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The ValveClamp system is a novel edge-to-edge mitral valve repair system designed for the ease of operation. We report the outcomes of our initial experience of treating functional mitral regurgitation (MR) with the ValveClamp system.The subjects of this study were patients with symptomatic functional MR despite standard medical therapy, who were treated with transapical ValveClamp implantation. The patients were divided into an atrial functional mitral regurgitation (AFMR) group and a ventricular functional mitral regurgitation (VFMR) group. Clinical and echocardiographic outcomes were evaluated at baseline and then at the 3-month follow up.Twelve patients, with a median age of 71 years (range 65-78 years), were assigned to the AFMR group (n = 5) or the VFMR group (n = 7). The device implantation rate was 100%, and 10 (83.3%) patients required implantation of only one clamp. The catheter time was less than 10 min in half of the patients, the fastest time being 5 min. There were no procedure-related complications. At the 3-month follow up, all patients were free from all-cause mortality, surgery, and rehospitalization. MR improved to ≤ 2 + in all 12 patients with MR grade 3 + or 4 + at baseline, (100%) and to ≤ 1 + in 9 of these patients (75%), with a low-pressure gradient. The left atrial diameter and the left ventricular end diastolic diameter decreased significantly in both the AFMR and VFMR groups. The left ventricular eject fraction at the 3-month follow up showed a rising trend in both the AFMR and VFMR groups, whereas PASP decreased remarkably. All 12 patients with baseline NYHA functional class III/IV (100%) showed improvement of at least 1 class, and 2 of these patients (16.7%) showed improvement of at least 2 classes.The ValveClamp system is simple and effective for transapical transcatheter edge to edge repair in patients with functional MR.

Objectives: Patients undergoing trans-carotid transcatheter aortic valve replacement (TC-TAVR) are more likely to suffer from a stroke because of cerebral blood hypoperfusion and blood occlusion caused by the introducer sheath compared with the trans-femoral (TF) approach. The present study aimed to compare the incidence of stroke between the TC and TF approaches and explore the causes of stroke after TAVR. Methods: We retrospectively reviewed the medical records of 414 consecutive patients with severe aortic valve stenosis who underwent TC- or TF-TAVR at our center from October 2010 to November 2019; these patients were included in this observational study. The clinical data, such as the incidence of stroke, were compared between TC- and TF-TAVR patients. The correlation between carotid artery blood block interval (CABBI) and neurological events was also analyzed. The study was approved by the Ethics Committee of Zhongshan Hospital of Fudan University (approval No. YL2014-32). Results: Patients undergoing TC-TAVR had a significantly higher incidence of stroke than those undergoing TF-TAVR (12.5% vs. 0, P < 0.001), whereas the baseline data and the incidence of other complications did not differ significantly between the patients undergoing TC- and TF-TAVR (P > 0.05). Moreover, in TC-TAVR patients, the average CABBI of stroke was significantly longer than that of nonstroke patients (61.7 ± 20.7 min vs. 25.1 ± 1.6 min, P = 0.001). The number of patients with CABBI >30 min in the stroke group was greater than that in the nonstroke group (P < 0.001). Conclusions: In the absence of the cerebral and carotid artery evaluation before TAVR, surgeons should take into consideration the time of CABBI

AIMS This study aimed to provide a simple index for predicting the definitive indication for transcatheter closure of atrial septal defect (ASD) with pulmonary arterial hypertension (PAH). METHODS AND RESULTS A positive response after attempted occlusion was defined as mean pulmonary artery pressure (MPAP) ≤30 mmHg or the decrement percentage of it ≥20% compared with baseline. If a positive response was achieved, the occluder would be released, and the procedure was defined as successful. In 209 patients who underwent a successful procedure without PAH-specific medicine, there was a dramatic decrease in the percentage of patients with pulmonary arterial systolic pressure (PASP) ≥50 mmHg from baseline to the one-year follow-up (79.4% to 14.0%, p

