JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 70, NO.
16, SUPPL C, 2017
OBJECTIVES To evaluate the clinical efficacy and long-term outcome
of transcatheter occlusion in sinus of Valsalva aneurysm(RAVA)
ruptured into right atrium.
METHODS Between January 2006 and April 2013, fifteen patients [11
males and 4 females, aged from 21 to 48 years with an average age
of (35.50
8.79) years] with RASA ruptured into right atrium were
enrolled in this study. Domestic made Patent ductus arteriosus (six
patients) or small waist double-disk ventricular septal defect (nine
patients) occluders was applied for transcatheter closure. All the
patients were followed up in terms of rhythm change, residual
shunt, shape of occlude, and possible valve regurgitation by
echocardiography.
RESULTS All RAVA were confirmed by aortography, including eleven
with the rupture of right coronary sinus of Valsalva and four with the
rupture of the noncoronary sinus of Valsalva shunting into the right
atrium. NYHA function class was (2.56
0.63) before the occlusion.
Cardiac catheterization showed mean pulmonary arterial pressure and
Qp/Qs ratio were (25.38
8.21) mmHg and 1.34-2.81(1.93
0.39),
respectively. Aortic angiography showed that the RSA was 4-
10(6.42
1.92)at its narrowest end. There were no serious complication
during the operation and all the patients gained successful trans-
catheter closure without residual shunt. After transcatheter RAVS
occlusion, mean pulmonary artery pressure decreased to
(16.1
5.3) mmHg (P < 0.05), the diameter of right atrium, right
ventricle, left atrium and pulmonary and left ventricular end-diastolic
dimension decreased significantly (P<0.05). All the patients were
followed up for 35-132(78.6
28.57)months and improved obviously in
NYHA function class (distributed in I or II, P<0.01)last follow up.
There were no infective endocarditis, device displacement and em-
bolism, serious aortic regurgitation, myocardial ischemia, serious
arrhythmia or death in any of the patients during the follow up.
CONCLUSIONS Transcatheter closure of Valsalva aneurysm ruptured
into right atrium with the domestic made PDA and small-waist ven-
tricular septal defect occluder is safe and effective, with a good long
term prognosis.
GW28-e1163
Safety and efficacy of transcatheter closure of ruptured sinus of
Valsalva aneurysm using the occluder of patent ductus
arteriosus and ventricular septal defect
1 1 1 1
Jiawang Xiao, Zhu Xianyang, Wang Qiguang, Zhang Duanzhen,
Cui Chunsheng,1 Chen Huo Yuan,1 Meng Lili,1 Wang Shuang1
1
Department of Congenital Heart Disease, General Hospital, Shenyang
Military Area Command, Shenyang, Liaoning, China
OBJECTIVES To evaluate the safety and efficacy of transcatheter
interventional treatment for ruptured sinus of Va1sa1va aneurysm
(RSVA) using patent ductus arteriosus (PDA) occluder and ventricular
septal defect(VSD) occluder.
METHODS Twelve-three patients with RSVA (15 males and 6 females,
aged from 17 to 64 years with an average age of [36.8
14.2] years)
were enrolled and nonrandom divided into PDA occluder group and
VSD occluder group in this study. All the patients were followed up at
least 12 months.
RESULTS All patients were confirmed by aortography and were
successfully treated, which showing right coronary sinus ruptured
into the right ventricle in 8 patients and into right atrium in 10,
and noncoronary sinus aneurysm ruptured into the right atrium in
5 patients. Aortic root angiography showed that the RSA
was(6.2
1.8)mm at its narrowest end. PDA occluder (2-4 mm larger
than the narrowest end of the opening of aneurysm) was applied in
10 patients and modified small waist type VSD occluder (2-5 mm
larger than the narrowest end) was used in 12 patients in two
groups. There were no significant differences in age, gender,
operation time and the ruptured diameter measured by aorta
angiography (all P> 0.05). Neither residual shunt (except in one
case, it disappeared at 3 months follow-up) nor severe aortic
regurgitation was found by transthoracic echocardiography. The
follow up was performed for 12 months to 9 years, there was no
device embolization, aortic valve regurgitation related occluder,
infective endocarditis, serious arrhythmia, myocardial ischemia or
death in any of patients between the two groups.
