Background: There is limited experience about transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder. Methods: Between March, 2015 and July, 2017, a total of 22 patients with doubly committed subarterial ventricular septal defects received transcatheter closure using Amplatzer ductal occluder and underwent clinical follow-up for at least 6 months. Results: Device implantation was finally successful in 21 (95.4%) patients despite failed occlusion in one patient and intra-procedural replacement of unsuitable occluders in four (19.0%) patients. In mean 12.3 months of follow-up, there were no major complications (death, aortic valve or sinus rupture, device dislocation or embolisation, grade 2 new-onset aortic regurgitation, etc.), resulting in clinical occlusion success of 95.4%. Mechanical haemolysis occurred in one patient and resolved with medication. Residual shunt was observed in 11 (52.4%) patients (9 mild, 2 moderate-severe) post-procedurally, 14 (66.7%) patients (12 mild, 2 moderate-severe) in hospital stay, and 2 (9.5%) patients (2 mild, 0 moderate-severe) at the last follow-up. Device-induced new-onset aortic regurgitation was found in nine (42.8%) patients (9 mild, 0 moderate-severe) post-procedurally and in hospital stay, which was resolved in two (9.5%) patients and unchanged in seven (33.3%) patients at the last follow-up. Another four (19.0%) patients newly developed mild aortic regurgitation during follow-up. Conclusions: Transcatheter closure of doubly committed subarterial ventricular septal defects with Amplatzer ductal occluder is technically feasible in the selected patients. However, further study is needed to confirm its long-term clinical outcomes.

Objective To investigate the feasibility and safety of modified percutaneous left atrial appendage occlusion (PLAAO) under transthoracic echocardiographic (TTE) guidance without general anesthesia instead of transesophageal echocardiographic guidance.Methods A total of 14 patients who met the inclusion criteria underwent modified PLAAO guided by TTE instead of TEE without general anesthesia.Regular clinical follow-up observations of PLAAO-related major adverse events were done in the perioperative period.Results All patients were successfully implanted with left atrial appendage occluder device (Watchman) without device-related serious complications.Immediately occlusion success rate was 100％.No major adverse events occurred during hospitalization and follow-up.The mean operation time was 108 ± 22 min(range 75-150 min)and the mean radiation exposure time was 15.8 ± 7.6 min(range 8-32 min).Conclusion Modified PLAAO guided by TTE instead of TEE without general anesthesia may be safe and effective.This method simplifies the operation process and is favorable for PLAAO application.But this modified PLAAO is still needed to be validated in more patients.

The 53-year-old women suffered from palpitation and polypnea in the last three months with persist atrial fibrillation and cardiac insufficiency associated with dilated cardiomyopathy.Her LAA was successfully closed by using a watchman occluder.

OBJECTIVE:To explore the value of serum neuron-specific enolase (NSE) before treatment in predicting brain metastases and prognosis of advanced non-small cell lung cancer (NSCLC).METHODS:A total of 128 hospitalized patients with advanced NSCLC from Jan 2012 to Mar 2012 were followed up, and their clinicopathological data, serum NSE, carcinoembryonic antigen, cytokeratin 21-1 (cyfra21-1) levels, albumin (ALB), white blood cell (WBC) before treatment were analyzed retrospectively to determine the factors affecting brain metastasis and prognosis of advanced NSCLC.RESULTS:Among the 128 NSCLC patients, 90 cases were of adenocarcinoma, 30 cases were of squamous cell carcinoma, and 8 cases were of large cell carcinoma. The median levels of pre-treatment NSE, CEA and cyfra21-1 were 13.6 ng/ml, 7.8 ng/ml and 6.1 ng/ml, respectively. The average levels of ALB and WBC were (35.41 ± 5.60) g/L and (8.16 ± 2.53) × 10⁹/ml, respectively. Multi-variate logistic regression analysis showed that serum NSE before treatment was associated with brain metastasis of advanced NSCLC (P = 0.030). Pre-treatment NSE levels were (34.18 ± 28.48) ng/ml in 28 patients with brain metastasis and (13.87 ± 4.49) ng/ml in 98 patients without brain metastasis (P < 0.05). The median survival time were 3.5 months in patients with normal levels of NSE, and 10.7 months in patients with elevated levels of NSE pre-treatment (P < 0.05).CONCLUSIONS:A higher pre-treatment level of NSE is closely correlated with brain metastasis of advanced NSCLC, and can be used as a predictor of brain metastases in advanced NSCLC. High pre-treatment levels of NSE indicate a poor prognosis in advanced NSCLC patients.

