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经胸微创膜部室间隔缺损封堵术围术期炎症因子的变化

先天性心脏病介入治疗48例

目的 总结对先天性心脏病患者行介入治疗的临床经验，以提高介入治疗的成功率。 方法 48例先天性心脏病患者采用Cardiacure-TM封堵器行介入治疗，其中房间隔缺损（ASD）21例，动脉导管未闭（PDA）12例，室间隔缺损（VSD）12例，ASD合并PDA 1例，VSD合并PDA 2例。 结果 全组患者无死亡，一次性封堵成功44例，介入封堵治疗成功率为91.7％（44/48）;15例次 PDA患者介入封堵治疗成功率为100％（15/15）; 22例次ASD患者成功率为90.9%（20/22）, 14例次VSD患者成功率为85.7％（12/14）。 封堵伞于术中脱落3例，其中ASD伞脱落2例，VSD伞脱落1例；介入治疗未成功1例。4例封堵未成功的患者中3例择期行体外循环修补手术治愈，1例行急诊体外循环修补手术治愈。随访40例，随访时间1~19个月，复查心脏杂音消失，心脏彩色超声心动图提示无残余分流。 结论 介入治疗是治疗先天性心脏病的有效方法，心胸外科医师掌握该项技术有其较多的优势。

Perventricular Closure of Atrial Septal Defect and Ventricular Septal Defect Through a Single Port: The Initial Experience

目的评价单穿刺点经胸微创封堵治疗房间隔缺损（ASD）合并室间隔缺损（VSD）的安全性及有效性。 方法纳入2014年6月至2015年8月于我院成功完成单穿刺点经胸微创封堵术治疗ASD合并VSD的8例患儿，分析患儿在术后第l个月、3个月、6个月的门诊随访资料。观察围术期及随访期间患者残余分流、瓣膜反流、心律失常等并发症发生情况。 结果8例患儿中，术后早期均无残余分流、心律失常，微量三尖瓣反流（TR）患者1例（12.5%）。平均随访时间5～9（6±2）个月，各瓣膜均未发现中度及以上反流，未发现存在血栓、严重心律失常、死亡的患者。 结论单穿刺点经胸微创封堵治疗ASD合并VSD安全、有效，且更为微创。

Comparative study of surgical and interventional closure for the treatment of patent ductus arteriosus in children

ObjectiveTo study effect of different surgical treatments for patent ductus arteriosus in children.MethodA total of 38 patients with patent ductus arteriosus who underwent surgical treatment of cardiothoracic surgery between January 2016 and December 2017 in our hospital were as an observation group (12 patients with severing suture, 26 patients with ligation, 14 males and 24 females, aged 0.08–8.67 years). In the same period, 38 patients with patent ductus arteriosus who underwent interventional closure in the Department of Cardiology were as a control group (17 males and 21 females, aged 0.50–5.42 years). The clinical effectiveness of the two groups was compared.ResultsThe operation time, postoperative hospital stay, and blood transfusion rate in the observation group were higher than those in the control group with statistical differences (P<0.05). There was no statistical difference in intraoperative blood loss and complications between the two groups.ConclusionsIn patients with a single patent ductus arteriosus or a small catheter, interventional closure of the patent ductus arteriosus is less trauma and faster recovery. But in patients with lower weigh, premature, other intracardiac malformations, large catheter, moderate or severe pulmonary hypertension, the surgery is better.

Transcatheter closure of congenital heart disease under the guidance of transthoracic echocardiography

Objective To explore the feasibility of transcatheter closure of congenital heart disease (CHD) under the guidance of transthoracic echocardiography (TTE). Methods A total of 37 patients with CHD who received transcatheter closure under the guidance of transthoracic echocardiography from November 2013 through November 2015 in our hospital were recruited. There were 15 males and 22 females, aged 1 to 16 years. Among them 32 patients suffered atrial septal defect and 5 patients had patent ductus arteriosus. The transcatheter closure of CHD was performed under the guidance of TTE. The patients underwent echocardiography follow-up at one, three and six months after surgery. Results Closure devices were successfully implanted in 37 patients under TTE guidance. The procedure was simple and safe. During the follow-up, no severe complication such as valvular injury, pericardial effusion, residual shunt and peripheral vascular injury occurred. Conclusion Transcatheter closure of CHD under TTE guidance is a feasible method and worth further clinical application.

