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简介：Thedeveloppercutaneoustreatmentsformitralregurgitation(MR)havebeenbasedonestablishedsurgicalprocedures.Mostarebasedinsomewayonmitralannuloplasty.IndirectangioplastyutilizingcoronarysinusandleafletrepairwiththeMitraClipdevicehavethemostdevelopmentandclinicalapplication.Morerecently,afterthesuccessoftranscatheteraorticvalvereplacement,transcathetermitralvalvereplacementhasemerged.Acriticalunansweredquestioniswhattherelativerolesofvalverepairandvalvereplacementwillbe.ThelargestexperienceinpracticeiswithMitraClipleafletrepair.Theevidencebaseforthedevelopmentofthesenoveltherapiesincludessomedatainsurgicalcandidates,andregistrystudiesthathavebeendonepredominantlyinhighriskpopulations.

简介：AbstractBackground:The past decade has witnessed an ever-increasing momentum of transcatheter aortic valve replacement (TAVR) and a subsequent paradigm shift in the contemporary management of severe aortic stenosis (AS). We conducted a multi-centric TAVR registry based on Chinese patients (the China Aortic valve tRanscatheter Replacement registrY [CARRY]) to delineate the clinical characteristics and outcomes of Chinese patients who underwent TAVR and compare the results between different valve types in different Chinese regions.Methods:CARRY is an all-comer registry of aortic valve disease patients undergoing TAVR across China and was designed as an observational study that retrospectively included all TAVR patients at each participating site. Seven hospitals in China participated in the CARRY, and 1204 patients from April 2012 to November 2020 were included. Categorical variables were compared using the chi-squared test, and continuous variables were analyzed using a t test or analysis of variance (ANOVA) test. The Kaplan-Meier curve was used to estimate the risk of adverse events during follow-up.Results:The mean age of the patients was 73.8 ± 6.5 years and 57.2% were male. The median Society of Thoracic Surgeon-Predicted Risk of Mortality score was 6.0 (3.7-8.9). Regarding the aortic valve, the proportion of bicuspid aortic valve (BAV) was 48.5%. During the hospital stay, the stroke rate was 0.7%, and the incidence of high-degree atrioventricular block indicating permanent pacemaker implantation was 11.0%. The in-hospital all-cause mortality rate was 2.2%. After 1 year, the overall mortality rate was 4.5%. Compared to patients with tricuspid aortic valve (TAV), those with BAV had similar in-hospital complication rates, but a lower incidence of in-hospital mortality (1.4% vs. 3.3%) and 1 year mortality (2.3% vs. 5.8%).Conclusions:TAVR candidates in China were younger, higher proportion of BAV, and had lower rates of post-procedural complications and mortality than other international all-comer registries. Given the use of early generation valves in the majority of the population, patients with BAV had similar rates of complications, but lower mortality than those with TAV. These findings further propel the extension of TAVR in low-risk patients.Trial Registration:https://www.chictr.org.cn/(No. ChiCTR2000038526).

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简介：Congenitalventricularseptaldefect(VSD)spontaneouscloseinducedbytranscathetertreatmentisrareandhasnotyetbeenreported.WereportononecaseofVSDspontaneouscloseinducedbytranscathetertreatmentina10yearsoldgirl.

简介：Transcatheteraorticvalvereplacement(TAVR)isincreasinglyusedforthetreatmentofhighorveryhighsurgicalriskpatientswithsevereaorticstenosis(AS)orfailingsurgicalbioprosthesis(valve-in-valve,VIV-TAVR).InTAVR,thecollapsedtranscatheterheartvalve(THV)isintroducedusingthedeliverysysteminsertedfromthefemoralartery(preferred)orotheralternativeaccesses(transapical,transaortic,transcarotid,subclavian/transinnominateortranscaval).Thedeliverysystemisthenadvanceduntilcoaxiallyalignedwiththeaorticannulus,wheretheTHVisdeployed.Thisprocedurecanbeassociatedwithcomplicationssuchasaccesssiteinjury(vascularcomplication),paravalvarleak,cerebrovasculareventsandconductiondisturbances.However,therapidacceptanceandsuccessesobservedwithTAVRhavebeenmadepossiblethroughcarefulpatientselection,preproceduralplanning(i.e.MDCTannularsizing),THVtechnology(i.e.newgenerationvalves),andproceduraltechniques(i.e.minimalistTF-TAVRandalternativepercutaneousaccessoptions),aswellasadecreaseincomplicationsasTAVRexperiencegrows.ThoughtheresultsorongoingclinicaltrialsevaluatingTAVRinintermediatesurgicalriskpatientsarepending,itislikelythatTAVRwillsoonbeapprovedforlowerriskpatientsaswell.

