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Jingquan Z, Deyong L, Huimin C, Hua F, Xuebin H, Chenyang J, Yan L, Xuebin L, Min T, Zulu W, Yumei X, Jinlin Z, Wei Z, Xiaochun Z, Daxin Z, Yun Z, Changsheng M, Zei PC, Di Biase L. Intracardiac echocardiography Chinese expert consensus. Front Cardiovasc Med 2022; 9:1012731. [PMID: 36277762 PMCID: PMC9584059 DOI: 10.3389/fcvm.2022.1012731] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
In recent years, percutaneous catheter interventions have continuously evolved, becoming an essential strategy for interventional diagnosis and treatment of many structural heart diseases and arrhythmias. Along with the increasing complexity of cardiac interventions comes ever more complex demands for intraoperative imaging. Intracardiac echocardiography (ICE) is well-suited for these requirements with real-time imaging, real-time monitoring for intraoperative complications, and a well-tolerated procedure. As a result, ICE is increasingly used many types of cardiac interventions. Given the lack of relevant guidelines at home and abroad and to promote and standardize the clinical applications of ICE, the members of this panel extensively evaluated relevant research findings, and they developed this consensus document after discussions and correlation with front-line clinical work experience, aiming to provide guidance for clinicians and to further improve interventional cardiovascular diagnosis and treatment procedures.
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Affiliation(s)
- Zhong Jingquan
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China,Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China,*Correspondence: Zhong Jingquan,
| | - Long Deyong
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China,Long Deyong,
| | - Chu Huimin
- Ningbo First Hospital, Zhejiang University, Ningbo, China
| | - Fu Hua
- West China Hospital, Sichuan University, Chengdu, China
| | - Han Xuebin
- The Affiliated Cardiovascular Hospital, Shanxi Medical University, Taiyuan, China
| | - Jiang Chenyang
- Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, China
| | - Li Yan
- Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Li Xuebin
- Peking University People’s Hospital, Beijing, China
| | - Tang Min
- Fuwai Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wang Zulu
- General Hospital of Northern Theater Command, Shenyang, China
| | - Xue Yumei
- Guangdong Provincial People’s Hospital, Guangzhou, China
| | | | - Zhang Wei
- Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | | | - Zhou Daxin
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhang Yun
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ma Changsheng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Paul C. Zei
- Brigham and Women’s Hospital, Boston, MA, United States
| | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
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Yan C, Wan L, Li H, Wang C, Guo T, Niu H, Li S, Yundan P, Wang L, Fang W. First in-human modified atrial septostomy combining radiofrequency ablation and balloon dilation. Heart 2022; 108:1690-1698. [PMID: 35676068 DOI: 10.1136/heartjnl-2022-321212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/18/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Preclinical research suggests that the combined use of radiofrequency ablation and balloon dilation (CURB) could create stable interatrial communications without device implantation. This study examined the first in-human use of CURB for modified atrial septostomy in patients with severe pulmonary arterial hypertension (PAH). METHODS Between July 2018 and October 2021, CURB was performed in 19 patients with severe PAH (age: 31.5±9.1 years; mean pulmonary artery pressure: 73 mm Hg (IQR: 66-92); pulmonary vascular resistance: 18.7 Wood units (IQR: 17.8-23.3)). Under guidance of intracardiac echocardiography and three-dimensional location system, (1) fossae ovalis was reconstructed and ablated point-by-point with radiofrequency; (2) then graded balloon dilation was performed after transseptal puncture and the optimal size was determined according to the level of arterial oxygen saturation (SatO2); (3) radiofrequency ablation was repeated around the rims of the created fenestration. The interatrial fenestrations were followed-up serially. RESULTS After CURB, the immediate fenestration size was 4.4 mm (IQR: 4.1-5.1) with intracardiac echocardiography, systolic aortic pressure increased by 10.2±6.9 mm Hg, cardiac index increased by 0.7±0.3 L/min/m2 and room-air resting SatO2 decreased by 6.2±1.9% (p<0.001). One patient experienced increased pericardiac effusion postoperatively; the others had no complications. On follow-up (median: 15.5 months), all interatrial communications were patent with stable size (intraclass correlation coefficient=0.96, 95%CI:0.89 to 0.99). The WHO functional class increased by 1 (IQR: 1-2) (p<0.001) with improvement of exercise capacity (+159.5 m, P<0.001). CONCLUSION The interatrial communications created with CURB in patients with severe PAH were stable and the mid-term outcomes were satisfactory. TRIAL REGISTRATION NUMBER NCT03554330.