CONCLUSIONS Transcatheter closure of RSVA is safe and effective,
VSD occluder and PDA occluder has their advantages for closing
different kinds of RSVA.
C151
GW28-e1164
Effectiveness and Safety of Levosimendan in Patients with Heart
Failure Complicated with Renal Insufficiency
Ming Zhao,1 Zhu Xianyang,1 Chen Jinru,1 Han Xiumin,1 Wang Shuang1
1
The General Hospital of Shenyang Military Region, Shenyang, China
OBJECTIVES To observe the efficacy and safety of levosimendan in
the treatment of heart failure based on conventional anti-heart failure
therapy and renal protection therapy in patients with heart failure
complicated with renal insufficiency.
METHODS There were all 62 cases of heart failure with renal insuffi-
ciency patients whom were hospitalized in Department of Congenital
Cardiology, General Hospital of Shenyang Military Area Command
during November 2012 and December 2015. They were 33 cases of male
patients, 29 cases of female patients. They were randomly divided
into control group(31cases) and treatment group(31cases). Control
group was given conventional therapy and dobutamine therapy(the
concentration of 3ug / kg / min continuous intravenous infusion of
10h, 1 / d, once every 7 days). The treatment group received both
conventional therapy and levosimendan therapy(using levosimendan
6ug / kg þ 5% glucose 20ml, 10min static push, and then 0.1ug / kg /
min concentration of continuous intravenous pump 24h). Serum
creatinine, creatinine clearance, N-terminal pro-brain natriuretic
peptide (NT-ProBNP) and left ventricular ejection fraction (LVEF)
were recorded at medication the same day, 24, 72 and 1 week after
drug administration.
RESULTS Cardiac function and renal function were improved in
both groups. Creatinine clearance rate, NT-ProBNP decreased
compared with before treatment. However, compared with the
control group, the increase of creatinine clearance rate and the
decrease of NT-ProBNP in the test group were more obvious
(P <0.05), and the patients had no obvious adverse reactions during
the treatment.
CONCLUSIONS Severe heart failure with renal dysfunction in patients
on the basis of conventional treatment plus levosimendan, for
patients with heart and kidney function improvement is safe and
effective.
GW28-e1165
Risk factors of pulmonary arterial hypertension in the elderly
patients with secundum atrial septal defect
Po Zhang,1 Zhu Xianyang,1 Wang Qiguang,1 Zhang Duanzhen,1
Han Xiumin,1 Sheng Xiaotang,1 Cui Chunsheng,1 Wang Shuang1
1
Department of Congenital Heart Disease, Cardiovascular research
institute of PLA, General Hospital of Shenyang Military Command,
Shenyang City, Liaoning Province, China
OBJECTIVES The objective of this study is to discover the risk factors
of pulmonary arterial hypertension(PAH) in the elderly patients with
secundum atrial septal defect(ASD).
METHODS Patients aged over 60 years old were included and un-
derwent right heart catheterization examination with local anesthesia
in General Hospital of Shenyang Military Command from April, 2000
to January, 2011. The patients were divided into different groups ac-
cording to the size of the ASD and the age.
RESULTS 1.78 patients were included, 17 cases were male (21.8 per
cent), 61 (78.2 per cent) were female, ratio was 1:3.6, mean age
was65.2
3.6years (range from 61 to 74 years), mean weight
was61.2
9.4 kg (range from 45 to 85 kg), mean height was 161.0
7.1
cm (range from 148.0 to 180.0 cm), mean body surface area(BSA)
was 1.61
0.15 m2 (range from 1.36 to 1.98 m2), mean size of ASD
was 22.2
6.0 mm (range from 6 to 32 mm), mean size of ASD
modified by BSA was 14.0
4.2 mm/ m2 (range from 3.6 to 22.0 mm/
m2). Mean systolic PAPwas46.4
13.0 mmHg (range from 22 to
80 mmHg), mean diastolic PAP was 16.2
5.6 mmHg (range from 5
to 30 mmHg), mean PAP was 26.3
7.2 mmHg (range from 13 to
43mmHg). 72 patients (92.3%) had pulmonary arterial hypertension
measured by right heart catheterization (RHC). 2. Pulmonary artery
pressure in patients with defects of >2 cm was higher than that in
patients with defects of <2 cm (P¼0.001). 3. Diameter of defects in
patients with pulmonary artery pressure >60mmHg was larger than
that in patients with pulmonary artery pressure < 60mmHg
(P¼0.039). 4. Pulmonary artery pressure has no correlation with age
and ASD defect size corrected by BSA in the patients aged over 60
(P>0.05).