简介：ObjectivesToexplorethefeasibility,necessity,andsecurityoftranscatheterclosureofpatentductusarteriosus(PDA)ininfants.MethodsTherewere230infantswithPDA.Theageswere(7.3±3.2)monthsandtheweight(6.6±2.8)Kginaverage.Theywereseparatedintotwogroups.GroupAwasformedbytheinfantsweighinglessthan6Kg,GroupBover6Kg.RightheartcatheterizationwasperformedfirsttocalculatetheratioofQp/Qs.ThendescendingaortographydemonstratedthediameterandshapeofPDA.Properoccluderwasselectedtofinishtheintervention.Echocardiographywasperformedafterintervention24hoursand1,3,6,12and24months.ResultsInGroupAthetechnicalachievementratiowas94.6%withtheaveragediameterofPDA(6.2±3.2)mm.InGroupBthetechnicalachievementratiowas100%withtheaveragediameterofPDA(4.8±2.5)mm.WeusedtheAmplatzerDuctOccluderwiththetypefrom6-8mmto12-14mm,thedeliverysheathfrom6Frenchto8French.24hoursafterintervention,echocardiographydemonstratedthattherewere6residualshuntsinGroupAwhile22inGroupB.After1year,residualshuntexistedinneithergroup.Therewere4patientswhosefemoralarteriespulsedweaklyafterinterventioninGroupA,whileinGroupBtherewere3.Theyallrecovered24hoursaftertheapplicationofurokinase.InGroupAbloodflowvelocityindescendingaortaincreasedin5infants,whileinGroupBtherewere3.Theyallresumedin6-12months.ConclusionsTranscatheterclosureofPDAininfantsissafeandtechnicallyfeasible.However,indicationshouldbestrictlyselectedandtheinterventionshouldbeperformedbyexperiencedphysician.

简介：ObjectivesToinvestigatethecauses,theraputicandpreventivemethodsofcomplicationsassociatedwithtranscatheterocclusionofatrialseptaldefect(ASD)usingtheAmplatzerseptaloccluder(ASO)inchildren.Methods289casesunderwenttranscatheterclosureofASDwithASO.Complicationsoccurredin9cases.Thecomplicationsinprocedureincludedsystemiccirculatorysystemicairembolismin2,pulmonaryairembolismin1,pericardialtamponadein1,ASOmalpositionrequiringemergencysurgicalremovalin1,transientatrialextrasystolesin1andsizingballoonrupturein1case.2caseswithpostoperativecomplicationswerefoundinthefollow-upstudies.TheseincludedperforationofmitralvalveandASOpartiallydislodged.Inthisstudy,5childrenwithintraoperativecomplicationreceivedemergencytherapyincludingsurgicalintervention,andothersneededonlyfollow-up,asthecomplicationsweretransientorasymptomatic.ResultsTherewerenochildrendeathinthisstudy.The5caseswhoreceivedtreatmentwerecompletelyhealing,andtheotherswithintra-procedurecomplicationswerealsohadnosequelaexisted.CaseswithmitralvalveandASOpartiallydislodgedwerestillinfollow-upstudies,asthe2patientshavingnosymptoms.ConclutionsAirembolismwereoccurredeasilyinatrialseptaldefectcaseswhoreceivedASOtherapy.Complicationsmainlycausedbyinappropriateoperativeprocedureandsomecomplicationsneededemergencytreatments.Follow-upstudieswereimportanttocaseswithtranscatheterocclusiontherapy.

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简介：AbstractSurgical resection (SR) is recommended as a radical procedure in the treatment of hepatocellular carcinoma (HCC). However, postoperative recurrence negatively affects the long-term efficacy of SR, and preoperative adjuvant therapy has therefore become a research hotspot. Some clinicians adopt transcatheter arterial chemoembolization (TACE) as a preoperative adjuvant therapy in patients undergoing SR to increase the resection rate, reduce tumor recurrence, and improve the prognosis. However, the findings of the most relevant studies remain controversial. Some studies have confirmed that preoperative TACE cannot improve the long-term survival rate of patients with HCC and might even negatively affect the resection rate. Which factors influence the efficacy of preoperative TACE combined with SR is a topic worthy of investigation. In this review, existing clinical studies were analyzed with a particular focus on several topics: screening of the subgroups of patients most likely to benefit from preoperative TACE, exploration of the optimal treatment regimen of preoperative TACE, and determination of the extent of tumor necrosis as the deciding prognostic factor.

简介：摘要：经导管主动脉瓣膜置换术具有创伤性小、术后并发症和致死率较低的优势，因此该手术具有极高的治疗安全性，成为了治疗复杂高危的主动脉瓣狭窄患者的主要治疗手段，根据相关学者的研究，为复杂高危主动脉瓣狭窄患者实施经导管主动脉瓣膜置换术治疗后的情况进行随访调查，证实了该手术用于治疗的安全性和与有效性。为患者实施手术治疗的时候，需要帮助患者完善各项检查，通过多学科协同评估患者的机体状态，制定合理的治疗方案，并且为患者实施个性化的护理方案，改善患者的心肾功能。护理人员需要充分了解经导管主动脉瓣膜置换术的流程、注意事项和潜在的危险，检测患者的病情，为患者术后实施呼吸支持，维持体循环等手段，降低并发症发病率。