Background Pretricuspid shunts have been associated with poorer survival rates in patients with Eisenmenger syndrome compared with postricuspid shunts and complex lesions. However, the risk stratification for persistent pulmonary hypertension (PH) in this population remains uncertain. Methods and Results We retrospectively enrolled 103 patients with pretricuspid shunts with high total pulmonary resistance >4.5 Wood units (estimated pulmonary vascular resistance ≥3 Wood units). During a mean±SD follow‐up of 20.95±24.84 months, 32 patients developed postoperative persistent PH after shunt correction. We identified 3 significant predictors of postoperative persistent PH, including mean pulmonary artery pressure after inhaled oxygen ≥40.5 mm Hg (odds ratio [OR], 7.78 [95% CI, 2.02–30.03]; P <0.01), total pulmonary resistance after inhaled oxygen ≥6.5 Wood units (estimated pulmonary vascular resistance ≥5 Wood units; OR, 12.23 [95% CI, 2.12–70.46]; P <0.01), and artery oxygen saturation at rest <95% (OR, 3.34 [95% CI, 1.07–10.44]; P =0.04). We established the prediction model with the C‐statistics of 0.85 (95% CI, 0.77–0.93; P <0.01), and the C‐statistic was 0.83 (95% CI, 0.80–0.86) after bootstrapping 10 000 times with a good performance of the nomogram calibration curve for predicting persistent PH. Conclusions Our study presents a multivariable risk stratification model for persistent PH after shunt correction in adults with pretricuspid shunts. This model, based on 3 hemodynamic predictors after inhaled oxygen, may assist in identifying individuals at higher risk of persistent PH after shunt correction.

(1) Background: the indications for transcatheter closure of large patent ductus arteriosus (PDA) with severe pulmonary hypertension (PH) are still unclear, and scholars have not fully elucidated the factors that affect PH prognosis. (2) Methods: we retrospectively enrolled 134 consecutive patients with a PDA diameter ≥10 mm or a ratio of PDA and aortic >0.5. We collected clinical data to explore the factors affecting follow-up PH. (3) Results: 134 patients (mean age 35.04 ± 10.23 years; 98 women) successfully underwent a transcatheter closure, and all patients had a mean pulmonary artery pressure (mPAP) >50 mmHg. Five procedures were deemed to have failed because their mPAP did not decrease, and the patients experienced uncomfortable symptoms after the trial occlusion. The average occluder (pulmonary end) size was almost twice the PDA diameter (22.33 ± 4.81 mm vs. 11.69 ± 2.18 mm). Left ventricular end-diastolic dimension (LVEDD), mPAP, and left ventricular ejection fraction (LVEF) significantly reduced after the occlusion, and LVEF recovered during the follow-up period. In total, 42 of the 78 patients with total pulmonary resistance >4 Wood Units experienced clinical outcomes, and all of them had PH in the follow-up, while 10 of them had heart failure, and 4 were hospitalized again because of PH. The results of a logistic regression analysis revealed that the postoperative mPAP had an independent risk factor (odds ratio = 1.069, 95% confidence interval: 1.003 to 1.140, p = 0.040) with a receiver operating characteristic curve cut-off value of 35.5 mmHg (p < 0.001). (4) Conclusions: performing a transcatheter closure of large patent ductus arteriosus is feasible, and postoperative mPAP was a risk factor that affected the follow-up PH. Patients with a postoperative mPAP >35.5 mmHg should be considered for targeted medical therapy or should undergo right heart catheterization again after the occlusion.