食管超声心动图监测下经胸微创房间隔缺损封堵术

目的评价经食管超声心动图（TEE）监测经胸微创房间隔缺损（ASD）封堵术的临床价值。方法本组16例ASD患者术前均经胸超声心动图检查粗筛，符合封堵条件后在全身麻醉下插入经食管超声探头，于手术开始前，根据ASD最大直径选择合适的封堵器。在手术开始后，监测整个封堵过程，引导封堵伞的放置，评价即刻封堵效果，确认是否有残余分流或并发症。结果16例患者中15例封堵成功，TEE显示封堵器与ASD边缘吻合紧密，无残余分流；1例直径31mm的ASD患者，封堵器放置后发现其后下缘存在残余分流，随即改行体外循环ASD修补术。随访3个月，效果满意。结论TEE对选择适合行封堵术的的ASD患者、选择封堵器大小、指导封堵器的释放、以及疗效评价均具有重要的作用。

Research progress on left atrial appendage occlusion for the treatment of atrial fibrillation combined with chronic kidney disease

Patients with atrial fibrillation complicated with kidney disease have a high risk of stroke and bleeding, and have some limitations or contraindications to oral anticoagulants. Left atrial appendage closure has been used as an alternative to oral anticoagulation in patients with atrial fibrillation, but its efficacy and safety in patients with atrial fibrillation and chronic kidney disease need to be further confirmed. This paper intends to review the research progress of left atrial appendage occlusion in patients with atrial fibrillation complicated with chronic renal insufficiency.

Feasibility of Blocking Congenital Ventricular Septal Defect or Congenital Atrial Septal Defect through Right Subaxillary Incision

ObjectiveTo evaluate the feasibility and safety of blocking congenital ventricular septal defect or congenital atrial septal defect through the small vertical incision of right subaxillary. MethodsWe retrospectively analyzed the clinical data of 38 patients underwent the surgery of blocking congenital ventricular septal defect or congenital atrial septal defect in our hospital from January to August 2015. There were 22 males and 16 females with a mean age of 10.3±5.2 months, weight of 8.2±3.5 kg. ResultsThere were 34 patients (89.5%) successfully blocked through the small vertical cut of right subaxillary. The average blood loss of those 34 patients was 19.5±13.4 ml and the mean time of surgery was 58.4±28.5 minutes. Four patients (10.5%) with ventricular septal defect failed to block because of aortic valve prolapse. Those patients underwent direct repair of ventricular septal defect under extracorporeal circulation while general anesthesia. There was no serious adverse event during the surgery. The extubation time was 3.9±1.6 hours, the ICU monitoring time was 1.8±0.8 days and the hospital stay time was 3.2±0.5 days. All patients discharged uneventfully. ConclusionBlocking congenital ventricular septal defect or congenital atrial septal defect through the cut of right subaxillary is a feasible, effective, safe, and minimally invasive method. The effect of early follow-up is well.

“一站式”经导管主动脉瓣置换术联合左心耳封堵术一例

Efficacy of transthoracic device closure versus surgical closure on ventricular septal defects: A systematic review and meta-analysis

Objective To compare the effects of transthoracic device closure and surgical closure on ventricular septal defect systemically. Methods A systematic literature search was conducted using the PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBM, Chinese Clinical Trial Register, ClinicalTrials. gov and Wanfang Database up to July 31, 2016. Quality was assessed and data of included articles were extracted. The meta-analysis was conducted using RevMan 5.0 and Stata 14.0 software. Results Eleven studies were identified, including 5 RCTs and 6 cohort studies involving 2 504 patients. For success rate, there was no statistical difference between the transthoracic closure group and the surgical closure group in RCT (RR=0.99, 95%CI 0.96 to 1.03, P=0.70); the success rate in the transthoracic closure group was lower than that in the surgical closure group in the cohort study (OR=0.21, 95%CI 0.08 to 0.55, P=0.002). Both results of RCTs and cohort studies showed that compared with surgical closure, transthoracic device closure reduced duration of the operation (RCT MD=–79.38, 95%CI –95.00 to –63.76, P<0.000 01; cohort studyMD=–66.26, 95%CI –71.20 to –61.31, P<0.000 01) and hospital stay (RCTMD=–2.10, 95%CI –2.65 to –1.55, P<0.000 01; cohort studyMD=–3.99, 95%CI –6.03 to –1.94, P=0.000 1), and the patients with blood transfusion (RCT RR= 0.04, 95%CI 0.01 to 0.11, P<0.000 01; cohort studyOR=0.01, 95%CI 0.00 to 0.13, P=0.001). In the transthoracic closure group the risk of postoperative arrhythmia reduced (RCT RR=0.20, 95%CI 0.13 to 0.32, P<0.000 01; cohort studyOR=0.46, 95%CI 0.31 to 0.67, P<0.000 1). In the transthoracic closure group a higher postoperative valvular regurgitation risk in RCT induced (RR=1.45, 95%CI 1.07 to 1.96, P=0.02) and the rate of postoperative valvular regurgitation in cohort study reduced (OR=0.43, 95%CI 0.20 to 0.92, P=0.03). However, there was no statistical difference in postoperative residual shunt (RCT RR=0.96, 95%CI 0.57 to 1.62, P=0.89; cohort study OR=0.52, 95%CI 0.12 to 2.25, P=0.38). Conclusion Transthoracic device closure can shorten duration of the operation, hospital stay and reduce the patients with blood transfusion and post- and intraoperative arrhythmia risk. Therefore, transthoracic device closure may be a better approach for some ventricular septal defect patients.