携带人B型利钠肽基因重组腺病毒对慢性心力衰竭大鼠心功能的影响

目的 观察外源基因人B型利钠肽对慢性心力衰竭(心衰)大鼠心功能的影响.方法 30只入选心衰大鼠,随机分为携带人B型利钠肽基因重组腺病毒组(Ad-hBNP组)、重组空白腺病毒组(Ad-Track组)、生理盐水组(NS组),另设不予任何治疗的假手术组作为对照;分别经腹腔注射予以相应治疗,每周1次,共4周.4周后实验动物行超声心动图、血流动力学检测,酶联免疫吸附试验检测血清外源基因人B型利钠肽水平,全心质量指数检测.结果 间断Ad-hBNP治疗后,Ad-hBNP组心衰大鼠室间隔厚度、左室后壁厚度、左室舒张末径、左室收缩末径[(2.34±0.29)mm、(2.28±0.18)mm、(6.50±0.42)mm、(3.54±0.59)mm]显著低于Ad-Track组[(2.71±0.35)mm、(3.02±0.85)mm、(7.71±0.83)mm、(4.72±0.80)mm,均为P＜0.05]和NS组[(2.78±0.23)mm、(2.83±0.53)mm、(7.34±0.97)mm、(4.55±0.77)mm,均为P＜0.05],而左室射血分数、左室短轴缩短率[(79.27±7.01)%、(43.38±6.73)%]显著高于Ad-Track组[(70.85±4.81)%、(35.72±3.68)%,均为P＜0.01]和NS组[(69.67±6.90)%、(34.91±5.10)%,均为P＜0.01].Ad-hBNP组与Ad-Track组和NS组比较:心率显著降低,左室收缩压显著升高[为(131.79±15.76)mm Hg(1 mm Hg=0.133 kPa)、(112.99±32.35)mm Hg、(117.13±15.26)mm Hg],左室内压最大上升速率显著升高[分别为(5037.20±430.41)mm Hg/s、(4217.40±1354.15)mm Hg/s、(4310.50±1293.97)mm Hg/s;P＜0.05];左室内压最大下降速率显著升高[分别为(-4382.00±1304.79)mm Hg/s、(-3725.00±791.34)mm Hg/s、(-3890.00±1043.73)mm Hg/s,均为P＜0.05];左室舒张末压降低[分别为(-4.24±4.00)mm Hg、(21.99±6.80)mm Hg、(18.00±12.25)mm Hg,均为P＜0.01];心脏质量及全心质量指数均降低.结论 间断给予Ad-hBNP能够有效地改善心衰大鼠心脏结构和功能.

Abstract：

Objective To evaluate the therapeutic effect of hBNP on rats with chronic heart failure (CHF). Methods Thirty CHF rats defined by echocardiography at 12 weeks post abdominal aortic constriction were randomly divided into Ad-hBNP group (2. 5 × 1010 VP/ml NS Ad-hBNP 1 ml/week ×4,n = 14), Ad-Track group ( n = 8 ), placebo group ( NS, n = 8 ), 10 sham-operated rats served as control group. After 4 weeks treatment, cardiac function was evaluated by echocardiography and hemodynamic measurements. Heart weight (HW) and HW/body weight (BW) ratio were determined. Results IVS,LVPW, LVEDD and LVESD were significantly reduced in the Ad-hBNP group [(2. 34 ±0. 29)mm, (2. 28 ± 0. 18)mm, (6. 50 ±0. 42)mm, (3.54 ±0. 59) mm] than those in the Ad-Track group[(2. 71 ±0. 35) mm,(3.02 ±0.85)mm, (7.71 ±0.83)mm, (4.72 ±0.80)mm] and in the NS group [(2.78 ±0.23)mm,(2. 83 ± 0. 53 ) mm, (7. 34 ± 0. 97 ) mm, (4. 55 ± 0. 77 ) mm, all P ＜ 0. 05]. The LVEF and LVFS of the Ad-hBNP group [(79. 27 ±7.01 )%, (43.38 ±6. 73)%] were significantly higher than in the Ad-Track group[(70.85±4.81)%, (35.72 ±3.68)%] and in the NS group[(69.67 ±6.90)%, (34.91 ±5.10)%, all P ＜0. 01]. HR[(417.48 ±32. 57) beats/min, (446. 85 ±61.49) beats/min, P ＜0. 05;(440. 83 ±32. 18) beats/min , P ＜0. 05], LVEDP[( - 4. 24 ±4. 00) mm Hg( 1 mm Hg =0. 133 kPa);(21.99 ±6. 80) mm Hg, P ＜0. 01; ( 18.00 ± 12. 25)mm Hg, P＜0. 01] were significantly decreased and while LVSP[(131.79 ±15.76) mm Hg; (112.99 ±32.35) mm Hg, P＜0.05; (117.13 ±15.26)mmHg], +dP/dtmax[(5037.20 ±430.41) mm Hg/s; (4217.40 ± 1354. 15)mm Hg/s, P ＜0.05;(4310. 50 ± 1293.97 ) mm Hg/s, P ＜ 0. 05] and - dP/dtmax [( - 4382. 00 ± 1304. 79 ) mm Hg/s;(-3725.00±791.34) mm Hg/s, P ＜ 0.05; ( - 3890.00 ± 1043.73) mm Hg/s, P ＜ 0.05] were significantly increased in Ad-hBNP group than in Ad-Track group and NS group ( all P ＜ 0. 05 ). HW and HW/BW were also decreased in Ad-hBNP group than in the Ad-Track group and the NS group. Conclusion Exogenous hBNP improved the cardiac function and attenuated remodeling in CHF rats.     

