Suxuan Liu

Percutaneous closure of postinfarct muscular ventricular septal defects: A multicenter study in China

BACKGROUND Surgical repair is an effective method to treat ventricular septal defect (VSD) complicating acute myocardial infarction (AMI). However, the mortality rate remains high. This study was designed to assess the immediate and mid-term results of transcatheter closure of postinfarct muscular VSDs. METHODS Data were retrospectively collected from 42 AMI patients who underwent attempted transcatheter VSD closure between 2008 and 2012 in seven heart centers of China. RESULTS Nine patients underwent emergent VSD closure in the acute phase (within two weeks from VSD) while the others underwent elective closure. The time between VSD occurrence and closure in emergency group and elective group was 7.7 ± 2.3 days and 35 ± 14.5 days, respectively (p<0.01). The percentage of procedure success in the emergency group and elective group was 77.8% (7/9) and 97% (32/33), respectively (p=0.048). The hospital mortality was higher for emergent closure in comparison to elective closure (66.7% vs. 6.1%, p<0.01). During a median follow-up of 25 months (0-58 months), two patients died at 8 and 29 months, respectively, and no serious complications occurred in other patients. CONCLUSION Interventional postinfarct VSD closure is a safe and effective approach that can be performed with a high procedural success rate, with favorable outcomes if it can be undertaken >14 days postinfarct.

Comparison of results and economic analysis of surgical and transcatheter closure of perimembranous ventricular septal defect

OBJECTIVES The last decade has witnessed considerable improvement in design and implantation techniques for the percutaneous closure of perimembranous ventricular septal defects. This study was undertaken to compare the results and economic analysis of traditional surgery and percutaneous closure with a modified double-disk occluder during hospitalization. METHODS A total of 345 consecutive patients who underwent isolated perimembranous ventricular septal defect closure were identified between July 2009 and July 2011 in our institution. A total of 157 patients with perimembranous ventricular septal defect (45.5%) underwent percutaneous closure and the remaining 188 patients (54.5%) were treated surgically. RESULTS In the percutaneous closure group, 156 patients (99.4%) had immediate complete closure and 186 (98.9%) in the surgical group were treated successfully (P = 0.671). The surgical group was significantly younger (P = 0.000) and larger in size (P = 0.000). One case of irreversible complete atrioventricular block and one death occurred in the surgical group. There was no significant difference in terms of hospital stay between the two groups. The total medical cost in the percutaneous closure group was lower compared with that in the surgical group (P = 0.005). Charges for medication, bed occupancy and nursing care of patients undergoing surgical closure were greater than those for patients undergoing transcatheter closure (P = 0.000, P = 0.000, P = 0.000, respectively). None of the patients in the percutaneous closure group required blood transfusion during hospitalization. Charges for radiography, lab and ultrasound in the percutaneous closure group were higher compared with those in the surgical group (P = 0.000, P = 0.000, respectively). CONCLUSIONS Compared with surgical repair at our institution, the superior clinical outcomes and economic benefits of percutaneous closure are inspiring. Percutaneous closure is a valuable alternative to surgery and allows more patients to be effectively treated in China.

Comparison of immediate results and mid-term follow-up of surgical and percutaneous closure of ruptured sinus of Valsalva aneurysm

BACKGROUND The past decade has witnessed considerable improvement in implantation techniques for percutaneous closure of ruptured sinus of Valsalva aneurysm. This study was undertaken to compare the immediate results and mid-term follow-up of traditional surgery and percutaneous closure of ruptured sinus of Valsalva aneurysm in China. METHODS Between January 1993 and January 2013, a total of 35 patients with ruptured sinus of Valsalva aneurysm were enrolled for attempted closure in our institution. Twenty patients (57.1%) underwent surgical repair and the other 15 patients (42.9%) underwent percutaneous closure. RESULTS Nineteen patients (95.0%) in the surgical group had complete closure and 14 patients (93.3%) in the percutaneous closure group were treated successfully (p=0.681). Twelve patients with ruptured sinus of Valsalva aneurysm combined with subarterial ventricular septal defect (VSD) underwent surgical repair concomitantly. Two patients in the percutaneous closure group were treated for ruptured sinus of Valsalva aneurysm and perimembranous VSD using occluders concomitantly. One case of severe hemolysis developed 8h after the procedure in the percutaneous closure group. One death and one case of patch leak occurred in the surgical group during hospitalization. The time of hospital stay in the percutaneous closure group was shorter than that in the surgical group (p=0.004). The total medical cost of isolated ruptured sinus of Valsalva aneurysm in the percutaneous closure group was lower compared with that in the surgical group (p=0.046). During a median follow-up of 15 months (2-240 months), there were no deaths, infective endocarditis, device embolization, or malposition. CONCLUSIONS Percutaneous closure is an attractive alternative to surgery in selected patients with ruptured sinus of Valsalva aneurysm for the better clinical advantages and economic benefits.