Left ventricular (LV) systolic dysfunction can occur after patent ductus arteriosus (PDA) closure and data in adult Chinese patients are lacking.We examined adult Chinese patients who underwent successful transcatheter PDA closure at Zhongshan Hospital. Echocardiographic studies were performed before closure, before discharge, and at 1, 3, 6, and 12 months after closure. A total of 430 patients were included between January 2010 and December 2016. Patients were divided into two groups based on LV end-diastolic diameter (LVEDD): Dilated LV Group:56 mm (n = 191) and Non-dilated LV Group: ≤56 mm (n = 239).LVEDD and LV ejection fraction (LVEF) were significantly decreased immediately after closure. Reductions in LVEDD (-10.5% ± 7.1% vs. -4.6% ± 7.0%, P 0.001) and LVEF (-8.9% ± 12.6% vs. -2.1% ± 8.6%, P 0.001) were greater in the Dilated LV Group. LV end-systolic diameter (LVESD) remained unchanged compared to levels before closure (-4.0% ± 5.4%, P = 0.257; -2.6% ± 5.4%, P = 0.201). 48 patients in the Dilated LV Group (25.1%) and 7 patients in the Non-dilated LV Group (2.9%) developed late LV systolic dysfunction. In multivariable analysis, LVEF ≥60%, LVEDD63 mm, and mean pulmonary arterial pressure (mPAP)29 mmHg were predictive of normal LV function after closure.Many adult Chinese patients developed early LV dysfunction after PDA closure and some patients developed late LV dysfunction. LVEF, LVEDD, and mPAP were identified as significant predictors of late LV systolic function.

To explore the relationship between serum high-density lipoprotein cholesterol (HDL-C) levels and the presence and severity of pulmonary arterial hypertension (PAH). A total of 177 patients with PAH and 103 patients without pulmonary hypertension (PH) were enrolled in this study. All patients underwent right heart catheterization (RHC) for diagnosing and assessing the severity of PAH. Demographics, comorbidities, and laboratory data including serum HDL-C levels were collected. Plasma HDL-C levels in patients with PAH were significantly lower compared with patients without PH (1.08 ± 0.36 vs 1.49 ± 0.36, p

Depression is a serious public health problem and an important factor leading to disease-related disability. Influenced by many factors, such as psychological, hormonal, and genetic factors, the incidence rate of depression in females is approximately two times that in males. However, in preclinical neuroscience research, the selection of the animals’ sex for use in depression models has been controversial. At present, in most preclinical studies, the animals generally chosen in depression models have been male rodents rather than female rodents. It remains doubtful whether the data obtained from male animals can be generalized to female animals. The performance of female animals in preclinical studies of depression has been inconclusive. Based on a review of a large number of original studies in the PubMed database, it was found that although male rodents are more commonly used in the study of depression, the use of female animals also shows good modeling of depression and has its advantages. The influence of the animals’ sex in the chronic unpredictable mild stress (CUMS) model needs further research.

The current study aimed to elucidate the efficacy of interatrial shunt device (IASD) for the treatment of acute pulmonary hypertensive crisis (PHC) and chronic pulmonary arterial hypertension (PAH). After establishing chronic PAH models using dehydrogenized monocrotaline (DHMCT), PAH dogs were implanted with IASDs (group A) or received no intervention (group B). One month later, DHMCT was injected again to establish an acute PHC. The prognosis, hemodynamics, ultrasound cardiography, electrocardiogram, and lung pathology of the dogs were observed. The baseline mean pulmonary arterial pressure increased from 12.70 ± 1.03 to 19.95 ± 1.75 mmHg and established a chronic PAH model 2 months after DHMCT injection (1.50 mg/kg). After an additional injection of DHMCT (1.50 mg/kg) in the chronic PAH model, acute PHC occurred. Mean PAP, sPAP, and pulmonary vascular resistance increased to 22.67 ± 1.80 mmHg, 35.70 ± 1.66 mmHg, and 12.50 ± 3.50 WOOD U, respectively. Cardiac output (CO) decreased to 1.31 ± 0.26 L/min, and the right-to-left shunt caused hypoxemia. The survival rates of the dogs with and those without IASD were 70.0% and 22.2% (P = 0.037), respectively. Six months after PHC, the CO between the dogs with and those without IASD were 1.44 ± 0.11 L/min and 1.18 ± 0.04 L/min (P = 0.028). The long-term survival rates were 50.0% and 22.2%, respectively (P = 0.21). IASD might be efficacious and beneficial for treating acute PHC and chronic PAH, as well as improving prognosis.