高龄初产妇妊娠晚期高脂血症性重症胰腺炎一例

患者女,36岁,初产妇,孕32周.因上腹胀痛不适1d于2012年2月25日中午入院 体检:T 37.9℃,R 23次/min,P 112次/min,BP 141/86 mm Hg(1 mm Hg =0.133 kPa),SPO296％.     

基于移动互联网的高血压自我管理对降压效果评价的Meta分析

目的:对基于移动互联网的患者高血压自我管理方式对高血压患者血压控制效果相关性研究报道的数据进行Meta分析。方法:计算机检索多个中英文数据库,包括PubMed、Cochrane图书馆、中国期刊全文数据库和万方数据库。纳入移动互联网支持的综合高血压管理模式对高血压患者血压控制效果的随机对照试验。进行文献质量评价后,采用Rev Man5. 3进行数据分析。结果:纳入文献12篇,总样本量4 015例。Meta分析结果显示:互联网干预组较常规组显著降低了高血压患者的血压水平,SBP下降3. 41 mm Hg(1 mm Hg=0. 133 k Pa),(95%CI:3. 49～3. 32 mm Hg; I~2=100%,P<0. 001),DBP下降1. 5 mm Hg(95%CI:-2. 2～-0. 8 mm Hg; I~2=62%,P<0. 001)。按照干预周期进行亚组分析,干预时间在1～6个月之间,干预组较对照组SBP和DBP分别下降2. 6 mm Hg和1. 32 mm Hg,干预周期在6～12个月之间,干预组较对照组SBP和DBP分别下降3. 0 mm Hg和1. 73 mm Hg。结论:利用集成3G/4G无线网络实时数据传输,加密云存储和手机APP为高血压患者自我管理提供决策支持的综合管理模式有较好的高血压管理效果,期待在高血压患者的血压控制方面评价互联网模式长期管理效果的研究,尤其是在我国社区,并进一步开展相关的卫生经济学评价。     

