Interventional cardiologists have traditionally relied upon fluoroscopic imaging for percutaneous coronary interventions. Transcatheter structural heart interventions, however, require additional imaging modalities such as echocardiography and multislice computed tomography (MSCT) for pre-, intra- and post-procedural assistance. During transcatheter structural heart interventions, interventional cardiologists and non-invasive cardiovascular imagers may use different terminologies to describe a certain structure, thus causing misunderstandings within the team. Herein, we present a modality- independent terminology for understanding volumetric images in the context of transcatheter heart valve therapies. The goal of this system is to allow physicians to readily interpret the orientation of fluoroscopic, MSCT, echocardiographic and MRI images, thus generalising their understanding of cardiac anatomy to all imaging modalities.
Objective To investigate the feasibility and efficacy of transcatheter directed thrombolysis （TDT） approach in treatment for deep venous thrombosis （DVT） of lower limbs and as compared with trans-dorsal pedis vein thrombolysis （TPVT） approach. Methods The clinical data of 437 patients with acute DVT （184 males and 253 females） at the age of （43±12） years （range 19-76 years） from July 2008 to January 2012 in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. Patients in the group TDT received TDT were 293 cases， 32 inferior vena cava filters were implanted. Patients in the group TPVT received TPVT were 65 cases， 4 inferior vena cava filters were implanted. Results The resolution time of thrombus in the group TDT was shorter than that in the group TPVT （6 d versus 9 d， P＜0.05）. The circumference difference of leg or upper leg before and after treatment in the TDT group was significantly greater than that in the TPVT group （P＜0.05）. The rate of venous patency was （65.2±15.4）% and preservation rate of valvular function was （78.2±12.6）% in the group TDT， and which was （63.8±16.3）% and （91.1±10.7）% in the group TPVT， respectively. The differences of venous patency rate was not statistically significant（P＞0.05） between two groups， but the prevervation rate of valvular function was significant difference （P＜0.05） .Hematomas in 3 cases and gross hematuria in 4 cases were observed， and displacement of inferior vena cava filter occurred in 1 patient in the group TDT. The gums bleed or gross hematuria in 5 cases were observed in the group TPVT. Conclusions Both TDT and TPVT can effectively relieve symptoms. TDT can shorten the course of disease， but itincreases functional damage of the deep vein valvular.
Objective To analyze predictive factors, clinical implications and prognosis effects of new-onset conduction block after transcatheter aortic valve implantation (TAVI). Methods The clinical data of 86 patients who underwent TAVI through transfemoral approach from 2019 to 2021 in Fujian Provincial Hospital were retrospectively analyzed, including 59 males and 27 females with an average age of 72.9±8.0 years. The patients were divided into a normal group and a new-onset conduction block group according to whether there was new-onset conduction block after operation, and then the new-onset conduction block group was subdivided into a left bundle branch block (LBBB) group (28 patients) and a complete atrioventricular block (CAVB) group (11 patients). We compared the hemodynamics and TAVI-related complications between the postoperative and early follow-up periods, and used the multivariate logistic regression models to identify risk factors for the new-onset conduction block. Results The median EuroSCORE of all patients were 8 (2) points before the operation. In the postoperative and early follow-up periods, the hemodynamics and TAVI-related complications had no statistical difference between the new-onset conduction block group and the normal group (P>0.05). The incidence of permanent pacemaker implantation (81.8%, 9/11) and mortality due to cardiac causes (18.1%, 2/11) in the CAVB group were significantly higher than those in the normal group and theLBBB group (P<0.05). Female, severe calcification of the aortic valve, too large valve size and deep valve implants were the risk factors for new-onset conduction block after TAVI. ConclusionThe incidence of LBBB and CAVB is high after TAVI, however, both of them do not significantly effect the hemodynamics of the patients. Higher incidence of permanent pacemaker implantation is found in the CAVB group which affects the rate of rehospitalization and mortality. Female patients, severe calcification of the aortic valve, too large valve size and deep valve implants are the risk factors for the new-onset conduction block after TAVI.