Background:Transcatheter closure of inferior sinus venosus defect (ISVD) is still contraindication. To explore whether transcatheter closure with patent ductus arteriosus (PDA) occluders is possible for ISVD.Methods:From June 2014 to March 2021, 12 patients were recruited diagnosed as <25 mm ISVD. The three-dimensional printing (3DP) heart model was produced based on multi-slice computed tomography (MSCT) scans. Preoperative closure simulation was planned on the personalized 3D model for each patient. Follow-up including electrocardiography (ECG), transthoracic echocardiography (TTE), and X-ray was traced.Results:3DP models of 12 patients were successfully printed. Twelve patients had been diagnosed with <25 mm ISVD and 4 of them had another secundum atrial septal defect (ASD). All patients were produced interventional therapy successfully. PDA occluder was implanted to closed ISVD, and ASD was closed using ASD occluder simultaneously. The average diameter of ISVD measured by TTE was (12.67±3.80), and the average diameter of sagittal axes and longitudinal axes measured by the 3D-printed model was (17.08±3.20) and (18.42±4.62) mm, respectively. The average size of PDA (diameter of pulmonary artery side) was (28.17±3.35) mm. Compared with the preoperative, the X-ray cardiothoracic ratio (0.51±0.04 vs. 0.47±0.06, P=0.007) and the right ventricle anterior-posterior diameter (31.17±5.65 vs. 24.58±3.75 mm, P<0.001) of postoperative was significantly decreased. During the average (47.75±27.52) months follow-up, it has achieved satisfying results, and there were no severe adverse events such as device transposition, death, and pericardial tamponade occurred.Conclusions:Assisting by 3D heart model, transcatheter closure of ISVD with PDA occluder had an excellent outcome. This method provides a new considerable treatment strategy for ISVD.

Background: There have been marked advances in devices such as Amplatzer Duct Occluder II (ADO-II) or vascular plug through 5Fr delivery sheath for closure of patent ductus arteriosus (PDA) in the past five decades, making it possible for cardiologists to deliver occluders via different approaches. However, comparisons of these different approaches have not been reported. Therefore, the aim of this study was to summarize and compare the advantages of different approaches for PDA closure, and to guide clinical strategies. Methods: This retrospective study included all patients undergoing transcatheter closure of PDA from 2019 to 2020. Patients were matched by 1:1 propensity score matching (PSM). The retrograde femoral artery approach (FAA) and simple vein approach (SVA) groups were compared with the conventional arteriovenous approach (CAA). Results: The average age of the 476 patients was 21.05 ± 21.15 years. Their average weight was 38.23 ± 24.1 kg and average height was 130.14 ± 34.45 cm. The mean diameter of the PDA was 4.29 ± 2.25 mm. There were 127 men and 349 women, comprising 205 adults and 271 children. Among them, 197 patients underwent CAA, 223 underwent SVA, and 56 underwent retrograde FAA. The diameter in the FAA group was smaller than that in the other two groups, but was similar in adults and children. In the PSM comparison of CAA and SVA, 136 patients with CAA and 136 patients with SVA were recruited. Simple vein approach was associated with markedly reduced length of hospital stay, length of operation, and contrast medium usage as compared with CAA (all P < 0.05). In the PSM comparison of FAA and CAA, 30 patients with CAA and 30 patients with FAA were recruited. The operation duration was longer in the CAA than in the FAA group. There were no significant differences in postoperative complications among groups. Conclusion: Patent ductus arteriosus closure by using the SVA and FAA is safe and effective, and has certain advantages in some respects as compared with CAA.

A 50-year-old woman was presented with chest tightness and palpitations. The transthoracic echocardiogram (TTE) showed an unroofed coronary sinus (URCS) syndrome (Panel A and B) with the larger right ventricle (RV) and moderate tricuspid regurgitation (TR). The preoperative multi-slice computed tomography (MSCT) revealed the expanding coronary sinus (CS) with a 22 mm defect to the left atrium (LA) and 20 mm to the coronary sinus ostium (CSO) (Panel C and D). The type of URCS was Ib without left superior vena cava, and several minor coronary veins were returned to the LA. The pulmonary to systemic blood flow ratio was 2.2:1. During the operation, a 26 mm atrial septal defect occluder was implanted to close the CSO that the coronary vein flow was returned to the LA. However, the device had a large deformation, and the mitral valve was affected by the left disc (Panel...

Objective:To explore the feasibility of interventional treatment for multiple atrial septal defect (ASD) with non-classical indications such as inferior sinus venosus multiple ASD or extremely short rim special types of multiple ASD.Methods:The above-mentioned special types of multiple ASD were subjected to multidetector computed tomography (MDCT) examination and 3D model printing performed before operation. Ten patients with appropriate defect size were treated with interventional therapy, and clinical and follow-up data were collected.Results:The interventional treatment was done successfully in all 10 patients. One patent ductus arteriosus (PDA) occluder and one ASD occluder were implanted in 9 patients, and 2 ASD occluders and 1 PDA occluder were implanted in one patient. The size of 10 PDA occluders is (16/14-32/30) mm and the average is (23.80±5.85)/(21.80±5.85) mm; the size of 11 ASD occluders is (10-36) mm and average is (23.27±7.91) mm. There were no obvious complications occurred. Compared with the preoperative (0.50±0.03), the X-ray cardiotho racic ratio of postoperative (0.44±0.02) was significantly decreased ( t=5.670, P<0.05). The anterior-posterior diameter of transthoracic echocardiography (TTE) [(26.60±3.69) mm] was significantly lower than that before surgery [(33.20±6.00) mm, t=5.250, P<0.05]. Conclusion:It is safe and effective to use PDA occluder and ASD occluder to close the special types of multiple ASD with non-classical indications.

