSIONnTrans-apical TAVI using the J-Valve™ prosthesis is potentially an effective treatment option for patients with AS or pure/dominant AR at high risk for open-heart surgery.

Perventricular Device Closure of Perimembranous Ventricular Septal Defect in Pediatric Patients: Technical and Morphological Considerations

BACKGROUNDnWe report our experience of using perventricular device closure (PVDC) in treating perimembranous ventricular septal defect (pm-VSD) with emphasis on technical and morphological considerations.nnnMETHODnThirty-one pediatric patients with pm-VSD who underwent successful PVDC were enrolled in this study. The pm-VSDs were divided into three different types (type I: tunnel shape; type II: with subaortic rim < 2 mm; type III: membranous aneurysm formation). Four closure strategies were utilized, corresponding to the morphology of the pm-VSD.nnnRESULTSnMean age of the patients was 2.1 years with mean VSD diameter 5.8 mm. Seven patients had type I VSD, nine presented with type II, and 15 had type III. Twenty-two concentric and nine eccentric devices were used with mean device size 7.3 mm. Complete closure was achieved in 97% of cases during follow-up. Procedure-induced tricuspid regurgitation (TR) was noted in nine patients at discharge; four resolved. Multivariable analysis showed that the procedure-induced TR was associated with the device size (odds ratio = 5.059; 95% confidence interval = 1.431-17.880).nnnCONCLUSIONnDifferent closure strategies allow for PVDC of various types of pm-VSDs in selected pediatric patients.

Minimally invasive perventricular device closure of doubly committed sub-arterial ventricular septal defects: single center long-term follow-up results

BackgroundTo evaluate the long-term safety and efficacy of using perventricular device closure in treating selected patient with doubly committed sub-arterial ventricular septal defect (VSD)MethodsDuring July 2007 and April 2011, 86 patients with doubly committed subarterial VSD who met the inclusion criteria were enrolled in this study. Perventricular closure was attempted using a unique design eccentric device under the guidance of transesophageal echocardiography. Complications such as residual shunt, arrhythmia, valve regurgitation were all recorded in postoperative period and during follow-up. Multiple logistic regression analysis was performed to study risk factors for procedure failure and complications.ResultPerventricular device closure was successfully done in 75 patients (87.2xa0%) with mean age 7.0u2009±u20097.0xa0years old, VSD size 4.8u2009±u20091.5xa0mm and device size 6.7u2009±u20091.7xa0mm. Complete closure rate was achieved in 94.7xa0% at discharge and 96xa0% during follow-up. No severe complications such as device embolism, significant arrhythmia, left ventricular outflow tract obstruction as well as obvious valve regurgitation were noted during follow-up (Mean 4.5u2009±u20091.5xa0years). Procedure induced trivial-mild grade aortic valve regurgitation (AR) was noted in 16 (21.3xa0%) patients at discharge while 8 of them resolved during follow-up. Multivariable analysis revealed that procedure-induced AR was associated device diameter to patients’ weight (ORu2009=u200912.3 95xa0% CI 1.5- 99.2). Perventricular device closure was failed in 11 patients, preoperative aortic valve prolapse was the major risk factor for failure of the procedure (ORu2009=u200965 95xa0% CI 7.5- 564.1).ConclusionPerventricular closure of doubly committed subarterial VSDs appears to be a safe and effective minimally invasive treatment option in selected patients with good long-term outcomes.Clinical trial registrationUnique Identifier: ChiCTR-TNC-00000203.

An asymptomatic lipoma of the right atrium in a neonate.

A 1-month-old boy was incidentally found to have a mass in the right atrium without any symptoms. The tumor was resected uneventfully 2 years later. Histologic examination showed intramyocardial lipoma, which is very rare in children. To date, cardiac lipoma has not been reported in neonates. We describe such a case herein.

Hemodynamic changes after transcatheter aortic valve implantation during sequential follow-ups in patients with bicuspid aortic valve compared with tricuspid aortic valve

BACKGROUNDnTo investigate the individual sequential hemodynamic changes after transcatheter aortic valve implantation (TAVI), especially for patients with bicuspid aortic valve (BAV), in comparison with tricuspid aortic valve (TAV).nnnMETHODSnThe study population comprised 85 patients with severe aortic stenosis who underwent TAVI for BAV (n = 49) or TAV (n = 36) with at least two serial echocardiographic follow-ups. Doppler echocardiography was scheduled to be performed at discharge and 1, 3, 6 months and 1 year after the procedure. D peak transvalvular velocities and D mean transvalvular gradients were calculated as the difference at follow-up time points and discharge. Paravalvular leak (PVL) was assessed as another indicator for prosthesis performance.nnnRESULTSnComparisons between patients with BAV and TAV revealed similar gradient performances (1.00 [-2.00, 2.00] vs. 1.00 [-0.25, 5.00] mm Hg, p = 0.57 at 1 month; -0.71 ± 7.52 vs. 1.55 ± 3.97 mm Hg, p = 0.21 at 3 months; 0.96 ± 7.81 vs. 1.53 ± 5.85 mm Hg, p = 0.79 at 6 months; 1.00 [-0.50, 2.25] vs. 3.00 [-0.50, 7.50] mm Hg, p = 0.07 at 1 year). Moreover, the incidence of ≥ mild PVL was not significantly different in patients with BAV and TAV during follow-up (34.88% vs. 19.35%, p = 0.14 at 1 month; 45.83% vs. 27.27%, p = 0.19 at 3 months; 30.00% vs. 23.53%, p = 0.89 at 6 months; 30.00% vs. 17.65%, p = 0.56 at 1 year).nnnCONCLUSIONSnTAVI is effective and applicable in BAV anatomy with sustained and acceptable mid- -term prosthesis hemodynamic performance. (Cardiol J 2017; 24, 4: 350-357).

Prevalence and Complications of Bicuspid Aortic Valve in Chinese According to Echocardiographic Database

As transcatheter aortic valve replacement has become an alternative treatment for patients at high risk for surgical aortic valve replacement, bicuspid aortic valve (BAV) draws our attention again. The reported frequency of BAV was 0.5% to 2% in western population. However, there was no such epidemiologic study in Chinese population. Our study sought to investigate the prevalence and complications of BAV in China by echocardiographic database. A total of 668 cases who were confirmed with BAV, identified from 195,708 echocardiographic records of 157,039 patients in the echocardiographic database of West China Hospital (between June 2008 and June 2012), were analyzed retrospectively. The incidence of BAV was 0.43% in the cohort, and 579 (86.68%) patients were complicated by various degree of aortic valve stenosis or aortic valve regurgitation. The incidence of infective endocarditis and aortic dissection was 0.68% episodes per patient-years with mean age of 42.96 ± 11.25xa0years and 0.18% episodes per patient-years with mean age of 43.00 ± 5.14xa0years, respectively. In conclusion, our study demonstrated that the prevalence of BAV and complications in Chinese was similar to that in the western population.