BACKGROUND: The autophagy associated signalling pathways such as AMPK/mTOR previously were suggested to play a crucial role in protecting from ischemia-reperfusion injury (IRI). The objective of this study was to evaluate the effect of metformin (DMBG) on autophagy during myocardial IRI with diabetes mellitus (DM). METHODS: The DM rat model was established using streptozocin, and further induced ischemia model via transitory ligation of the left anterior coronary artery and following reperfusion. The model rats were treated with 400 mg/kg/day DMBG for one week. Autophagosomes were investigated using transmission electron microscopy. Autophagy-associated signalling pathways were detected by western blot. RESULTS: The myocardial infarct size was shown to significantly increase in the DM rats exposed to IRI compared to negative control, but decrease in DMBG treated. The mature autophagosomes were elevated in infarction and marginal zones of DM+IRI+DMBG compared to DM+IRI. Furthermore, the increasing protein levels of LC3-II, BECLIN 1, autophagy related 5 (ATG5) and AMP-activated protein kinase suggested activated autophagy-associated intracellular signalling AMPK and mTOR pathways upon DMBG treated. CONCLUSIONS: Taken together, the outcomes demonstrated that DMBG could activate autophagy process to provide a cardio-protective effect against DM induced myocardial IRI.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) is an important and major player in the pathophysiology of hypercholesterolemia and atherosclerosis. Recently, PCSK9 has been implicated in the pathogenesis of inflammatory diseases. Whether PCSK9 is involved in idiopathic pulmonary arterial hypertension (IPAH) remains unclear. This study aimed to investigate the relationship between PCSK9 and IPAH. Serum PCSK9, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-1 β (IL-1β), and monocyte chemotactic protein-1 (MCP-1) were measured by enzyme linked immunosorbent assay. Transthoracic echocardiography was performed among 40 IPAH patients and 20 control subjects. Hemodynamic data were collected via right heart catheterization in patients with IPAH. Serum PCSK9, TNF-α, IL-6, IL-1β, and MCP-1 levels were significantly higher in IPAH patients than in control subjects (p

Background This study aims to investigate whether small balloon aortic valvuloplasty (BAV) reduces the need for permanent pacemaker implantation (PPMI) after transcatheter aortic valve implantation (TAVI). Methods This was a retrospective analysis using data from our local TAVI database. Small BAV was defined as a small balloon size (=18 mm) pre-dilatation. Normal BAV was defined as a balloon size >18 mm. The primary endpoint was the incidence of new PPMI. Results Of 99 consecutive TAVI patients, five patients were excluded due to pre-existing permanent pacemaker. Patients in the small BAV group (n=57) had a significantly lower PPMI rate compared with the normal BAV group (n=37) (3.5% vs. 18.9%, P=0.026). Moderate or severe aortic valve regurgitation post-procedure was similar between the small BAV and normal BAV groups (5.3% vs. 8.1%, P=0.480); likewise, the mean aortic gradient post-procedure did not differ significantly (11.5±5.2 mmHg vs. 12.2±7.3 mmHg, 1 mmHg=0.133 kPa, P=0.580) between the groups. Device success rates were also similar (94.7% vs. 91.8%, P=0.680). In multivariable analysis, small BAV (P=0.027), the ratio of prosthesis diameter to annulus diameter (P=0.048), and mean aortic gradient by echo in the basement (P=0.021) were independent predictors of PPMI. Conclusions The small BAV strategy is associated with a low rate of permanent pacemaker implantation after transcatheter self-expanding valve implantation in this single-center observational study.

Background: The aim of this study is to investigate the prevalence and outcome of tricuspid regurgitation (TR) in the Chinese population. Methods: The echocardiography database, including 134,874 patients at our heart center from 2010 to 2012, was retrospectively analyzed. Results: The rates of mild, moderate, and severe TR were 2.96, 2.22, and 1.39%, respectively. Of these patients, 4.86% had primary TR, 91.41% had functional TR, and 3.73% had unexplained TR. The rate of TR was increased in elders (odds ratio: 1.038 for 1 year’s increment; 95% confidence interval: 1.037–1.040; p < 0.001) and females (odds ratio: 1.386; 95% confidence interval: 1.327–1.448, p < 0.001). The major etiologies of TR were left-sided valve heart disease (VHD) and dilated cardiomyopathy. The survival rate of severe TR patients with pulmonary artery hypertension (PAH) was lower than in those without PAH (p < 0.0001). There was a positive association between the prevalence of TR and impaired left ventricular ejection fraction. Compared to the non-left-sided VHD group, the left-sided VHD group had a better prognosis among severe TR patients. The 5-year survival rates were 79.69, 71.12, and 77.01% in the groups of left-sided VHD, non-left-sided VHD, and all patients. Conclusions: Patients with severe TR have a bad prognosis, especially those with non-left-sided VHD and those with PAH.