C152 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 70, NO. 16, SUPPL C, 2017
CONCLUSIONS The patients aged over 60 with defects >2cm were
more likely to have severe PAH than those with defects < 2cm.
Pulmonary artery pressure measured by right heart catheterization
has no correlation with the age and ASD defect size corrected by
BSA.
GW28-e1166
Clinical characteristics of coronary artery disease in patients
with atrial septal defect
Duanzhen Zhang,1 Zhu Xianyang,1 Cui Chunsheng,1 Chen Huoyuan,1
Wang Shuang1
1
Department of Congenital Heart Disease, General Hospital of
Shenyang Military Command, Shenyang, China
OBJECTIVES Ostium secundum atrial septal defect (ASD) is a com-
mon cardiac anomaly that may be first encountered in the adult
because patients with ASD are usually asymptomatic when they are
young. Guidelines for coronary angiography suggest that all patients
aged older than 50 years receive coronary angiography before cardiac
or vascular surgery. However, the prevalence of coronary artery dis-
ease (CAD) in patients with ostium secundum ASD is still unclear. The
aims of this study were to investigate the prevalence of and the risk
factors for CAD in patients aged elder than 50 years with ostium
secundum ASD.
METHODS A retrospective study was performed on patients aged
> 50 years old with ostium secundum ASD. All the patients un-
derwent selective coronary angiography (SCA) after comprehensive
clinical evaluation, and the presence of CAD and the degree
of stenosis were observed. Significant CAD was defined as the
presence of more than 50% stenotic lesions during SCA. The risk
factors for CAD including gender, age, body mass index, blood
lipid, ASD size, pulmonary pressure and combined diseases were
investigated.
RESULTS A total of 525 patients (157 men, 29.9%) aged from 50
to 74 (58
6) years with body mass index of 23.5
3.4 kg/m2
were included in this study. 131 (25.0%) patients with systemic
hypertension, 32(6.1%) with diabetes, and 156 (29.7%) with atrial
flutter/ fibrillation were detected. The size of ASD was 22.3

8.9 mm and the pulmonary systolic/diastolic pressures were 44
16
/ 16
7 mmHg. Among the patients, significant CAD was detected in
68 patients (13.0%); 46 patients had one vessel disease, 18 had two
vessel disease and 4 had three vessel disease. Patients with CAD
exhibited male preponderance (19.1% versus 10.3%, P<0.01) and the
prevalence of CAD increased with age. No significant differences were
observed in body mass index, ASD size, pulmonary pressure, levels of
cholesterol, triglyceride and low density lipoprotein, and the per-
centage of atrial flutter/ fibrillation between the patients with CAD and
those without CAD. The prevalence of CAD was 7.7% in patients
with ASD without systemic hypertension and diabetes, 22.6% with
systemic hypertension, 31.2% with diabetes and 50.0% with both,
respectively. Systemic hypertension and diabetes were the indepen-
dent risk factors for CAD in patients with ASD. The overall prevalence
of CAD was 13.0% in men and 3.5 in women aged from 50 to 54 years
old, and the prevalence of CAD in patients without systemic hyper-
tension and diabetes at the same age was 5.6% in men and 2.6% in
women, respectively.
CONCLUSIONS Whether routine SCA be performed to detect CAD in
patients with ASD referred for cardiac surgery or device closure
depends on not only age but also gender and risk factors. Routine SCA
is recommended in man combined with hypertension and diabetes
even the age is younger than 50 years. However, it seems reasonable
to delay the cut-off age to perform SCA to 55 years for woman without
hypertension and diabetes.
RHEUMATIC AND VALVULAR HEART DISEASE
GW28-e0235
Assessment of left ventricular function in patients with chronic
aortic regurgitation by three dimensional strain imaging:
Comparison with cardiac magnetic resonance imaging
Qingyu Zeng,1 Li Zhang,1 Mingxing Xie1
1 1
Department of Ultrasound, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
OBJECTIVES The aims of this study were to evaluate the change of
geometry and function in patients with chronic aortic regur-
gitation(AR) using three-dimensional speckle tracing imaging(3D-STI)
and to discuss its relationship with conventional LV parameters of
systolic and diastolic function.