老年心衰伴与不伴心肌缺血患者动态血压PP与PPI改变的临床意义

目的为观察老年冠心病心衰患者伴与不伴心肌缺血(MI)改变时动态血压的脉压(PP)和脉压指数(PPI)的变化,并探讨其临床意义。方法有患者均符合WHO冠心病及NYHA关于心衰的诊断和分级标准。对患者同步进行24 h的动态血压(ABPM)与动态心电图(AECG)监测,符合本研究条件的冠心病心衰患者共94例。根据AECG上有无MI改变分为两组:MI组:48例,男性12例,女性36例,年龄60～85岁,其中心衰Ⅱ级16例,Ⅲ～Ⅳ级32例;无MI组:46例,男性9例,女性37例,年龄60～82岁,其中心衰Ⅱ级20例,Ⅲ～Ⅳ级26例。观察指标:24 h平均收缩压(SBP)、舒张压(DBP)、PP和PPI,白昼平均SBP、DBP、PP和PPI,夜间平均SBP、DBP、PP和.PPI。PP=SBP-DBP,PPI=PP/SBP。MI诊断标准为:J点后60 ms处ST段呈缺血型压低1 mm,持续1min,两阵间最短间隔时间为1 min。结果伴有MI患者的24 h、白昼和夜间平均SBP[分别为(125.20±21.15)mm Hg、(126.02±21.16)mmHg、(123.67±22.02)mm Hg]均明显高于不伴MI的患者[分别为(116.78±11.08)mm Hg、(117.89±11.06)mm Hg、(114.96±13.48)mmHg](P<0.05),而舒张压无差异[分别为(68.10±11.64 mm Hg、(68.61±11.92)mm Hg、(66.79±11.57)mmHg及(67.35±7.03)mm Hg、(68.30±7.17)mmHg、(65.65±7.99)mm Hg](P>0.05)。伴有MI患者的24 h、白昼和夜间PP、PPI[分别为(56.96±18.43)mm Hg、(0.48±0.08)mm Hg,(57.15±18.20)mm Hg、(0.45±0.08)mm Hg,(57.21±19.51)mm Hg、(0.46±0.09)mm Hg]均明显高于不伴MI的患者[分别为(49.41±10.43)mm Hg、(0.42±0.06)mm Hg,(49.59±10.32)mm Hg、(0.41±0.06) mm Hg,(49.52±11.38)mm Hg、(0.42±0.06)mm Hg](P<0.05～0.001)。结论本研观察结果发现,伴有MI的冠心病心衰患者中主要表现为SBP增高。对老年而言,大动脉硬化程度远大于外周阻力,SBP较DBP上升更明显,甚至出现SBP升高,DBP下降,从而导致PP增大的情况,故PP能更客观地反映血管病变程度。在对两组ABPM的PP和PPI进一步分析发现,伴有MI的冠心病心衰患者,24 h、白昼和?     

盐酸卡替洛尔滴眼液降眼压疗效观察

目的 观察β-受体阻滞剂盐酸卡替洛尔滴眼液对患者24 h眼压的影响.方法 选取30例既往无抗青光眼药物使用史的患者,测量患者用药前24 h眼压(时间点为2:00 AM、6:00 AM、10:00 AM、2:00 PM、6:00 PM、10:00 PM).测量后给予患者盐酸卡替洛尔滴眼液点眼治疗,每天7:00 AM及7:00 PM各1次,每次1～2滴.观察患者用药15 d后的24 h眼压,并进行对比分析.结果 用药前患者24 h内6个检测点平均眼压分别为(19.77±2.51、19.52±2.34、20.38±2.71、20.07±3.65、19.97±4.10、19.97±4.31) mm Hg(1 mm Hg=0.133 kPa),用药后患者平均眼压分别为(17.12±2.38、17.42±2.60、18.18±2.36、18.02±3.77、17.72±3.17、17.35±3.40)mm Hg,用药前后患者平均眼压差异有统计学意义(t=11.68,P=0.000).其中用药前后日间平均眼压下降幅度为(2.46±2.05)mm Hg,夜间平均眼压下降幅度为(2.17±1.88) mm Hg,两者差异无统计学意义.结论 盐酸卡替洛尔滴眼液可有效降低患者眼压,其24 h降眼压幅度是稳定的.