Cardiac hypertrophy is the response of the heart to a variety of hypertrophic stimuli; this condition progresses to heart failure and sudden death. MicroRNAs (miRs) are a family of small, non-coding RNAs that mediate posttranscriptional gene silencing. Recent studies have identified miRs as important regulators in cardiac hypertrophy. One specific miR, miR-150 has been reported to be downregulated in hypertrophic murine hearts. However, the role of miR-150 as a regulator of cardiac hypertrophy remains unclear. In the present study, we used gain-of-function and loss-of-function approaches to investigate the functional roles of miR-150 in cardiac hypertrophy induced by aortic banding. The extent of the cardiac hypertrophy was evaluated by echocardiography and by pathological and molecular analyses of heart samples. Our results revealed that transgenic mice that overexpress miR-150 in the heart were resistant to cardiac hypertrophy and fibrosis through down-regulation of serum response factor (SRF). Conversely, the loss of function of miR-150 by genetic knockdown or antagomiR approaches produced the opposite effects. These studies suggest that miR-150 plays an important role in the regulation of cardiac hypertrophy and SRF is involved in miR-150 mediated anti-hypertrophic effect. Thus, miR-150 may be a new therapeutic target for cardiac hypertrophy.

Introduction Balloon expandable transcatheter pulmonary valve systems are not applicable to the large majority of patients with chronic severe pulmonary regurgitation (PR) following surgical right ventricular outflow tract (RVOT) rehabilitation. This report describes the clinical use and short-term follow-up of a novel transcatheter self-expanding pulmonary valve system (Venus P Valve) for rehabilitation of the RVOT in patients with chronic severe PR. Methods Patients with native RVOT and severe PR were selected on a case-by-case basis as part of early clinical experience with this valve. Patient demographics and pre-procedural, intra-procedural, and follow-up data were reviewed. Results Five patients (four females) with a mean weight of 54.8 ± 11.4 kg were selected for attempted valve deployment. Patients were either NYHA class II (n = 3) or class III (n = 2) at baseline. PR was grade 4 in all cases with mean right ventricular end-diastolic volumes of 155.0 ± 16.6 ml/m2 on cardiac MRI. Mean minimum “annular” diameter on transthoracic echocardiogram was 22.8 ± 2.5 mm and mean RVOT diameter was 31.8 ± 5.1 mm. Uncomplicated successful valve delivery was achieved in all five cases with a mean fluoroscopy time of 22.8 ± 8.8 min. Valve sizes used were 26 (n = 3), 30 (n = 1), and 32 (n = 1). Mean pulmonary artery diastolic pressure increased from 3 ± 3.7 mm Hg to 9.9 ± 6.9 mm Hg (P = 0.06). On mean follow-up of 3.4 ± 2.5 months PR grade is 0 (n = 3) or 1 (n = 2) in all cases. NYHA class has improved at least one class in all cases and right ventricular volumes assessed by echocardiography have normalized in all three patients with follow-up to 3 months. Conclusions The Venus P Valve provides excellent short-term pulmonary valvar function in the native RVOT of patients with surgically induced chronic severe PR. © 2014 Wiley Periodicals, Inc.

A 58-year-old man with exertional dyspnea (New York Heart Association class II) was admitted to our hospital. He suffered from acute anterior myocardial infarction 1 year earlier and had undergone percutaneous coronary intervention and closure of ventricular septal rupture (VSR) with an Amplatzer

The presence of a mechanical aortic valve prosthesis has been considered a contraindication to retrograde percutaneous closure of mitral paravalvular leaks, because passing a catheter through the mechanical aortic valve can affect the function of a mechanical valve and thereby lead to severe hemodynamic deterioration. We report what we believe are the first 2 cases of retrograde transcatheter closure of mitral paravalvular leaks through a mechanical aortic valve prosthesis without transseptal or transapical puncture. Our experience shows that retrograde transcatheter closure of mitral paravalvular leaks in this manner can be an optional approach for transcatheter closure of such leaks, especially when a transapical or transseptal puncture approach is not feasible. This technique might also be applied to other transcatheter procedures in which there is a need to pass a catheter through a mechanical aortic valve prosthesis.

