Aortic valve annulus and sinus-tube joint diameters in normal adults of Chinese Han ethnic group

Background The anatomic value of the aortic root is important for aortic valve repair. This study was to determine the normal diameters of the aortic valve annulus （AVA） and sinus-tube joint （STJ） in the healthy adults of Chinese Han ethnic group, and to provide a morphological foundation for potential clinical application.
Methods Echocardiography was performed in 326 normal subjects, who were divided into 5 groups according to their age. The diameters of the AVA and STJ were measured in the parasternal long-axis view, and normalized to body surface area （BSA）. They were averaged for each age group and for each gender. Differences were then determined between the normalized diameters for each age group and for both genders. Pearson＇s product-moment correlation coefficient was used to determine the differences between AVA and STJ diameters. It was also used to determine any positive or negative correlations between the above two variables and age. BSA, weight, and height.
Results The diameters of the AVA and STJ of Han nationality patients increased with an increase in age, BSA, weight, and height. The correlation coefficient between AVA diameter and BSA was 0.4944 （P 〈0.0001）, between AVA diameter and age, 0.1138 （P〈0.05）, between AVA diameter and weight, 0.4521 （P〈0.001）, and between AVA diameter and height, 0.4713 （P 〈0.001）. The correlation coefficient between STJ diameter and BSA was 0.3910 （P 〈0.0001）, between STJ diameter and age, 0.3667 （P 〈0.0001）, between STJ diameter and weight, 0.4586 （P 〈0.0001）, and between STJ diameter and height, 0.3736 （P 〈0.0001）. The difference between the above two diameters was statistically significant at 2.42±2.45 mm （paired t-test; t=-17.25; P 〈0.0001）. AVA and STJ diameters were similar in both genders of each group when indexed to BSA.
Conclusions The diameters of the AVA and STJ of adults of Chinese Han ethnic group increase with age, BSA, weight, and height. The diameters of the AVA and the STJ are     

TRANSCATHETER CLOSURE OF LARGE SECUNDUM ATRIAL SEPTAL DEFECTS WITH AMPLATZER SEPTAL OCCLUDER

Objective To evaluate the safety and feasibility of transcatheter closure of large secundum atrial septal defects （ ASDs ） with Amplatzer septal occluder （ ASO ） . Methods A total of 26 patients （ age 16 to 67 years, median 43 years; body weight 52 to 102 kg, median 67 kg ） with large ASDs underwent an attempted transcatheter closure using ASO. Large ASD was defined as those with a balloon-stretched diameter of ≥ 30 mm. Another 81 patients with small-to-moderate ASD during same period who underwent closure served as controls. Results In patients with large ASDs, the ASD dimension means were （ 22.1 ± 3. 2 ） mm （ range from 16 to 30 mm） and （23. 8 ± 2. 6） mm（ range from 18 to 31 ram） assessed by transesophageal echocardiography （ TEE ） and transthoracic echocardiography （ TIE）, respectively. The mean balloon-stretched diameter of the ASD was （31.9 ± 2. 1 ） mm （ range from 30 to 37mm ）. The size of device was （32. 0 ±1.9 ）mm （ range from 30 to 36mm）. The transcatheter procedure was successful in all patients （ 100% ）. Seventeen deployments were performed using the conventional left atrium approach, and remaining 9 patients required the right upper pulmonary vein approach. Immediately after deployment, TEE revealed that complete closure rate was 73%. Procedure-related complications were recorded in 3 patients （12%）, including device embolization in one patient, pericardial effusion in one patient, and large hematoma at puncture site in one patient. During follow-up, the complete closure rate increased to 88% at 24 h after procedure and 100% at 6 months. The procedural success rates, immediate TEE results and TTE results at 24 h and 6 months after procedure, were not significantly different between patients with large ASDs and those with small-to-moderate ASDs. Conclusion Transcatheter closure of large ASDs using ASO is technical feasible and relatively safe. Proper care selection and specific technique modification such as the right upper pulmonary vein approach is vital for the implantation success.     

