Standard Study On Technical Regulation Of Interventional Therapy Of Common Congenital Heart Disease And Valve Disease,Long-term Effect And Clinical Application Of New Technologies

Part one:Standard study on technical regulation of interventional therapy of common congenital heart disease and valve diease,long-term effect and clinical application of new technologiesBcakground and ObjectiveWith advance in technology,transcatheter interventional therapy for congenital heart dieases is in a rapid development stage,the number of interventional cases in our country increased rapidly year by year.This study is in order to evaluate the clinical efficiency and safety of transcatheter interventional therapy for common congenital heart dieases(including ASD,VSD,PDA,PS) and valve dieases,assess effects of intervention in short-time,medium-time and long-time follow up,at the same time,we study on clinical application of new technologies and new materials in interventional therapy for congenital heart dieases, accumulate clinical datas for guidelines of transcatheter interventional therapy for congenital heart dieases and valve dieases.Material and methodsOne hundred and seven consecutive patients who underwent transcatheter interventional therapy from May.2009 to Aug.2009 were including in this study,including 55 patients with ASD,26 patients with VSD,19 patients with PDA,4 patients with PS,3 patients with MS.We selected personalized interventional protocol for each patient,and focused on clinical effects and complications of intervention.We studied changes about TTE variations preoperatively and postperatively(24 hours,1 month,3 months,6 months after the procedure),for to understand effects of the operations on cardiac structural remodeling and hemodynamics,and observed clinical efficiency and safety of new technologies and new materials.TTE test include distance of VSD to SVC,IVC,AV,MV;distance of VSD to AV,MV;valve regurgitation;LVDd,RADtr,LVEF,LADap,PVG,MVG,MVA,PASP and other datas.ResultsIn 55 patients with ASD,ASD was closed successfully in 53 patients(technique success rate:96.36%), one patient's occluder droped after operation,we retrieved occluder and replaced another occluder successfully. severe complicatioms was happened on 2 paytients.In 26 patients with VSD,VSD was closed successfully in 25 patients(technique success rate:96.15%),without any severe complications such as A-V block, severe complicatioms was happened on one patients.In 19 patients with PDA, PDA was closed successfully in 19 patients(technique success rate: 100%),including 3 patients with huge PDA, severe complicatioms was happened on one patients.In 4patients with PS, pressu re gradient across the pulmonary valve decreased immediately after PBPV,cardiac functions and clinical symptoms of patients improved.In 3 patients with MS, cardiac functions and clinical symptoms of 2 patients improved after PBMV,mitral valve area of three patients was enlarged in different level. After procedure,heart chamber diameter of all patients diminished and cardiac structural remodeling improved,the PASP decreased,result in improving global cardiac functions. The greatest change of datas in each group happened 24 hours after operation,there has statistic significance between 24 hours postoperatively and preoperatively.ConclusionsIn the patients selected, transcatheter interventional therapy for congenital heart dieases and valve dieases is safe and effective,short-time and medium-time follow up show great outcome.Intervention has some complications,including severe complications,so we need to control indication strictly,procedure must be correct and standard,these procedure must be taken in major medical center.Part two:Interventional therapy of atrial septal aneurysm associated with secondum atrial septal defectBcakground and Objectiveatrial septal aneurysm associated with secondum atrial septal defect is specific field in intervention of ASD. This study is designed for evaluating the safety and efficiency of transactheter closure of atrial septal aneurysm(ASA) associated with secoundum atrial septal defect (ASD).Material and methodswe investigated 19 patients,aged from 20-72(average:43±14.9) years old. All patients were diagnosed of ASA associated with ASD by physical examination, X ray and TTE. AS As were all convexed into right atrial. The largest diameter of ASA was from 15 to 29 (average:21.7±3.9) mm,the largest diameter of ASD was from 3-28(average: 13.1±6.6)mm.14 cases were single hole ASD,2 cases were two hole ASD and 3 cases with multiple holes ASD.1 case with the distance between each ASD holes was less than 7mm, and 4 case with the distance between each ASD holes was more than 7 mm.Results18 cases were successfully occluded just for once,and 1 case occluded for two try,and the technique success rate was 100%. The sizes of implanting occluders were from 14 to 34 (average,22.1±6.9).A11 of patients were implanted only one occluder to to close ASD hole. Immediately after occlusion, examined by TTE, transseptal blood was disappear,ASD was completely closed in all 19 cases. During 1～12 months followed up, heart size resumed to normal in 17 cases (89.5%). Another 2 cases right heart sizes were decreased. None was found occluder shift and other complications.ConclusionsInterventional therapy of ASA associated with ASD is safe and feasible.