Objectives: The objective of this study was to evaluate the safety and efficacy of transcatheter closure of perimembranous ventricular septal defect (pmVSD) and intracristal VSD (icVSD) using the Shanghai Shape Memory Alloy (SHSMA) pmVSD occluder. Background: There is still limited experience with transcatheter closure of pmVSD and icVSD. Methods: Between January 2003 and September 2010, 348 patients with pmVSD and 47 patients with icVSD underwent transcatheter closure using a SHSMA pmVSD occluder. Results: The total successful closure rate in pmVSD and icVSD subjects was 97.4 and 78.7%, respectively. During the perioperative period, no death, major bleeding or hemolysis occurred in both groups. In pmVSD group, one case of occluder dislodgement, one case of pericardial tamponade, and two cases of thromboembolism occurred. None in icVSD group had these complications. During a median of 3.2 years of follow-up, there was no evidence of significant residual shunt and device-related valve regurgitation. None in icVSD group and 10 patients (2.9%) in pmVSD group had a persistent arrhythmia. Overall, only one patient (0.3%) with pmVSD acquired complete atrioventricular block requiring implantation of a permanent pacemaker. The rim from the tricuspid valve to the defect < 4 mm was the only predictor of arrhythmic complications after procedure (OR = 4.24; P = 0.021). Conclusions: Transcatheter closure of pmVSD in selected patients using the SHSMA occluder is effective and safe. Transcatheter closure of icVSD in experienced hands using this device is also feasible and safe. © 2011 Wiley Periodicals, Inc.

Background: Recently, assessment of left ventricular (LV) torsional deformation has become an important approach for quantifying LV function. This study sought to evaluate LV torsion using speckle tracking imaging in patients with atrial septal defect (ASD). Methods and Results: Basal and apical LV short-axis images were analyzed in 45 asymptomatic adults with isolated secundum ASD and 45 matched normal subjects. The apical rotation parameters were similar between 2 groups; however, the peak basal clockwise rotation was significantly depressed (-5.4 ±2.8° vs -6.9 ±2.6°, P

To evaluate the accuracy of echocardiography in identifying aortic valve structures and determine the prevalence of bicuspid aortic valves (BAV) in severe aortic stenosis (AS) population to provide useful information for transcatheteraortic valve replacement (TAVR).A total of 300 AS patients undergoing surgical aortic valve replacement were included to determine the accuracy of transthoracic echocardiography in indentifying BAV from January 2009 to July 2013. The echocardiographic data of our hospital from 2004 to 2012 was retrospectively reviewed. 1 371 patients with isolated severe native aortic valves stenosis were consecutively enrolled.The aortic valve structures could be defined by transthoracic echocardiography in 75.7% (227/300) patients with severe AS. With BAV diagnosis during operation as gold standard, the accuracy of transthoracic echocardiography in identifying BAV was 89.4% (203/227). Among 1 371 patients with severe AS, the percentage of BAV in patients aged40 years, aged 40-59 years, aged 60-69 years, aged 70-79 years and aged ≥ 80 years was 60.0% (57/95), 57.5% (262/456), 42.7% (184/431), 43.2% (133/308) and 21.0% (17/81), respectively. Incidence of BAV in patients with degenerative calcific valve was significant higher than in those with rheumatic heart disease (44.3% (552/1 246) vs. 4.0% (3/76), P0.01). Proportion of combined aortic regurgitation ≥ grade 2 was significantly lower, ascending aortic diameter was larger and left ventricular end-diastolic dimension was smaller in BAV patients compared to severe AS patients with tricuspid valves (all P0.01), while aortic valve annuals diameter and accompanying cardiovascular diseases between BAV and tricuspid aortic valve groups were similar (all P0.05).Transthoracic echocardiography could accurately identify aortic valve structures in about 76% patients. BAV is common in severe AS patients across all ages. These results provide important information for the popularization of TVAR.