Transcatheter Closure of Intracristal Ventricular Septal Defect With Mild Aortic Cusp Prolapse Using Zero Eccentricity Ventricular Septal Defect Occluder.

BACKGROUND Transcatheter closure is a well-established therapy for patients with perimembranous ventricular septal defects (VSDs), but with limited experience in intracristal VSDs (IVSDs) with aortic cusp prolapse (ACP). METHODSANDRESULTS From 2012 to 2014, we reviewed 38 patients with IVSDs complicated with mild ACP who underwent device closure, and, in light of the findings, assessed the effect of transcatheter intervention on preoperative mild ACP. The zero eccentric VSD occluder was chosen for closure (Shanghai Shape Memory Alloy Ltd, Shanghai, China). The mean defect was 4.8±1.6 mm (range, 2-8) as measured by transthoracic echocardiography and the mean device size was 10.1±2.1 mm (range, 4-14). Placement of the device was successful in 35 patients (92.1%). In the remaining 3 patients (7.9%), major complications occurred and they were converted to surgical intervention: severe aortic regurgitation (AR) in 2 patients and occluder dislodgement in 1 patient. During the follow-up (median 14.2 months; range, 3-24), no deaths, residual shunt, late-onset AR, heart block, or device failure occurred. CONCLUSIONS The mid-term prognostic results of high success rate and low complications rate in this study are inspiring. Transcatheter closure of IVSD with mild ACP can be performed safely and effectively as an alternative to surgery in selected patients.

Simultaneous Transcatheter Treatment of Perimembranous Ventricular Septal Defect and Other Congenital Cardiopathies

OBJECTIVE To assess the efficacy and safety of simultaneous transcatheter corrections of perimembranous ventricular septal defect (VSD) and other congenital cardiopathies. PATIENTS/METHODS From 2004 to 2012, 56 patients (25 male, 31 female), aged 14.2±10.1, with compound congenital cardiovascular abnormalities underwent simultaneous transcatheter interventional procedure. Of the 56 patients, 32 had VSD and atrial septal defects (ASD); 17 had VSD and patent ductus arteriosus (PDA); and seven had VSD and pulmonary valve stenosis (PS). Percutaneous balloon pulmonary valvuloplasty (PBPV) was performed before the closure of VSD, PDA, or ASD. RESULTS The combined transcatheter interventional procedure was successfully performed in all patients. Among these, two occluders were implanted in each of 49 patients, seven patients with VSD combined with PS underwent successfully balloon valvuloplasty and VSD closure. The size of VSD, ASD and PDA detected by TTE was 4.8±1.7 mm, 9.0±5.0 mm and 4.5±2.5 mm, respectively. The occluder diameter of VSD, ASD and PDA was 7.6±2.2 mm, 14.3±6.2 mm and 7.9±3.2 mm, respectively. The peak-to-peak transpulmonary gradient decreased from 60.4±19.7 mmHg to 15.0±5.0 mmHg (p<0.001) in seven patients with VSD combined with PS. One patient with VSD and ASD had a permanent pacemaker implanted because of third-degree atrioventricular block two months after the procedure. There were not serious adverse events in relation to the combined procedures during the 23.8±20.7 months of follow-up in other 55 patients. CONCLUSION The simultaneous treatment of VSD and other congenital cardiopathies using transcatheter-based procedures is safe and effective, which can provide satisfactory results.