Abstract：

Objective To investigate the effect of carteolol hydrochloride eye drops on 24-hour variation of intraocular pressure (IOP). Methods The 30 patients who had never used any anti-glaucoma eye drops were chosen, and their 24-hour variation of IOP (at 2:00 AM, 6:00 AM, 10:00 AM, 2:00 PM, 6:00 PM, 10:00 PM) were measured. Then carteolol hydrochloride eye drops were used twice a day (7:00 AM and 7:00 PM), 1-2 drops each time. Fifteen days later, their 24-h IOP was measured again and the data were analyzed. Results The average IOP at six monitoring points before treatment were (19.77±2.51) mm Hg, (19.52±2.34) mm Hg, (20.38±2.71) mm Hg, (20.07±3.65) mm Hg, (19.97±4.10) mm Hg and (19.97±4.31) mm Hg, the corresponding data after 15 days of treatment were (17.12±2.38) mm Hg, (17.42±2.60) mm Hg, (18.18±2.36) mm Hg, (18.02±3.77) mm Hg, (17.72±3.17) mm Hg and (17.35±3.40) mm Hg (t=11.68, P=0.000). The difference before and after treatment was (2.46±2.05) mm Hg during day and (2.17±1.88) mm Hg during night, and no significant difference was found between them. Conclusions Carteolol hydrochloride eye drops could significantly reduce the IOP, the decreased extent of 24-h IOP is stable.     

高血压患者血压水平和脉压及脉压指数与蛋白尿的关系

目的高血压患者收缩压(SBP)、舒张压(DBP)、脉压(PP)及脉压指数(PPI)与蛋白尿的关系,并进一步评价各自在反映蛋白尿严重程度上的优劣和(或)一致性.方法将所有研究对象按SBP≥180 mm Hg(68例)、160～179 mm Hg(81例)、140～159 mm Hg(57例)分为3组;按DBP≥110 mm Hg(59例)、100～109 mm Hg(79例)、90～99 mm Hg(67例)分为3组;按PP≤40 mm Hg(39例)、41～60 mm Hg(61例)、61～80 mm Hg(56例)和大于80 mm Hg(43例)分为4组;按PPI≤0.400(50例)、0.401～0.500(70例)、0.501～0.600(62例)和大于0.600(17例)分为4组.采用全自动散射比浊仪及全自动生化分析仪测定所有研究对象的尿蛋白和血脂水平,比较各组蛋白尿的发生率.结果各组间性别、年龄、总胆固醇、甘油三酯、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇水平均无显著性差异.随收缩压、舒张压、脉压及脉压指数的增加,蛋白尿的发生率明显增高(%P%<0.05).结论收缩压、舒张压、脉压水平和脉压指数与蛋白尿的发生密切相关,且4者在反映蛋白尿的发生上具有较好的一致性.     

肺动脉平滑肌的氯离子通道

正常肺动脉压力为15～30 mm Hg/5～10 mm Hg(1 mm Hg=0.133 kPa),平均压力为10～20 mm Hg.动脉收缩压>30 mm Hg者称为肺动脉高压.虽然对于肺动脉高压的研究已有100多年历史,但是其发病机制至今尚未完全明确 [1-2].     

高血压患者脉压对尿微量白蛋白的影响

目的 探讨高血压患者脉压变化对尿微量白蛋白(UmALB )排泌量的影响.方法 选取160例原发性高血压患者,根据脉压(PP)水平分成PP＜70 mm Hg组,77例和PP≥70 mm Hg组,83例,两组均行系统降压治疗1月,将血压达标(BP 140/90 mm Hg)者再继续治疗观察5月,分析这些患者治疗前后PP及UmALB 的变化,并进行比较.结果 PP＜70 mm Hg组治疗前后UmALB量无明显改变.PP≥70 mm Hg组治疗后有60例血压达标,该组总的UmALB分泌量减少,其中治疗后PP＜70 mm Hg病例比治疗后PP≥70 mm Hg病例的UmALB分泌量明显减少(P＜0.05).结论 高血压患者随着脉压变化可引起UmALB 排泌量的变化,PP从≥70 mm Hg降至PP＜70 mm Hg时UmALB排泌量显著下降.     

血压变异性与脑血管病住院患者脑小血管病关系的研究

目的研究血压变异性(blood pressure variability,BPV)与脑血管病患者脑小血管病(cerebral small vessel disease,CSVD)的相关性。方法收集我院神经内科住院的脑血管病患者341例,完成24h动态血压监测及头颅MRI扫描,获得血压变异标准差(SD)等BPV相关参数并根据MRI上CSVD严重程度进行总体评分,根据影像学上总体CSVD评分分为CSVD 0分组55例,CSVD 1分组117例,CSVD 2分组86例,CSVD 3分组49例,CSVD≥4分组34例。收集患者一般临床资料,采用logistic回归分析BPV参数是否为CSVD的独立危险因素。结果不同CSVD评分组性别、糖尿病、高脂血症、吸烟及体质量指数比较,无统计学差异(P0.05),而年龄、高血压比例比较,差异有统计学意义(P0.01);不同CSVD评分组夜间收缩压SD、夜间舒张压SD、夜间动脉压SD比较,无统计学差异(P0.05)。CSVD 0、1、2、3、≥4分组24h收缩压SD[(11.7±3.0)mm Hg(1mm Hg=0.133kPa)vs (12.6±3.1)mm Hg vs(13.6±3.3)mm Hg vs(13.7±3.7)mm Hg vs(13.7±3.2)mm Hg]、昼间收缩压SD[(11.1±3.0)mm Hg vs(12.0±3.2)mm Hg vs(13.0±3.2)mm Hg vs(13.7±3.8)mm Hg vs(12.8±3.1)mm Hg]、24h舒张压SD[(8.4±1.9)mm Hg vs(9.0±2.3)mm Hg vs(9.1±2.2)mm Hg vs(9.7±2.4)mm Hg vs(9.1±2.8)mm Hg]、昼间舒张压SD[(7.9±1.8)mm Hg vs (8.5±2.5)mm Hg vs (8.6±2.3)mm Hg vs (9.4±2.2)mm Hg vs (8.6±3.2)mm Hg]、24h动脉压SD[(9.1±1.9)mm Hg vs (9.9±2.4)mm Hg vs (10.4±2.3)mm Hg vs (10.6±2.4)mm Hg vs(10.1±2.5)mm Hg]、昼间动脉压SD[(8.9±1.9)mm Hg vs (9.5±2.5)mm Hg vs (10.0±2.3)mm Hg vs (10.4±2.4)mm Hg vs (9.7±2.8)mm Hg]比较,差异有统计学意义(P0.05,P0.01)。logistic回归分析显示,24h收缩压SD是CSVD的独立危险因素(P=0.032)。结论 24hBPV及昼间BPV与CSVD严重程度存在一定相关性。     

经皮二尖瓣球囊扩张术治疗老年人二尖瓣狭窄的临床观察

目的 探讨经皮二尖瓣球囊扩张术(PBMV)治疗老年人二尖瓣狭窄的疗效、安全性及并发症的预防.方法 采用改良的房间隔定位法及运用跨二尖瓣技术对老年二尖瓣狭窄患者行逐步球囊扩张.手术前后分别记录即刻左心房压、肺动脉平均压、二尖瓣跨瓣压差及二尖瓣口面积,并进行手术后随访.结果 PBMV有效扩大了二尖瓣口面积,与术前比较,术后左心房压下降[分别为(25.3±6.7)mm Hg(1 mm Hg=0.133 kPa)与(16.4±5.8)mm Hg]、二尖瓣跨瓣压下降[分别为(17.6±6.7)mm Hg与(6.8±2.9)mm Hg]、肺动脉压下降[分别为(38.6±12.1)mm Hg与(29.2±9.8)mm Hg],二尖瓣口面积增加[分别为(1.05±0.22)cm2与(1.61±0.38)cm2],心功能明显改善,差异均有统计学意义(P＜0.05或P＜0.01).随访结果表明,PBMV疗效稳定.结论 PBMV操作技术的改进能明显改善老年患者二尖瓣狭窄症状,显著降低手术的并发症.

Abstract：

Objective To evaluate the efficacy and safety of the improved percutaneous balloon mitral valvuloplasty (PBMV) in elderly patients with mitral stenosis. Methods Elderly patients with severe mitral stenosis received an improved PBMV which included a modified way of atrial septal puncture and technique across the mitral valve. The left atrial pressrue (LAP), mean pulmonary pressure (MPA), mean gradient across the mitral value (MPG) and mitral valve area (MVA) were recorded and compared before and after the operation. Long term follow up were made. Results After operation, the LAP decreased [(25.3±6.7) mm Hg vs.(16.4±5.8) mm Hg,1 mm Hg=0.133 Kpa], MPG decreased [(17.6±6.7) mm Hg vs.(6.8±2.9) mm Hg], MPA decreased [(38.6±12.1) mm Hg vs. (29.2±9.8) mm Hg], MVA increased [(1.05±0.22)cm2 vs.(1.61±0.38)cm2] and the New York heart association heart function classification improved. The follow-up result showed that the effect of PBMV was constant. Conclusions Improved PBMV may be an effective and safe measure for patients with mitral stenosis.     

The Amplatzer septal occluder

The Amplatzer Septal Occluder is made from a Nitinol wire mesh shaped into 2 disks with a connecting waist, which serves to center the device in the defect while occluding it. The Amplatzer device is also available in a configuration with no central waist for use in patients with patent oval foramen, or multi-perforated aneurysm of the interatrial septum. For the purposes of this review, we analysed our experience using the Amplatzer device in 150 patients with interatrial communications. Of these, 104 had a defect within the oval fossa, 33 a patent oval foramen, and 13 had undergone fenestration of a Fontan procedure. Of those with defects within the oval fossa, a device was implanted in 100 patients, and 2 of these patients subsequently required surgical intervention, 1 because of migration and the other because of malformation of the device. Of the remaining 98 patients, complete occlusion has been achieved in 90% at 1 year. Any residual leaks are either trivial or small. In those with a patent oval foramen, the septal occluder was used to close 20, whilst the device designed specifically for this purpose was used in 13. On follow-up contrast echocardiography, only 2 patients have a small residual right-to-left shunt. Complete occlusion was achieved for all the Fontan fenestrations, although 1 patient later underwent surgery for baffle dehiscence. Other significant complications occurred in 2 patients who developed deep vein thrombosis, and 3 patients who suffered transient supraventicular arrhythmias. Although the Amplatzer device has been in clinical use for only 3 years, its unique design, and ease of use, has resulted in its widespread adoption by many centres. The results to date are very encouraging, but it must be remembered that there is, as yet, no long-term follow-up data available for this life-long implant.     

国产室间隔缺损封堵器与Amplatzer封堵器的疗效比较

目的比较国产室间隔缺损封堵器与Amplatzer封堵器在经导管室间隔缺损封堵术中的疗效。方法41例患儿采用Amplatzer封堵器,76例患儿采用国产封堵器进行室间隔缺损封堵术,对比两组的疗效、并发症和费用等情况。结果国产组75例封堵成功（成功率99%）,进口组40例封堵成功（成功率98%）。两组患儿术前各项临床指标、手术和X线曝光时间、封堵成功率及住院天数,术后各项并发症发生率比较差异无统计学意义,两组患儿治疗前后左室舒张末径、收缩末径及C/T值减少程度无明显差异,治疗总费用进口组明显高于国产组。结论国产室间隔缺损封堵器与Amplatzer封堵器相比较其疗效、并发症发生率无显著差异,治疗费用低,临床应用前景广泛。     

Late endocarditis of Amplatzer atrial septal occluder device in a child

Bacterial endocarditis following atrial septal defect closure using Amplatzer device in a child is extremely rare. We report a 10-year-old girl who developed late bacterial endocarditis, 6 years after placement of an Amplatzer atrial septal occluder device. Successful explantation of the device and repair of the resultant septal defect was carried out using a homograft patch. The rare occurrence of this entity prompted us to highlight the importance of long-term follow up, review the management and explore preventive strategies for similar patients who have multiple co-morbidities and a cardiac device. A high index of suspicion is warranted particularly in pediatric patients.     

Occlusion of Fontan fenestrations using the Amplatzer septal occluder

Objective—To evaluate the efficacy and safety of the Amplatzer septal occluder device for occlusion of Fontan fenestrations.
Subjects—Five children aged 5-10 years who had undergone a fenestrated Fontan operation.
Setting—Tertiary paediatric cardiology centre.
Methods—Each patient had right and left heart catheterisation to assess haemodynamic suitability for fenestration closure. Sizing of the defect was achieved with a balloon wedge catheter and transoesphageal echocardiography. Transcatheter occlusion of the fenestration was accomplished using a 4 mm device in three patients, and 5 mm or 9 mm devices in the other two patients. Residual shunting following occlusion was assessed using angiography and echocardiography.
Results—100% occlusion rate of the fenestration was achieved in all patients. No complications or device failures were seen during the three month follow up period.
Conclusion—The Amplatzer septal occluder device is safe, and effectively occludes the Fontan fenestration.

Keywords: Fontan circulation;  fenestration occlusion;  Amplatzer septal occluder device;  congenital heart disease     

Embolization and retrieval of the Amplatzer septal occluder.

Embolization and percutaneous retrieval of the Amplatzer septal occluder (ASO) after release have been reported. However, the incidence, the causes of embolization, and the methods for effective retrieval have not been systematically described. In a survey of the ASO company-designated proctors, the incidence of ASO embolization in this group's experience was 0.55% (21 embolizations in 3824 device placements) with a wide range of patient demographics, atrial septal defect (ASD) sizes, and device sizes. Most embolizations occurred because of inadequate rim or undersized devices. Of the 21 embolizations, 15 of the devices were retrieved percutaneously with a gooseneck snare without morbidity or mortality. Six were retrieved at surgery. Of the 21 patients, 12 had ASO closure of their ASDs, and 9 had surgical ASD closure. In vitro, all devices could be retrieved with sheathes 2 Fr sizes larger than their recommended delivery sheath. Any device larger than 26 mm could be retrieved with its delivery sheath. The ability to pull the snared button into a sheath was variable and was assisted by pulling the device from above with a bioptome and by using a rigid notched sheath. Because the incidence of ASO embolization is about 1 in 200 in the most experienced hands, all operators should be prepared with the techniques and equipment required for percutaneous ASO retrieval.     

Amplatzer封堵器经导管治疗多孔房间隔缺损

目的 :探讨 Amplatzer封堵器经导管治疗多孔房间隔缺损的临床应用价值。方法 :全组患者 6（男 2 ,女 4）例 ,年龄 4～ 5 0岁 ,经 TTE或 TEE检查诊断为多孔房间隔缺损。均在 X线和 TTE或 TEE监测下经导管行 Amplatzer封堵器治疗。术后重复 TTE或 TEE、ECG及 X线平片检查以评价疗效。结果 :全组 6例患者 Amplatzer封堵器置入均获成功 ,术中无重要并发症发生。其中置入 1个封堵器的患者 5例 ,置入 2个封堵器的患者 1例。术后即刻TTE或 TEE检查 5例无残余分流 ,1例小缺损孔有少量残余分流 ,随访 1年中少量残余分流仍存在。1例肺动脉压中度增高患者 ,术后 3 0 min测量肺动脉压下降 >2 0 mm Hg。随访期间所有患者封堵器位置形态良好 ,未发现封堵器的变形 ,移位以及金属结构断裂等改变 ;右房 ,右室有不同程度的缩小 ,X线平片显示肺血有不同程度减少 ;术后ECG检查均未见心律失常发生。结论 :Amplatzer封堵器经导管治疗多孔房间隔缺损是安全有效的。对于相隔距离较近的多孔房间隔缺损 ,可采用单个封堵器封堵 ;而相隔距离较远的缺损 ,可采用同时置入两个封堵器     

经静脉闭合房间隔缺损的疗效观察

目的 :评价经静脉置入 Amplatzer封堵器治疗继发孔型房间隔缺损 (ASD)的疗效。方法 :2 4例患者术前经多普勒超声心动图检查 ASD直径为 6～ 30 (18.96± 7.0 3) m m。在透视及经超声心动图引导下经静脉置入Am platzer封堵器闭合 ASD。结果 :2 4例 ASD直径的球囊测量值为 15～ 36 (2 6 .2 5± 7.5 7) mm ,选择的封堵器直径为 14～ 36 (2 6 .5 2± 7.15 ) m m。 2 4例封堵器置入均获得成功 ,术中无并发症 ,1例在术后第 3天出现 度 型房室传导阻滞 ,2周后恢复。 7例术后即刻超声检查显示微量残余分流 ,术后 1周复查均无分流。结论 :经静脉置入 Amplatzer封堵器治疗 ASD是一种有效的非外科手术方法。