A new tap-delay-line (TDL) channel model based on indoor radio wave propagation characteristics and measurement data is developed in this paper. It can estimate the mean power delay profile (PDP) simply and effectively for the LOS and NLOS routes. The model is proven to be consistent with the measurement results. Under the assumption of the WSSUS channels, the tap frequency correlations, tap amplitude distributions, tap Doppler spectrum and the tap space correlations are analyzed as well to find new ways to evaluate a TDL model. The channel models and parameters studied in this paper are important for indoor MIMO channel modeling and simulations for new radio system at 5GHz.

Cardiac hypertrophy is the response of the heart to a variety of hypertrophic stimuli; this condition progresses to heart failure and sudden death. MicroRNAs (miRs) are a family of small, non-coding RNAs that mediate posttranscriptional gene silencing. Recent studies have identified miRs as important regulators in cardiac hypertrophy. One specific miR, miR-150 has been reported to be downregulated in hypertrophic murine hearts. However, the role of miR-150 as a regulator of cardiac hypertrophy remains unclear. In the present study, we used gain-of-function and loss-of-function approaches to investigate the functional roles of miR-150 in cardiac hypertrophy induced by aortic banding. The extent of the cardiac hypertrophy was evaluated by echocardiography and by pathological and molecular analyses of heart samples. Our results revealed that transgenic mice that overexpress miR-150 in the heart were resistant to cardiac hypertrophy and fibrosis through down-regulation of serum response factor (SRF). Conversely, the loss of function of miR-150 by genetic knockdown or antagomiR approaches produced the opposite effects. These studies suggest that miR-150 plays an important role in the regulation of cardiac hypertrophy and SRF is involved in miR-150 mediated anti-hypertrophic effect. Thus, miR-150 may be a new therapeutic target for cardiac hypertrophy.

Balloon expandable transcatheter pulmonary valve systems are not applicable to the large majority of patients with chronic severe pulmonary regurgitation (PR) following surgical right ventricular outflow tract (RVOT) rehabilitation. This report describes the clinical use and short-term follow-up of a novel transcatheter self-expanding pulmonary valve system (Venus P Valve) for rehabilitation of the RVOT in patients with chronic severe PR.Patients with native RVOT and severe PR were selected on a case-by-case basis as part of early clinical experience with this valve. Patient demographics and pre-procedural, intra-procedural, and follow-up data were reviewed.Five patients (four females) with a mean weight of 54.8 ± 11.4 kg were selected for attempted valve deployment. Patients were either NYHA class II (n = 3) or class III (n = 2) at baseline. PR was grade 4 in all cases with mean right ventricular end-diastolic volumes of 155.0 ± 16.6 ml/m(2) on cardiac MRI. Mean minimum "annular" diameter on transthoracic echocardiogram was 22.8 ± 2.5 mm and mean RVOT diameter was 31.8 ± 5.1 mm. Uncomplicated successful valve delivery was achieved in all five cases with a mean fluoroscopy time of 22.8 ± 8.8 min. Valve sizes used were 26 (n = 3), 30 (n = 1), and 32 (n = 1). Mean pulmonary artery diastolic pressure increased from 3 ± 3.7 mm Hg to 9.9 ± 6.9 mm Hg (P = 0.06). On mean follow-up of 3.4 ± 2.5 months PR grade is 0 (n = 3) or 1 (n = 2) in all cases. NYHA class has improved at least one class in all cases and right ventricular volumes assessed by echocardiography have normalized in all three patients with follow-up to 3 months.The Venus P Valve provides excellent short-term pulmonary valvar function in the native RVOT of patients with surgically induced chronic severe PR.

To evaluate the immediate and mid-term outcomes of percutaneous device closure using patent ductus arteriosus (PDA) or ventricular septal defect (VSD) occluders in patients with ruptured sinus of Valsalva aneurysm (RSVA).Ten patients (6 males and 4 females; age range, 19-63 years) were selected for the percutaneous device closure of RSVA between January 2005 and September 2011. In 2 patients, RSVA originated from the right coronary sinus (RCS) and ruptured into the right atrium (RA); in 6, from the RCS into the right ventricle, including 2 with very small VSDs; and in 2, from non-coronary sinus into the RA.The defects were angiographically found to be 7-15 mm at their narrowest end. All the defects were successfully occluded using either a PDA occluder 2-4 mm larger than the narrowest end or a VSD occluder 3-5 mm larger than the narrowest end. No coronary arteries were checked for patency after closure. Immediately postoperative or follow-up echocardiography showed neither significant residual shunt nor severe aortic regurgitation (AR). Clinically, the patients developed no device embolism, infective endocarditis, or hemolysis. One patient was found to have newly-developed AR at the first follow-up at 1 month. The RSVA had been closed with a PDA occluder. One case suffered from periprocedural myocardial infarction without any symptoms.It is feasible and effective to use percutaneous device closure of RSVA with a PDA or VSD occluder.