Comparison of Immediate and Long-term Results between the Single Balloon and Inoue Balloon Techniques for Percutaneous Pulmonary Valvuloplasty

BACKGROUND This study was undertaken to compare the immediate and long-term follow-up results of balloon pulmonary valvuloplasty (BPV) between the single balloon and Inoue balloon for isolated pulmonary valve stenosis (PS). METHODS A retrospective analysis of outcomes following BPV in 38 children using the single balloon and 42 adults using the Inoue balloon at a single institution was performed. RESULTS The majority of children (76.3%) were asymptomatic while 26 adults (61.9%) presented with symptoms. The ratio of balloon size to pulmonary valve annulus was 1.23 ± 0.12 in the children group and 1.22 ± 0.10 in the adult group (P=0.641). The children group had a right ventricle-pulmonary artery systolic gradient of 52.79 ± 35.08 mmHg that decreased to 22.55 ± 12.92 mmHg following BPV (P<0.001). The adult group had a gradient of 94.79 ± 42.19 mmHg that decreased to 34.02 ± 15.00 mmHg following BPV (P<0.001). Mild pulmonary regurgitation occurred in eight children (21.1%) and 10 adults (23.8%) (P=0.768). During a median follow-up of 15 years, gradients were not significantly different from that obtained at one-month follow-up in children (P=0.280) and adults (P=0.373). CONCLUSIONS Adults can be treated with BPV using the Inoue balloon with encouraging immediate and long-term follow-up results that are similar to those in children using the single balloon.

Metabolomic profiles delineate the effect of Sanmiao wan on hyperuricemia in rats.

A serum metabolomic method based on ultra-high-performance liquid chromatography coupled with mass spectrometry was developed to characterize hyperuricemia-related metabolic profiles and delineate the mechanism of Sanmiao wan (SMW), a traditional Chinese medicine (TCM), in treating hyperuricemic rats. With partial least-squares discriminant analysis for classification and selection of biomarkers, 13 potential biomarkers in mouse serum were identified in the screen, primarily involved in purine metabolism, arginine and proline metabolism, citrate cycle, phenylalanine metabolism, tryptophan metabolism and glycerophospholipid metabolism. Taking these potential biomarkers as screening indexes, SMW could reverse the pathological process of hyperuricemia through partially regulating the perturbed metabolic pathway except for glycerophospholipid metabolism. Our results showed that a metabolomic approach offers a useful tool to identify hyperuricemia-related biomarkers and provides a new methodological cue for systematically dissecting the underlying efficacies and mechanisms of TCM in treating hyperuricemia.

Percutaneous closure of a giant pseudoaneurysm of the ascending aorta after valve replacement

A 45-year-old male who underwent aortic valve replacement 3 years ago was transferred to our institution on January 13, 2012. He presented with progressive dyspnea, palpitation, orthopnea, abdominal distension and lower limb edema, which developed 1 month after aortic valve replacement. Despite the use of excellent medical therapy, the patient had a deteriorating cardiac function. Cardiac auscultation revealed a grade 3/6 systolic murmur at the right upper sternal border. Chest radiograph showed bilateral pleural effusion, diffuse interstitial markings, and a hugely enlarged heart shadow with a spherical configuration on its right side. Computed tomography angiography (CTA) showed that an aortic pseudoaneurysm originated from an orifice (about 6 mm in diameter) in the ascending aorta. Transthoracic echocardiography (TTE) revealed the giant aortic pseudoaneurysm fistulating into the right atrium (Fig. 1). The fistula measured 10 mm at the diameter and the pseudoaneurysmmeasured 80 × 65 mm at the maximal echocardiographic diameters. Cardiac enlargement showed that the left atrial volume was 72 ml, the left ventricular volume was 118 ml and the right atrial volume was 96 ml with severe tricuspid regurgitation (12 ml). The ejection fraction was 40%. He was considered to be a high-risk candidate for repeat surgery and referred for percutaneous closure on January 15, 2012. An aortic angiogram was performed to confirm the presence of the giant pseudoaneurysm (online Video 1). A modified muscular occluder (Shanghai Shape Memory Alloy Ltd., China) similar to the Amplatzer occluder, was used in this procedure. It was made of a 0.005-in nitinol wire mesh with fabric inside and approved by the State Food and Drug Administration (SFDA) of China in 2003 (Fig. 2). The occluder was delivered via the right femoral artery using a 10French delivery sheath. Final aortogram revealed that there was no residual flow into the pseudoaneurysm and the occluder was wellpositioned (online Videos 2 and 3). The procedure was well tolerated by the patient and completely without immediate complications. Post-operative day 3, TTE demonstrated no residual flow across the pseudoaneurysm. CTA revealed that the occluder was well fixed into the neck of pseudoaneurysm (Fig. 3). At one-year follow-up, chest radiograph showed that the size of the pseudoaneurysm gradually decreased (Fig. 4). TTE showed no residual flow to the pseudoaneurysm, with an ejection fraction of 62%. The left atrial volume was 66 ml, the right atrial volume was 91 ml, and the right atrial volume had decreased from 118 ml to 97 ml. The volume of tricuspid regurgitation had decreased from 12 ml to 2 ml. Furthermore, the patient had no serious health problems and enjoyed a good quality of life during the follow-up.