目的 探讨COOK普通弹簧圈联合可解脱带纤维毛弹簧圈栓塞系统栓塞体肺侧支在复杂先天性心脏病(先心病)外科治疗中的应用价值及经验.方法 回顾性分析2016年1月至2018年8月中国医学科学院阜外医院收治的15例复杂先心病合并体肺侧支患者的临床资料,评价COOK普通弹簧圈联合可解脱带纤维毛弹簧圈栓塞系统在体肺侧支栓塞术中的可行性、安全性和有效性.结果 15例患者中共发现33支体肺侧支血管,均栓塞成功,无血管损伤、弹簧圈移位及脱落等术中并发症发生.术中共用COOK普通弹簧圈34枚,直径3～8 mm,长度3～8 cm;共用Interlock可解脱弹簧圈28枚,其中15枚为钻石型,13枚为普通2D型,弹簧圈直径为2～6 mm,长度为2.3～8.0 cm.15例患者中10例属于杂交手术,即在杂交手术室行体肺侧支栓塞术后即刻行外科手术;5例因先心病外科术后发生灌注肺或左心功能不全需持续呼吸机辅助通气,不能拔除气管插管而行心血管造影及体肺侧支栓塞术,术后均顺利拔除气管插管.结论 COOK普通弹簧圈联合可解脱带纤维毛弹簧圈栓塞系统栓塞体肺侧支在复杂先心病治疗中疗效确切,可推广应用.

目的 评价经导管封堵先天性心脏病(先心病)外科矫治术后及室间隔缺损封堵术后室水平残余分流的安全性、有效性以及中长期随访结果.方法 回顾性分析2011年1月至2019年12月我院收治的35例先心病术后室水平残余分流患者的临床资料,结合介入封堵治疗情况和随访结果进行描述性分析.结果 35例患者中23例合并室间隔膜部瘤,其中6例右室面有两处或多发破口.34例封堵成功,其中4例采用2枚封堵器进行封堵.所封堵的右室面破口直径3～10.2 mm,平均(4.89±1.58)mm.所选择的封堵器直径5～20 mm,平均(9.16±3.59)mm,封堵器直径较缺损直径大1.8～10.4 mm,平均大(4.29±2.39)mm.封堵成功的患者中,31例随访1～51个月,与封堵术前相比,患者术后末次随访的左心室舒张末期内径、左心房内径及心胸比均有降低(P＜0.05).所有随访患者术后均未出现房室传导阻滞、感染性心内膜炎、封堵器脱落、主动脉瓣中大量反流及死亡等严重并发症.结论 经导管介入封堵术治疗先心病术后室水平残余分流是一种安全有效的方法,中长期随访效果良好,应成为此类患者首选的治疗方法.

3D printing technology has made great progress in recent years. With the development of computer, imaging technology and new materials, 3D printing technology has also played its unique role in the clinical application of structural heart disease. Its 3D model can not only help doctors and medical students to understand the heart anatomy and surgical training better, but also help surgeons to perform preoperative planning, intraoperative guidance and even surgical innovation. In the future, the combination of 3D printing technology with tissue engineering will hopefully solve the dilemma of artificial valves and vascular grafts. The application of 3D printing in structural heart disease can be expected in the future.

目的:评价第二代Amplatzer动脉导管未闭封堵器(ADO II)在非动脉导管未闭结构性心脏病中临床应用的疗效.方法:2011年5月至2015年1月应用ADO II治疗非动脉导管未闭结构性心脏病的患者28例,年龄中位数5岁(5个月～42岁),体重中位数19.3 kg(4.2～91.0 kg).封堵后观察封堵器的位置、形态及封堵效果.结果:28例患者应用ADO II封堵手术均成功.膜部室间隔缺损患者14例,肺动脉闭锁合并室间隔缺损、行体肺动脉侧支血管封堵患者10例,其他适合应用ADO II封堵的患者4例.28例患者未发生与股动脉穿刺有关的并发症、溶血和血栓栓塞并发症,无死亡病例.结论:ADO II形态小、可控性好,容易输送,对血管损伤小,适用于小型膜部室间隔缺损、粗大迂曲体肺侧支血管及一些少见的结构性心脏病,封堵安全、有效.