【Abstract】Objective To investigate the change of vascular endothelial growth factor (VEGF) expression in HepG2 cells under hypoxia. Methods HepG2 cells were cultured under hypoxia（hypoxia group） and normal condition (control group). VEGF expression of HepG2 cells was examined by immunohistochemical staining. The growth of HepG2 cells was examined by MTT colorimetry and cell count. VEGF level in the culture medium was measured by ELISA.Results After 48 h and 72 h of culture, the growth rate of HepG2 cells in hypoxia group was lower than that in control group (P＜0.05). The cell count in hypoxia group (2.51×104/μl and 2.69×104/μl, respectively) was much lower than that in control group(3.01×104/μl and 3.52×104/μl) after 48h and 72h of culture (P＜0.05). In hypoxia group, VEGF level in the culture medium after 24 h and 48 h was higher than that in control group (P＜0.05, P＜0.01). Conclusion Hypoxia may enhance the VEGF expression in HepG2 cells and this could be the reason of high expression of VEGF after transcatheterized hepatic arterial chemoembolization.
In recent years, the transcatheter interventional therapy of valvular disease has been developed rapidly, and new therapeutic devices are emerging, which has become the first-line treatment in parallel with surgery. Although the interventional therapy of valve disease in China started relatively late, the development speed is relatively fast, and many remarkable achievements has been accomplished. This article will introduce the application of transcatheter intervention in valvular diseases in China, including aortic valve disease, mitral valve disease, pulmonary valve disease and tricuspid valve disease.
Transcatheter aortic valve replacement (TAVR) has been a crucial treatment for elder patients with aortic stenosis in developed countries, which is still at its beginning in China. TAVR is a risky and complicated technic; and to promise the long-term development of it, we need to build a multiple disciplinary heart team consisted of doctors from different specialties and guided by various disciplines, also to guarantee the team operates well. In order to help Chinese doctors understand heart team well, this article describes component parts and requirement for each member of the team, in aspect of cardiologist, cardiac surgeon, echocardiologist, radiologist, anesthesiologist and nursing team; and discuss team operation mechanism through pre-procedural evaluation, procedural cooperation, peri-procedural management and post-procedural follow-up.
Transcatheter aortic valve replacement (TAVR) as a mature technology has been widely applied in Western countries. In China, with the first two domestic prostheses being approved for commercial use, the technology now is expecting a fast development. In this article, we reviewed the features of Chinese aortic stenosis patients, the early Chinese experience of TAVR, the application of domestic prostheses and remaining problems.
Transcatheter aortic valve replacement (TAVR) is the best treatment for severe aortic stenosis with high surgical risk, and low body weight significantly increased the risk of surgery and postoperative all-cause mortality. A case of elderly female diagnosed with severe aortic valve stenosis and extremely low body weight was presented in this article. Additionally, horizocardia and low located coronary orifice were also found in this patient, which markedly increased the risk and complexity of the TAVR procedure. During the operation, circulatory collapse occurred, and prosthetic valve was quickly released under emergency cardiopulmonary resuscitation. The operation was successful and the patient’s vital signs recovered soon. The follow-up showed that the patient was in good condition.
This paper reported a 75-year-old female patient. She was admitted to our hospital for “repeated chest pain, shortness of breath for more than 5 years, and syncope 3 times”. The CT scan of the patient showed severe aortic valve stenosis, bicuspid valve, and severe calcification; then she underwent transcatheter aortic valve replacement in our hospital. After the prosthesis was implanted, there was a significant paravalvular leak. Considering the triangular area formed between the calcified clumps, the valve was not fully dilated. Paravalvular leak closure was performed during the operation, attempted through the valve stent mesh to closuring. A rare incarceration of the transmitter occurred. An attempt was made to pull out the incarcerated transmitter through a pull-up technique, which resulted in the prosthesis prolapse. The patient was eventually transferred to surgery aortic valve replacement.
Atrial functional mitral regurgitation has been referred to patients with atrial fibrillation related functional mitral regurgitation without left ventricular dysfunction and it has nowadays received remarked attention in structural heart disease field. Significant dilation of mitral annulus and left atrium, insufficient leaflet remodeling, iatrogenic leaflet tethering, reduced annular contractility and increased valve stress by flattened saddle shape of the annulus might be important triggers of atrial functional mitral regurgitation. Recently, several studies indicated that transcatheter edge-to-edge mitral valve repair could be an effective strategy for atrial functional mitral regurgitation. In this review, the definition, mechanism together with efficacy and safety of transcatheter edge-to-edge mitral valve repair in atrial functional mitral regurgitation are discussed.