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Affiliation(s)
- Chaowu Yan
- Department of Structural Heart Disease, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Linyuan Wan
- Department of Echocardiography, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Hua Li
- Department of Cardiology, Beijing Tongren Hospital, Beijing, China
| | - Cheng Wang
- Department of Cardiology, Xuzhou Medical University Affiliated Hospital, Xuzhou, Jiangsu, China
| | - Tingting Guo
- Center for Respiratory and Pulmonary Vascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Hanxu Niu
- Johnson and Johnson Medical China Ltd, Shanghai, China
| | - Shiguo Li
- Department of Structural Heart Disease, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Pingcuo Yundan
- Department of Structural Heart Disease, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Lei Wang
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
| | - Wei Fang
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng, Beijing, China
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4
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Sun W, Zou H, Yong Y, Liu B, Zhang H, Lu J, Shen Y, Li P, Xu T, Chen X, Du A, Jiang M, Hua Y, Sheng Y, Zhou B, Lotan C, Kong X. The RAISE Trial: A Novel Device and First-in-Man Trial. Circ Heart Fail 2022; 15:e008362. [PMID: 35378984 DOI: 10.1161/circheartfailure.121.008362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Currently, standard medical therapies have limited effects on heart failure with preserved ejection fraction (HFpEF), which impacts on the life quality and survival of patients. This study aimed to evaluate the safety and efficacy of the percutaneous radiofrequency ablation-based interatrial shunting for HFpEF with a novel atrial septostomy device. METHODS A preclinical study in 11 normal domestic pigs and the first-in-man study in 10 patients with HFpEF were performed. The major safety events and interatrial shunt performance were evaluated at baseline, 1 month, 3 months, and 6 months post-procedure in both animals and human patients. The clinical functional status was also assessed in the first-in-man study. RESULTS Percutaneous radiofrequency ablation-based interatrial shunting therapy was performed successfully both in animals and patients. In the animal study, a left-to-right interatrial shunt was created with a mean defect size of 5.5±2.2 mm without procedure-related safety events. Seven pigs showed the continuous shunting with a mean defect size of 4.1±1.5 mm at 6 months. In the first-in-man study, a median interatrial defect diameter of 5.0 (4.0-6.0) mm was measured immediately. No major safety events including death and thromboembolism were observed. The continuous shunting with the defect size of 4.0 (3.0-4.0) mm could still be observed in 7 patients at 6 months. The clinical status was significantly improved with NT-proBNP (N-terminal pro-B-type natriuretic peptide) reduced by 2149 pg/mL ([95% CI, 204-3301] P=0.028), with 6-minute walk distance increased by 88 m ([95% CI, 50-249] P=0.008) and with New York Heart Association class improved in 8 patients at 6 months. CONCLUSIONS The present results showed that percutaneous radiofrequency ablation-based interatrial shunting was a safe and potentially effective therapy for HFpEF, providing a nonpharmacological and nonimplanted option for HFpEF management. REGISTRATION URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1900027664.
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Affiliation(s)
- Wei Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.).,Cardiovascular Device and Technique Engineering Laboratory of Jiangsu Province, Nanjing, China (W.S., X.K.)
| | - Huayiyang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.)
| | - Yonghong Yong
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.)
| | - Boxun Liu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.)
| | - Hao Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.)
| | - Jieyu Lu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.)
| | - Yihui Shen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.)
| | - Peng Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.)
| | - Tianhua Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.)
| | - Xuguan Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.)
| | - Anning Du
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.)
| | - Ming Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.)
| | - Yang Hua
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.)
| | - Yanhui Sheng
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.)
| | - Bin Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.).,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, China (B.Z., X.K.)
| | - Chaim Lotan
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (C.L.)
| | - Xiangqing Kong
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (W.S., H. Zou, Y.Y., B.L., H. Zhang, J.L., Y. Shen, P.L., T.X., X.C., A.D., M.J., Y.H., Y. Sheng, B.Z., X.K.).,Cardiovascular Device and Technique Engineering Laboratory of Jiangsu Province, Nanjing, China (W.S., X.K.).,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, China (B.Z., X.K.)
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5
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Corno AF, Adebo DA, LaPar DJ, Salazar JD. Modern advances regarding interatrial communication in congenital heart defects. J Card Surg 2021; 37:350-360. [PMID: 34842296 DOI: 10.1111/jocs.16166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The interatrial communication, one of the most frequent congenital heart defects, represents an important intracardiac shunt between systemic and pulmonary circulations. Direction and magnitude of the interatrial shunting depends upon several features, including defect size, shape and location, pressure difference between right and left atrium, and difference in right and left ventricular compliance. METHODS In this review article, the presence or absence of interatrial communication, and its role, have been analyzed, as they can have a critical impact on the cardiovascular physiopathology, and the interatrial communication can prove to be either clinically harmful, useful or indispensable. Accordingly, the utility and role of the interatrial communication in modern congenital, pediatric and adult, disease has evolved, with modification of the indications to close, maintain patency, or create an interatrial communication. RESULTS The interatrial communication and shunting can be manipulated to maximize the oxygen delivery to the tissues, accordingly with the underlying congenital heart defect. While not always relevant to patients with bi-ventricular circulations, this becomes extremely important in children and adults with complex congenital heart defects. CONCLUSIONS With improving long-term survival for the vast majority of congenital heart patients, an advanced understanding of the role and utility of the interatrial communication, and of all the possibilities of its manipulation, is essential to improve the patient outcomes.
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Affiliation(s)
- Antonio F Corno
- Department of Pediatric and Congenital Heart Surgery, Houston Children's Heart Institute, Memorial Hermann Children's Hospital, University of Texas Health, McGovern Medical School, Houston, Texas, USA
| | - Dilachew A Adebo
- Department of Pediatric and Congenital Cardiology, Houston Children's Heart Institute, Memorial Hermann Children's Hospital, University of Texas Health, McGovern Medical School, Houston, Texas, USA
| | - Damien J LaPar
- Department of Pediatric and Congenital Heart Surgery, Houston Children's Heart Institute, Memorial Hermann Children's Hospital, University of Texas Health, McGovern Medical School, Houston, Texas, USA
| | - Jorge D Salazar
- Department of Pediatric and Congenital Heart Surgery, Houston Children's Heart Institute, Memorial Hermann Children's Hospital, University of Texas Health, McGovern Medical School, Houston, Texas, USA
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