Objective: Transcatheter closure is usually contraindicated in secundum atrial septal defect with no rim to right pulmonary vein. The morphology of an atrial septal defect is special in these patients, and the off-label use of a duct occluder might make transcatheter closure possible with the assistance of a personalized heart model. However, the related data are absent. This study was performed to investigate the off-label use of a duct occluder in the transcatheter closure of an atrial septal defect with no right pulmonary vein rim. Methods: Seven consecutive patients with an atrial septal defect (2 male/5 female; 40.1 +/- 15.2 years) with no right pulmonary vein rim were referred for attempted transcatheter closure, and a personalized heart model was produced on the basis of multislice computed tomography images. With the elastic heart model, in vitro trial occlusion was performed with a duct occluder for preoperative evaluation, and the results were compared with postoperative outcomes. Results: A single atrial septal defect was identified in 6 patients, and a double atrial septal defect was identified in another patient (1 atrial septal defect with no right pulmonary vein rim and 1 with sufficient surrounding rims). The size of the atrial septal defect was 13.4 +/- 2.2 mm, and the in vitro balloon-stretched diameter was 20.2 +/- 3.2 mm in the heart model. In vitro trial occlusion was achieved in all patients, and subsequent in vivo transcatheter closure was performed successfully with the duct occluder of the same size (24.3 +/- 3.1 mm). During follow-up (1.57 +/- 0.84 years), mild pericardial effusion was identified in 2 patients and disappeared within 3 months. No other complications occurred. Conclusions: By using a personalized heart model, the off-label use of a duct occluder is feasible and safe in the transcatheter closure of an atrial septal defect with no right pulmonary vein rim. Further research is required to evaluate the long-term outcomes.

目的 分析总结经皮肺动脉瓣球囊扩张术(PBPV)单中心临床应用30年治疗肺动脉瓣狭窄的临床价值及疗效.方法 1986年4月至2016年4月阜外医院共完成1229例PBPV,对其中临床资料完整的655例患者进行了6个月及以上的有效随访,随访时间为0.5～11.5年,平均(2.6±1.3)年,主要随访包括电话随访及门诊随访(以复查超声心动图为主).结果 1229例患者术后即刻导管测量的跨瓣压差(PG)由术前(74.40±29.64)mmHg下降至(25.05±8.62)mmHg,下降明显(P<0.001),最后1次随访时超声心动图测量的平均PG维持在(21.91±17.22)mmHg.PBPV成功率达到98.5％(1211/1229),发生术中及围术期死亡3例(死亡率0.2％),其他严重并发症(包括三尖瓣腱索断裂、肺动脉瓣重度反流)发生率为0.4％(5/1229).超声心动图随访中3.1％(20/655)肺动脉瓣反流程度较术后24 h有所增加,再狭窄发生率为1.1％(7/655).结论 30年的临床应用经验表明PBPV作为一种主要治疗单纯性肺动脉瓣狭窄的介入技术,其总体近、中、远期疗效满意,并发症发生率低,可作为一项瓣膜病微创治疗时代的主流技术继续应用于临床.

BACKGROUND The aim of this study was to compare early and long-term results of eversion carotid endarterectomy (e-CEA) and patch carotid endarterectomy (p-CEA). MATERIAL AND METHODS In a retrospective study, we collected data on 441 patients who underwent CEA (e-CEA=211 vs. p-CEA=230) between October 2009 and October 2015 at our institute. Economic costs, postoperative hospital days, use of shunts and antibiotics, early (30-day) complications, long-term restenosis, and mortality rates were compared between groups during 4 to 76 months of follow-up. RESULTS Patients in the p-CEA group had a significantly higher percentage of antibiotic use (58.3% vs. 27%, respectively; P0.05). Long-term complication, including stroke or heart attack, recurrent stenosis rate, and mortality rate, showed no difference between the 2 groups (all P>0.05). Kaplan-Meier analysis shows that the recurrent stenosis-free and survival rates were not significantly different between the 2 groups (P=0.867, P=0.177, respectively). CONCLUSIONS The adverse event rates of perioperative and long-term follow-up showed no significant difference between the e-CEA and p-CEA groups. Both e-CEA and p-CEA are effective for carotid artery stenosis.