Pulmonary arterial hypertension is a life-threatening disease characterized by marked and sustained elevation of blood pressure in the lungs. Statins, 3-hydroxy-3-methylglutaryl CoA (HMG-CoA) reductase inhibitors, have been shown to attenuate the effects of pulmonary hypertension resulting from hypoxia, Monocrotaline exposure, or Monocrotaline exposure in the setting of pneumonectomy. In particular, the effects of Simvastatin have been well studied. Whether other statins, such as Atorvastatin, are capable of preventing dehydromonocrotaline-induced pulmonary hypertension in beagles has not been explored.We used eighteen 3-month-old beagles of both genders, weighing 10.3 ± 3.2 kg. The experimental animals were randomized into one of 3 groups: the control group (n = 6), the dehydromonocrotaline (DHMC) + vehicle group (n = 5), and the DHMC + Atorvastatin group (n = 7). The beagles were injected with DHMC (n = 12) on day 1, and from day 5 to day 65 they received Atorvastatin (2 mg/kg, daily by gavage) or vehicle (0.9% saline, daily by gavage) treatment. We used the thermodilution method of hemodynamic measurements at baseline and at day 65 of treatment. At day 65, pulmonary tissue was sampled for morphometry and real-time quantitative PCR.After 65 days, DHMC increased mean pulmonary arterial pressure (mPAP), and this increase was prevented with Atorvastatin treatment (32 ± 11 mmHg vs. 15 ± 3 mmHg, P.05). Hematoxylin and eosin staining demonstrated less pulmonary endothelium destruction and smooth muscle cell proliferation in the Atorvastatin-treated beagles, compared with the DHMC group. The eNOS mRNA expression was increased in the DHMC group, and this increase was prevented in the Atorvastatin-treated group. In addition, IL-1β, prepro-ET-1, TNF-α, and VEGF (vascular endothelial growth factor) mRNA expression levels were increased in the lungs of the DHMC group, and these increases were reduced toward normal levels in the Atorvastatin-treated group.Atorvastatin prevents the effects of monocrotaline-induced pulmonary hypertension in beagles.

Left ventricular (LV) torsional deformation plays an important role with respect to LV ejection and filling. However, no data are available on the impact of overload relief on LV torsional deformation after transcatheter ASD closure. This study sought to evaluate LV twist and untwisting before and early after device closure of ASD using the speckle tracking imaging (STI). We acquired basal and apical LV short-axis ultrasound images in 30 asymptomatic patients (29 +/- 9 years, 9 males) scheduled for percutaneous closure of an ASD before and 1-day after transcatheter ASD closure. All data were offline analyzed with Echopac 7.0 software. After transcatheter ASD closure, there was no significant difference in peak apical rotation and time to the peak (P0.05 for both). However, a significantly improved basal rotation was recorded, including significantly increased peak clockwise rotation (-7.1 +/- 3.2 degrees vs. -5.4 +/- 2.9 degrees , P = 0.014), decreased initial counterclockwise rotation (2.0 +/- 1.8 degrees vs. 5.1 +/- 3.2 degrees , P0.001) and shortened time to peak clockwise rotation (105.5 +/- 16.5% vs. 118.0 +/- 18.5% of systolic period, P = 0.001). LV twist was significantly improved in patients with ASD after the device closure (16.1 +/- 6.7 degrees vs. 12.2 +/- 6.3 degrees , P = 0.001), whereas there was no significant difference in peak untwisting rate, time to the peak and untwisting during IVRT (P0.05 for all). In conclusion, LV systolic twist could be significantly improved but diastolic untwisting remained unchanged after transcatheter ASD closure. This improvement was mainly attributed to the improved LV basal rotation rather than the unchanged apical rotation.