METHODS The aims of this study were to evaluate the change of ge-
ometry and function in patients with chronic aortic regurgitation(AR)
using three-dimensional speckle tracing imaging(3D-STI) and to
discuss its relationship with conventional LV parameters of systolic
and diastolic function.
RESULTS With the degree of regurgitation increasing, the measures of
EDVI, ESVI, LVMI, LVRI, EDSI, ESSI gradually increase, but the mea-
sures of Ld/Td, Ls/Ts gradually decrease. Comparing with control
group, the measures of GLS were lower, but RoA, Twist were larger in
moderate group. And GLS, GRS,Torsion, RoA, Twist were lower in
severe group. Correlation analysis showed that Ld/Td, Ls/Ts, LVRI,
GLS, GRS, RoA, Twist has a positive correlation and ESSI, EDSI, LVMI
has a negative correlation with LVEF. And GLS has a negative corre-
lation with E/E’. Multiple linear regression analysis identified GLS,
GRS, RoA as predictors of LV ejection fraction in all patients with AR
and LAd, EDSI, LVMI, LVRI as predictors of E/E’. Comparing with
CMR, the measures of EDV, ESV, SV, LVEF, LVM by 3D-STI were not
significant difference.
CONCLUSIONS Patients with moderate AR exits subclinical LV
longitudinal axis dysfunction in the early stage and an increased
apical rotation and an preserved radial, circumferential strain
maybe the factors to remain normal ejection fraction of left ven-
tricular. And the volumetric parameters and three dimensional
strain parameters can be related to left ventricular diastolic and
systolic function.
GW28-e0339
Novel simple biomarker for predicting clinical outcomes in
infective endocarditis patients with normal left ventricular
ejection fraction
Yuanhui Liu,1 Pengcheng He,1 Xuebiao Wei,1 Ning Tan,1 Danqing Yu,1
Jiyan Chen1
1
Guangdong General Hospital, Guangdong Cardiovascular Institute
OBJECTIVES Monocyte to high density lipoprotein cholesterol ratio
(MHR) was a newly emerged inflammatory marker. However, its
prognostic value in patients with infective endocarditis (IE) and
normal left ventricular ejection fraction (LVEF) was unclear.
METHODS We enrolled consecutive patients with IE and normal
LVEF. The association of MHR with in-hospital and long-term mor-
tality was evaluated. A receiver operator characteristic (ROC) curve
analysis was performed to evaluate the predictive value of MHR for
clinical outcomes. Multivariate logistic regression was used to deter-
mine the independent risk of MHR for adverse outcomes.
RESULTS Of 698 patients included, 44 (6.3%) developed in-hospital
mortality. The occurrence of in-hospital death (3.9, 4.3 and 10.8%,
p¼0.003) and major adverse clinical events (MACEs) (15.6, 20.9 and
30.6%, p<0.001) were increased from the lowest to the highest MHR
tertiles. ROC analysis demonstrated that MHR had good predictive
value for in-hospital mortality (AUC¼0.670, 95%CI¼0.58-0.76,
P<0.001), and was similar to C-reactive protein (AUC: 0.670 vs. 0.702,
P¼0.444). Furthermore, MHR>21.3 had a sensitivity of 74.4% and
specificity of 57.6% for predicting in-hospital mortality. Multiple
analysis showed that MHR>21.3 was an independent predictor of in-
hospital (OR¼3.21, 95%CI¼1.38-7.47, P¼0.007) and one-year death
(HR¼2.24, 95%CI¼1.21-4.17, P¼0.011). Kaplan-Meier survival curves
showed that patients with MHR>21.3 had an increased one-year
mortality relative to those without (P<0.001).
CONCLUSIONS Elevated MHR was independently associated with in-
hospital and long-term mortality in patients with IE and normal LVEF.
GW28-e0486
3D Echocardiographic evaluation of the association between
pulmonary hypertension and right ventricle function in patients
with severe rheumatic mitral stenosis
Jingjing Liu,1 Lingyun Fang1
Department of Ultrasound, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan