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Our hospital completes the world's first case of reverse closure of patent foramen ovale via internal jugular vein puncture

Updated: Dec 24, 2020
From: Department of Structural Heart Diseases
Edited by: Liu Huiting

On December 16, the team led by Professor Zhang Yushun created another miracle and spent 5 hours successfully accomplishing the world's first case of transcatheter closure of patent foramen ovale (PFO) complicated with atrial septal aneurysm through the internal jugular vein puncture.

Two months ago, a male patient, surnamed Wang, suddenly suffered from movement disorder of his left upper limb and was unable to move normally. Cranial MRI at a local hospital prompted the sign of "cerebral infarction", leading to cerebral hemorrhage during the treatment. He was transferred to another hospital in Xi 'an and discharged after treatment for 4 days. At 1 month after discharge, the patient experienced chest pain, hemoptysis and shortness of breath. He was diagnosed with pulmonary embolism and underwent inferior vena cava filter placement in another hospital. Postoperatively, he suffered from multiple thrombi in the veins of bilateral lower limbs. He suffered from cerebral infarction due to venous thrombosis entering his brain through the PFO, and subsequently developed pulmonary embolism. The physicians from the local hospital recommended Professor Zhang Yushun, the most authoritative expert in PFO surgery, to the patient.

On December 15, preoperative consultation was delivered with the department and determined that the patient was diagnosed with PFO complicated atrial septal aneurysm. In addition, the inferior vena cava filter was completely occluded by thrombi, leading to severe edema of bilateral lower limbs. Hence, it was impossible to utilize conventional route to insert the foramen ovale occluder, which significantly increased the surgical difficulty. Besides, the patient suffered from moderate anemia, liver insufficiency and large foramen ovale. If the conventional method was adopted to place the filter and close the foramen ovale, the microthrombi might form, resulting in abnormal embolism and cerebral infarction.

Professor Zhang Yushun proposed that it is extremely complicated to close the foramen ovale due to the surgical route. We’ve accumulated certain experience in closing atrial septal defects through the superior vena cava. Nevertheless, no scholars have closed the foramen ovale via the superior vena cava after literature review. It is an extremely challenging task than expected, simply like "walking or climbing up a mountain backwards". All team members should be mentally prepared. More importantly, the catheter and guide wire should be self-designed.

On December 16, the world's first case of transcatheter closure of PFO complicated with atrial septal aneurysm was performed in the First Affiliated Hospital of Xi’an Jiaotong University (XJTU). Considering the complexity of the surgery, Professor Zhang Yushun organized a qualified team consisting of Physician Wang Xingye, Physician Xie Xuegang, Dr. He Lu and nurses from Interventional Operation Room. Since it was impossible to identify the foramen ovale with the catheters available on market. Professor Zhang Yushun's team repeatedly molded the catheter with a hair dryer and eventually pinpointed the foramen ovale. However, it was difficult to place the guide wire in the proper position since the procedure resembled "walking backwards". After extensive attempts and arduous efforts, the team finally successfully closed the PFO complicated with atrial septal aneurysm by using the left coronary artery catheter, MPA1 catheter, 180-degree anti-bending long sheath and two-and-a half rounds of guide wires,etc. The total operation time was 5 hours. The team creates breakthrough and innovation in the surgical pattern, overcomes the occlusion of the original inferior vena cava route, reduces the risk of general anesthesia, avoids using the transesophageal echocardiography monitoring, alleviates surgical pain and simplifies the surgical procedures. Besides, it lowers the risk of surgery, maximizes clinical benefits and reduces the surgical expense.

Under the leadership of Professor Zhang Yushun, Department of Structural Heart Diseases of our hospital creates another groundbreaking miracle and completes the world's first case of "reverse transcatheter closure of patent foramen ovale complicated with atrial septal aneurysm via the jugular vein puncture" after accomplishing the first case of "closure of inferior atrial septal defect via the ventricular septal occluder" around the globe.

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