BACKGROUND:Limited data have reported the outcomes of percutaneous closure of patent ductus arteriosus (PDA) in patients with unilateral absence of pulmonary artery (UAPA). This study aimed to evaluate the symptomatology, diagnosis and therapy, especially the transcatheter closure of PDA in patients with PDA associated with UAPA.MATERIALS AND METHODS:Patients diagnosed with PDA and UAPA were retrospectively enrolled from August 2010 through January 2016. Clinical data, treatment and follow-up information were evaluated.RESULTS:Thirteen patients (6 males and 7 females) were diagnosed with PDA associated with UAPA. Percutaneous closure was successfully conducted in 6 patients successfully. The median age was 7 years (7 months to 37 years). The mean diameter of the PDA and occluders were 4.7 ± 1.8mm (2-7mm) and 11.3 ± 3.9mm (6-14mm), respectively. The mean pulmonary artery pressure was 41.5 ± 13.5mmHg (25-62mmHg). The diameter of PDA has no relationship with the degree of pulmonary artery pressure (r = 0.239, P = 0.648). In 4 patients, systolic pulmonary arterial pressure decreased significantly after closure with 69.0 ± 10.7 versus 48.0 ± 11.3mmHg (P = 0.146), and also the mean pulmonary arterial pressure was 54.5 ± 5.7 mm Hg versus 30.5 ± 3.9mmHg (P = 0.04). In all, 1 patient had a trace residual shunt, which disappeared within 24 hours.CONCLUSIONS:In appropriate patients with PDA associated with UAPA, transcatheter closure of PDA has the potential to improve the pulmonary artery hypertension. Further follow-up is required to monitor the long-term outcomes.

Objective: To explore the short and mid-term efficacy of device closure of patent foramen ovale (PFO) for treating the patients with PFO combining cryptogenic stroke (CS) and transient ischemic attack (TIA). Methods: A total of 56 PFO patients with CS and TIA receiving device closure in our hospital from 2009-05 to 2015-12 were retrospectively studied. Transthoracic echocardiography (TTE), electrocardiogram (ECG), chest X-ray were examined at 24h, 1 month, 3 and 6 months after theoperation; telephone visit was conducted every 6 months thereafter. Results: There were 54/56 PFO patients combining CS and 2 combining TIA; 53 (94.6%)patients received PFO occluder from Starway medical technology. Aspirin was used for 6 months after the operation. The patients were followed-up for the average of (34.67±23.24) months. No body suffered from post-operative stroke and TIA; no residual shunt was observed. Conclusion: The short and mid-term efficacy of device closure has been satisfactory for treating the patients with PFO combining CS and TIA; its overall clinical value should be further investigated in large population and long-term study.

目的：先天性单侧肺动脉缺如是一种极为少见先天性心血管疾病，其常合并其他心血管畸形包括法乐四联症、间隔缺损、主动脉缩窄等等。合并动脉导管未闭时，一侧肺动脉同时接受来自肺循环和体循环双重供血，故往往伴有不同程度的肺动脉高压。本研究旨在探讨该类患者的临床诊断经验及经导管介入封堵动脉导管未闭在的时机及有效性。

Right pulmonary artery-left atrial fistula is a rare congenitalcardiac anomaly, and only a few articles published so far have reported the diagnosis and treatment of right pulmonary artery-left atrial fistula. In this study, we report three cases of successful transcatheter closure or surgical repair of right pulmonary artery-left atrial fistula.

1病例资料患者,男,52岁。因"发作性胸闷、胸痛、气短5年"入院。患者5年前无明显诱因出现胸闷、胸痛、气短,活动时发作,休息后可好转。2年前查超声心动图:先天性心脏病,房间隔缺损（ASD）,未治疗。2014年3月外院行冠状动脉（冠脉）造影示:冠脉未见异常。无其他病史。入院体检:BP:120/80mmHg（1mmHg=0.133kPa）,T:36.7℃,神志清楚,精神尚可,双肺呼吸音清,心率:80次/min,律齐,