The conventional transcatheter closure of patent ductus arteriosus (PDA) requires femoral artery puncture and angiography for duct anatomic and shunting estimation. If such estimation can be replaced by transthoracic echocardiography (TTE), the procedure will be further simplified, with fewer invasions. This study aimed to examine whether TTE can serve as an alternative to aorta angiography and as a major guidance for transcatheter duct closure. The study enrolled 298 consecutive patients (71 males and 227 females) with PDA. In the study, TTE with combined two-dimensional echocardiography (2DE) imaging and color-coded flow imaging (CDFI) was performed to measure the minimal shunting width (MSW) as the estimated minimal duct size for selection of an Amplatzer duct occluder (ADO) and to monitor the transcatheter duct closure intraprocedurally. The MSW was validated against the duct-stretched diameter (SDD), against the minimal waist diameter of the conical part of a released occluder measured by X-ray spot picture after successful duct closure (SDC), and against the size of the finally used ADO (SADO). Good correlation was found between MSW and SDD [SDD (mm) = 1.31 MSW; r = 0.89; p < 0.01] and between MSW and SADO [SADO (mm) = 1.71 MSW; r = 0.88; p < 0.01]. Of 296 patients who received occlusion using MSW as the reference for selection of the occluder, SDC was attained in 288 (97.3%), 5 (1.7%), and 2 (0.7%) patients, respectively, at the first, second (1 ADO replacement), and third (2 ADO replacements) occluding attempt. Acute occluder dislodgement occurred in one patient (0.3%). At the 12-month follow-up assessment, no major complications were found, and the total immediate or 12-month SDC was 99.7%. Echocardiography as an alternative major guidance to angiography for transcatheter duct closure is technically feasible, and TTE guidance can further simplify the procedure, with fewer invasions and potential complications.

目的:总结急性重症心肌炎(AFM)的临床特征与治疗策略.方法:对我院2005-08-2013-02收治的30例AFM患者的临床资料进行回顾性分析.结果:30例患者中,10例治愈,14例好转,6例死亡.6例急性期死亡患者均在入院后48 h内死亡,并伴有心源性休克.结论:AFM的早期诊断和治疗极具挑战性.中老年患者心电图酷似心肌梗死样改变,极易误诊,超声心动图在纠正误诊中具有重要价值.早期冠状动脉造影同样十分重要.一旦确诊,应积极采取综合治疗,及时给予机械辅助治疗将显著改善预后.

Transcatheter device closure (TCDC) and intraoperative device closure (IODC) have emerged as minimally invasive methods in the treatment of secundum atrial septal defects (ASDs), but the long‐term safety and efficacy remains uncertain for the large ASDs.

Objective To evaluate the safety and feasibility of transulnar catheterization for routine diagnostic and therapeutic coronary interventions. Methods and Results 36 patients underwent transulnar catheterization were chosen between February 2007 and December 2008 in our hospital. The success rate of operation, X-ray exposure time, incidence of entry site complications and major adverse cardiovascular events in hospital were analyzed. Results The success rate of operation was 100%, X-ray exposure time was 5.3±2.2 mins in coronary angiographic patients and 16.3±8. 2 mins in therapeutic coronary interventional patients, there was no entry site complication and major adverse cardiovascular event in hospital. Conclusion Transulnar artery approach is safe and feasible for routine diagnostic and therapeutic coronary interventions.

Objective:To explore the security and feasibility of 5F guiding catheter for percutaneous coronary intervention(PCI) by radial artery.Methods:A total of 102 patients underwent PCI by radial artery were randomly divided to group A (treated with 6F guiding catheter,n=54) and group B (treated with 5F guiding catheter,n=48) according to the size of guiding catheter.The success rate of operation,incidence of entry site complications and adverse cardiovascular events in hospital major were compared between the two groups.Results:Higher incidence of entry site complications was documented in A group when compared with B group (P0.01),there were no differences in the success rate of operation and major adverse cardiovascular events in hospital(P0.05).Conclusion:Percutaneous coronary intervention by radial artery with 5F guiding catheter reduces incidence of entry site complications,is safe and feasible.

BACKGROUND As a kind of sirolimus-eluting stent (SES) made in China, Firebird SES is more effective than bare metal stent (BMS) and not inferior to Cypher SES for short coronary lesions in terms of reduction of restenosis and revascularization. However, Firebird SES does not show any benefits in patients with a very long coronary lesion (VLCL). The present study was undertaken to evaluate the safety and efficacy of Firebird SES for VLCL by comparison of Cypher SES and BMS. METHODS In this prospective, nonrandomized and comparative study, eligible patients with de novo coronary lesion (> or = 30 mm) between January 2005 and June 2006 were allocated into Firebird SES group, Cypher SES group or BMS group. They were subjected to an angiographic follow-up of 6 months and a clinical follow-up of 12 months. The primary endpoints constitute the in-stent and in-segment restenosis rates at 6 months. The secondary endpoint was defined as a major adverse cardiovascular event (MACE) that was a 12-month combined endpoint of all-cause deaths, reinfarction or in-stent thrombosis, and target-lesion revascularization. The 12-month in-stent thrombosis was also evaluated to address the safety of Firebird SES implantation exceptionally. RESULTS A total of 468 patients were assessed for eligibility. Of 113 patients who were finally included according to the prior inclusion and exclusion criteria, 39 (41 lesions) were treated with Firebird SES, 37 (39 lesions) with Cypher SES, and 37 (37 lesions) with BMS. There were no significant differences in the baseline characteristics between the three groups; but there were longer lesions, more frequent use of overlapping stent in the Firebird SES group and the Cypher SES group. Angiographic follow-up showed that the rates of binary stenosis were similar between the Firebird SES group and the Cypher SES group (in-segment: 14.6% vs 12.8%, relative risk (RR) 1.14, P = 0.81; in-stent: 9.8% vs 10.3%, RR 0.95, P = 0.94), and significantly lower than those in the BMS group (in-segment: vs. 36.1%, RR 0.41 or 0.36, P = 0.04 or 0.03, respectively; in-stent: vs 30.6%, RR 0.32 or 0.34, P = 0.03 or 0.04, respectively). The total MACE rate up to 12 months was also similar in both SES groups (7.7% vs 5.4%, P = 1.000), and significantly lower than that in the BMS group (27.0%, P = 0.034 or 0.024, respectively). The in-stent thrombosis rate in the follow-up period was 2.6% in the Firebird SES group, not higher in the Cypher SES and BMS groups (2.7% and 2.7%, respectively, P = 1.000). CONCLUSIONS In the treatment of VLCL, Firebird SES would be safer and more effective than BMS. Firebird SES may be not inferior to Cypher SES in terms of restenosis and MACE.

Objective:To monitor the alteration of residual shunts by using two-dimensional echocardiography (2DE) and color-coded Doppler flow imaging(CDFI) during trans-catheter closure of patent ductus arteriosus (PDA ) with Amplatzer duct occluders, and to discus its clinical significance.Methods:The 102 consecutive patients underwent trans-catheter closing PDA and had bed-side echocardiography monitoring for the residual shunting, among whom aged at 1~63,average(9.2±8.2 ) years, and the minimal diameter and the length of PDA measured by echocardiograph were (6.1±1.9) mm and (10.0±2.5) mm, respectively. 2DE and CDFI were performed to monitor the types, the ratios and the width of residual shunts immediately, and every 5 min for 30 min following well-positioning occluders into PDA.Results:(1)Immediately after well-positioning occluders, nineteen patients(18.6%) had no residual shunts, eighty-three (81.4%) had residual stunts in which CDFI detected 41 central and 133 marginal residual shunts(102 shunts of 2mm, 31 shunts of ≥2mm in width);(2) CDFI monitoring revealed that all the central residual shunts quickly disappeared in 10~15 min; 95% the marginal shunts with the width of 2mm dissolved automatically in 25 min, only 6% the marginal shunts with the width of ≥2mm dissolved automatically in 30 min, and another 94% this shunts did not remarkably change in shunting size.At the end of 30 min monitoring, the marginal residual shunts remained 5% and 94%, respectively, when the initiate shunting width was 2mm and ≥2mm (P0.001).Conclusion:Echocardiography for monitoring the alteration of residual shunts during trans-catheter closure of PDA is technically simple and feasible, an alternative for aorta-angiograpgy; and the occluders should be replaced when the marginal shunting was ≥2mm and/or lasting for more than 30 min.

目的观察冠状动脉分叉病变经皮冠状动脉介入治疗(PCI)后分支血管病变程度变化,探讨分叉病变PCI中较简单的边支血管处理策略可行性及临床意义。方法病例入选条件:①各类分叉病变;②主支植入支架,边支不植入支架,除非≥2 mm血管在主支PCI后发生闭塞:③分支血管开口在主支支架后受压≥50％且直径≥2 mm者则采用球囊对吻,否则不行球囊对吻:④所有患者均使用药物洗脱支架(包括CYPHER、TAXUS、FIREBIRD及PARTNER)。符合上述条件的患者98例,男性67例、女性31例,平均年龄63．3岁。对上述患者进行定期临床随访及冠状动脉造影,以QCA测量分支开口直径狭窄率(DSR)、最小血管内径(uLD),并进行TIMl分级。结果本组采用和不用球囊对吻者分别为29例(30％)和69例(70％);主支支架植入后7例(7％)发生分支血管闭塞,3例经球囊对吻后恢复TIMI3级血流,其余4例因分支血管较小未做进一步处理。6个月和12个月随访期间MACE(均为心绞痛)累计发生率分别10％和25％。PCI术前(n=98)、术后即刻(n=98)、术后6个月(n=76)和术后12个月(17=45)分支血管开口MLD分别为(1．91±0．5)、(1．3±0．6)、(1．2±0．6)和(1．4±0．6)mm;DSR分别为45．1%10．3％、66．8%±16．5％、67．2%±16．1％和67．6％±13．8％;TIMI血流分别为2．8±0．4、2．5±0．6、2．5±0．3和2．4±0．6。统计分析显示,MLD、DSR和TIMI血流分级在PCI术前与术后各随访阶段差异有统计学意义,但术后即刻与术后6个月及12个月随访时差异无统计学意义。结论分叉病变PCI时不必对边支血管尤其直径小于2 mm者采取激进的处理策略:简单处理策略可降低PCI的难度．确保主支血管PCI术顺利完成,增加治疗效果-费用比。