Differential expression profile of long non-coding RNAs in human thoracic aortic aneurysm

Thoracic aortic aneurysm (TAA) is progressive fatal aortic pathological dilation, which is characterized by increased proteoglycans and loss of elastic fibers. Recent advances in long non‐coding RNAs (lncRNAs), an important regulator in many biological processes, suggested the close correlation between expression patterns and disease progression. In the present study, the ascending aortic tissues were collected from ascending TAA patients (n = 33) and organ donors (n = 16). Microarray analysis and real‐time PCR were then applied to detect the lncRNA expression profiles. A total of 147 differentially expressed lncRNAs were determined, including 104 upregulated and 43 downregulated lncRNAs. Bioinformatics analysis showed 51.7% of differentially expressed lncRNAs were sense‐overlapping, and most of the down‐regulated lncRNAs were located on chromosome 1, 7, and 12. Subgroup analysis of TAA patients indicated that the expression of lnc‐HLTF‐5 was significantly higher in hypertension group than non‐hypertension group (P < 0.05). Spearman correlation analysis further confirmed that the lnc‐HLTF‐5 level was positively correlated with the expanded ascending aortic diameter (rs = 0.483, P = 0.004) and MMP9 level (rs = 0.465, P = 0.006). Our results expanded the lncRNA expression patterns in aortic disease, and provided experimental basis for future investigation on TAA pathogenesis.

Immediate- and medium-term effects of simultaneous percutaneous corrections of secundum type atrial septal defect combined with pulmonary valve stenosis in local anesthesia and without transesophageal echocardiography guidance

BACKGROUND The feasibility and efficacy of simultaneous percutaneous treatment of secundum type atrial septal defect (ASD) combined with pulmonary valve stenosis (PS) have not been proved. OBJECTIVE To evaluate the safety and efficacy on the clinical benefit of simultaneous percutaneous correction of these two pathologies under local anesthesia and without transesophageal echocardiography guidance. METHODS Transpulmonary gradient, functional status, pulmonary regurgitation (PR), and tricuspid regurgitation (TR) were studied in 35 patients undergoing percutaneous balloon pulmonary valvuloplasty and ASD closure from March 2004 to July 2012. All patients were followed up until January 2013, an average of 39 months. RESULTS According to color Doppler transthoracic echocardiography (TTE) before the intervention, the ASD defect size and transpulmonary gradient were 17±8.4 mm and 88±37.8 mmHg, respectively. Post-interventionally, the peak-to-peak transpulmonary gradient decreased from 77±37.6 mmHg to 20±16.2 mmHg (p<0.001) and the ASD occluder size was 23±10.5 mm. In all those patients, there was no residual shunt detected, and moderate and severe TR decreased from 45.7% (16/35) and 20% (7/35) to 8.6% (3/35) and 5.7% (2/35) before and after intervention detected by TTE, respectively. Eight patients had mild PR after procedure and two of them recovered at 6 months and no patient encountered severe adverse events at the latest follow-up. CONCLUSION Simultaneous percutaneous corrections of ASD combined with PS are feasible, safe, and effective with satisfactory results.