<International Circulation> : Thank you very much. Would you like to share with us any updates on ASD closure devices?

　　《国际循环》：非常感谢。您是否能和我们分享关于房间隔缺损（ASD）封堵器的进展？

　　Prof. Hijazi: Sure. So， ASD closure devices， as we all know， has to do with the communication between the right atrium and the left atrium. Again， it a common form of congential heart disease. About ten percent of children born with heart defects are born with ASD. In China alone there’s about one million patients with ASD. So it’s very common. And just from the historical point-of-view， the first case done in the cath lab was in 1974 done by a Dr. King out of the Oxford clinic in Louisiana. He did the first case in the world and since then many different device operations have come and gone because of complications and results. Right now there are a few devices approved inside the United States and outside as well that could really produce excellent results. The most common device in the United States is called the amplatzer device. There are a few variations of this device in China that look similar with slight modifications. And then the second device in the US is called the GORE HELEX device. It’s softer and made of gortex material. In Europe now one of the more common devices is the Occlutech  device. It looks like the amplatzer but has a slightly different pattern or design. The selection for ASD closure is based once again on the ECHO. The ASD has to be between the rims of the left artery and the right artery and should have good rims all around. The most important rims are the inferior， prosterior， and superior walls. The interior rim is the least important but as we follow patients after device closure there have been a few cases of what we call， “device erosion” which means that the disk of the device eroded through the wall and caused fluid around the heart in some cases caused death. I’m giving a talk tomorrow about the risks of device closure. Fortunately it’s rare but unfortunately if not detected right away can be lethal. So， to minimize risk we ask the cardiologist surgeon to pre-select the cases well and those patients where the aortic rim is very deficient to not oversize the device by more than 150 percent because we have noticed that a common denominator of all the patients that had device origin deficient rim and the operator oversized the device a lot. A reason for this is they are afraid the device with migrate or slip and they therefore chose a bigger device. The price you may pay for this is erosion. Otherwise， in my opinion， ASD closure is safer than open-heart surgery， just as effective as open-heart surgery and of course you can go home the same day. These patients will need to followed up on for their whole life， about every two to three years to be given an echo-cardio gram and an EKG to look for certain complications that may happen after a long time.

　　Hijazi教授：当然。我们知道，ASD封堵器是为了治疗左右心房间的分流。ASD也是先天性心脏病常见类型。约10%先天性心脏病儿童患ASD。仅中国就有约一百万ASD患者。从历史角度来说，第1例导管室中进行的房间隔封堵于1974年由美国路易斯安那州牛津医院King医生完成，他完成了世界第1例手术，从那开始，许多不同封堵器手术由于并发症和成功率的原因而来去匆匆。目前美国和世界其他地区有几种封堵器通过批准。这几种封堵器效果的确很好。美国最常用的封堵器叫Amplatzer封堵器。在中国这种封堵器基本相同，有一些小的改变。美国第二常用的封堵器叫GORE HELEX封堵器。这种封堵器更软，由gortex材料制成。在欧洲，最常见的封堵器之一是Occlutech封堵器，和Amplatzer看上去很相似，但在设计方面有一些不同。对于ASD封堵的选择仍基于超声结果。ASD应当在左侧动脉和右侧动脉边缘之间，且周围边缘应当良好。最重要的为下、后和上缘。下缘重要性最低，但我们随访封堵术后患者发现几例“封堵器侵蚀”并发症，即封堵器的盘侵蚀了心脏壁，造成患者心包积液，并导致一些患者死亡。我明天所做的报告会讨论封堵器风险。幸运的是封堵器并发症很罕见，不幸的是如果没有及时发现，则可能致命。因此，为了尽量减少风险，我们事先请心脏外科医师对患者进行选择，主动脉缘不足，超过封堵器尺寸150%的患者不适合进行封堵术。因为我们发现并发症共同原因是患者边缘不足，而术者使用了过大的封堵器，他们害怕封堵器会移动或滑动，而代价是发生封堵器侵蚀。此外，我的看法是ASD封堵比外科开胸手术更安全，有效性与外科手术相似，可以当天出院。这些患者需终生随访，每2~3年进行超声心动图和心电图检查，以发现可能出现的远期并发症。

　　<International Circulation> : Thank you very much for talking about the complications. What might be expected in the treatment of valvular heart disease by 2020?

　　《国际循环》：感谢您对并发症的介绍。到2020年，心脏瓣膜病的治疗方面可能会有哪些进展？

　　Prof. Hijazi: Valvular heart disease， as we discussed earlier， mainly has to do with the aortic valve and the mitral valve. This is a blossoming field as there are millions of patients with aortic valve stenosis and mitra valve regurgitation. Why one patients develops aortic valve stenosis and another patient does not we still don’t know. Some patients they have the tendency to build up calcium on the valve and basically the valve becomes null. The treatment is open-heart surgery and the surgeon removes these old， calcified valves and puts a new valve. These valves can be purely metallic or a tissue valve from either cows or pigs. Over the past about five years transcatheter valve implantation (TAVI) has emerged a lot. Now there are so many companies that make valves. The first company to be FDA approved was the interception valves. This was the Mercedes of the valves or the valve to compare with but there are other valves too. There are two valves now. The first is the interception valve in the United States and the other is being studied now and is called the electronic CoreValve. These two types have different designs as the CoreValve is self-expandable and now there are other valves that are being tested and evaluated in humans for the first time. We now have the St. Jude’s Portico valve， the Boston Scientific Lotus valve， and etc. There are so many valves coming so I think the future for transcatheter valve repair/replacement has a very bright and promising. I would not be surprise if in fifteen to twenty years from now about ninety percent of patients needing valve replacement have it by a catheter rather than open-heart surgery. So the future is very promising.

　　Hijazi教授：心脏瓣膜病主要是关于主动脉瓣和二尖瓣。这是快速发展的领域，因为有数百万的主动脉狭窄和二尖瓣反流患者。我们目前仍然不知道为什么有的患者会发生主动脉瓣狭窄而其他患者不会。有些患者有发生瓣膜钙化倾向，使瓣膜逐渐丧失功能。外科手术治疗是移除原有钙化瓣膜并植入新瓣膜。新瓣膜可以是完全金属瓣或从牛或猪获得的生物瓣。在大约5年时间中，经导管瓣膜植入术（TAVI）有了很大进展。目前有许多公司生产瓣膜。FDA批准的首个瓣膜是Interception瓣膜，性能非常优越。也有其他瓣膜。目前有两种瓣膜。第一种是美国的Interception瓣膜，另一种目前正在研究，叫CoreValve。这两种瓣膜设计不同，CoreValve瓣膜是自膨胀式瓣膜。目前还有其他一些正在人体中进行测试和评估的瓣膜。我们目前有圣犹达公司的Portico瓣膜以及波士顿科学公司的Lotus瓣膜等。有如此多瓣膜出现，我们认为经导管瓣膜修复/置换前景非常光明。如果在15~20年内，90%的需要进行瓣膜置换的患者会通过导管手术而非开胸手术，我并不会感到惊奇。因此未来非常有希望。