目的在房间隔缺损(ASD)及室间隔缺损(VSD)导管封堵治疗过程中,观察常规量肝素抗凝是否足以阻止导管相关性血栓形成(CARTH),探讨优化抗栓方案可否有效防止CARTH。方法将142例ASD及VSD患者分成两组:A组82例,男51例,女31例,中位年龄为21岁,为2004年6月前导管封堵病例,术中采用常规抗凝即肝素100 U／kg,术程超过1 h者追加肝素1 000 U／h;B组60例,男38例,女22例,中位年龄为22岁,为2004年6月后导管封堵病例,术中采用优化抗凝方案,即肝素150 U／kg,术程超过1 h者追加肝素1 000 U／h,术中用肝素0．9％NaCL溶液充满输送导管并防止血液逆流。术中应用超声心动图检测心腔内异常条索状血栓回声的发生率(THR)及长度(THL),术后检测输送导管及输送杆上附着的血栓体积(THV)。结果两组年龄、性别、疾病构成比例(ASD／VSD)、两组所使用的输送导管大小的操作时间的差异无统计学意义(P值均>0．05)。A组和B组THR分别为11．0％和1．7％,THL分别为(0．34±1．03) cm和(0．02±0．15) cm,两组THR和THL的差异均有统计学意义(P值均<0．01)。A组和B组THV分别为(0．84±1．51)和(0．08±0．31) mm3,两组的差异有统计学意义(P值均<0．01)。A组CARTH的发生率及其大小均高于B组,但术中两组均未发生血栓栓塞临床事件。结论在ASD和VSD导管封堵治疗过程中,常规量肝素抗凝不能完全阻止CARTH,强化抗栓方案可较有效地防止其发生,从而减少潜在的血栓栓塞危险。

目的探讨慢性完全闭塞性病变(CTO)病变术前远端血管血流状态对PCI术后临床症状及心功能的影响。方法病例入选条件:完全性血管闭塞;闭塞时间≥1个月;PCI达到造影成功标准;应用药物洗脱支架。符合上述条件的患者89例,男性59例,女性30例,年龄40- 79岁。病变血管分布:左主干病变2例、LAD病变39例、LCX病变16例、RCA病变24例、LAD+RCA病变5例、LAD+LCX病变3例。将上述患者分成: A组24例,CTO远端血管床前向或逆向血流正常或接近正常。B组42例,CTO远端血管床前向或逆向血流减少。C组23例,CTO远端血管床前向或逆向血流显著减少或几乎无血流。三组年龄、性别及病变血管分布差异无统计学意义。PCI后随访半年,分别应用CCS标准进行心绞痛分级(CCSS)、NYHA标准进行心功能分级(NYHAS)、二维超声心动图评价左室射血分数(EF),并评估累计主要不良心血管事件[(MACE),包括非致死心肌梗死、靶血管再次PCI或CABG、心血管死亡]的发生率。结果三组PCI术前后比较:CCSS分别为3．0±0．4和1．5±0．2(P<0．01)、3．5±0．6和1．9±0．5(P<0．01)、1．8±0．6和1．6±0．4(P>0．05)。NYHAS分别为2．6±0．3和1．5±0．4(P<0．01)、3．0±0．9和2．0±0．3(P<0．01)、2．8±0．5和2．6±0．6(P>0．05)。EF分别为45．5％±9．9％和50．9％±10．5％(P<0．01)、44．8％±9．6％和46．3％±8．5％(P<0．01)、39．1％±10．2％和40．2％±11．1％(P>0．05)。MACE分别为4．2％、7．1％和13．0％(P>0．05)。结论CTO病变PCI术对缓解心绞痛及改善心功能的疗效取决于PCI前远端血管床的血流状态及存活心肌的数量。

探讨在二维超声心动图(2DE)及彩色多普勒血流显像(CDFI)引导下、不需股动脉穿刺及主动脉造影的改良动脉导管未闭(PDA)导管封堵法的可行性及安全性.