Model for end-stage liver disease-sodium predicts prognosis in patients with chronic severe hepatitis B

Background Serum sodium predicts prognosis in chronic severe hepatitis B and may improve the prognostic accuracy of the model for end-stage liver disease （MELD） score, but the available information is limited. The present study was undertaken to study the clinical use of the serum sodium incorporated MELD （MELD-Na） and assess its validity by the concordance （c）-statistics in predicting the prognosis of the patient with chronic severe hepatitis B.
Methods A total of 426 adult patients with a diagnosis of chronic severe hepatitis B between January 1, 2007, and December 31, 2007 at a single center were studied. The scores of serum sodium, MELD, MELD-Na, and ΔMELD-Na （ΔMELD-Na=MELD-Na at 14 days after medical treatment -MELD-Na score on admission） of the patients with chronic severe hepatitis B were calculated. The 3-month mortality in the patients was measured, and the validity of the models was determined by means of the concordance （c） statistics.
Results The average MELD, MELD-Na scores of survival group were 25.70±5.08 and 26.60±6.90, and those of dead group were 35.60±6.78 and 42.80±9.57 on admission. There was a significant difference in MELD and MELD-Na between the survival and dead groups （P 〈0.01）. The average △MELD-Na score of the survival group was -0.97±3.51, and that of the dead group was 3.45±2.38 at 2 weeks after the treatment. There was a significant difference in △MELD-Na between the survival and dead groups （P 〈0.01）. The areas under the receiver-operating characteristic curves of Na, MELD and MELD-Na for the occurrence of death in 3 months were 0.742, 0.875 and 0.922. The 3-month mortality of the MELD-Na scores group 〈25, 25-30, 31-34, 35-40 and 〉40 were 2.0%, 5.4%, 35.4%, 53.8 % and 86.9%, respectively. There was a significant difference in the 3-month mortality between the five groups （P 〈0.05）. The 3-month mortality of the △MELD-Na〉0 group was 65.9%, and that of the △MELD-Na ≤0 group was 15.8%; there was a significant difference in     

Early detection of lesions of dorsal artery of foot in patients with type 2 diabetes mellitus by high-frequency ultrasonography

This study evaluated the value of high-frequency ultrasonograpy for early detection of dorsal artery of foot in patients with type 2 diabetes mellitus （MD）. Eighty subjects including 40 patients with type 2 MD （T2DM group） and 40 healthy volunteers （NC group） were recruited. The intima-media thickness （IMT）, the inner diameter and the perfusion of dorsal artery of foot were measured by using high-frequency ultrasonograpy. Meanwhile, the parameters of vascular elasticity, including stiffness parameter （]3）, pressure-strain elastic modulus （Ep）, arterial compliance （AC）, augment index （AI）, and pulse wave conducting velocity （PWV]3） were detected by means of echo-tracking technique. The results showed that no significant difference was found in the IMT, systolic diameter （Ds）, diastolic diameter （Dd） and peak systolic velocity （PSV） between T2DM and NC groups. Ep and PWVβ were increased, and AC was decreased in T2DM group as compared with those in NC group with the differences being significant （P〈0.05 for all）. There was no significant difference in β and AI between T2DM and NC groups. It was concluded that high-frequency ultra- sonography in combination with echo-tracking technique is sensitive and non-invasive, and can be used for early detection of sclerosis of the lower extremity artery in patients with type 2 MD.     

Clinical value of stereoscopic three-dimensional echocardiography in assessment of atrial septal defects: Feasibility and efficiency

Stereoscopic three-dimensional echocardiography（S-3DE） is a novel displaying technol-ogy based on real-time 3-dimensional echocardiography （RT-3DE）. Our study was to evaluate the feasibility and efficiency of S-3DE in the diagnosis of atrial septal defect （ASD） and its use in the guidance for transcatheter ASD occlusion. Twelve patients with secundum ASD underwent RT-3DE examination and 9 of the 12 were subjected to transcatheter closure of ASD. Stereoscopic vision was generated with a high-performance volume renderer with red-green stereoscopic glasses. S-3DE was compared with standard RT-3D display for the assessment of the shape, size, and the surrounding tis-sues of ASD and for the guidance of ASD occlusion. The appearance rate of coronary sinus and the mean formation time of the IVC, SVC were compared. Our results showed that S-3DE could measure the diameter of ASD accurately and there was no significant difference in the measurements between S-3DE and standard 3D display （2.89±0.73 cm vs 2.85±0.72 cm, P〉0.05; r=0.96, P〈0.05）. The appearance of coronary sinus for S-3DE was higher as compared with the standard 3D display （93.3% vs 100%）. The mean time of the IVC, SVC for S-3DE monitor was slightly shorter than that of the standard 3D display （11.0±3.8 s vs 10.3±3.6 s, P〉0.05）. The mean completion time of interven-tional procedure was shortened with S-3DE display as compared with standard 3D display （17.3±3.1 min vs 23.0±3.9 min, P〈0.05）. Stereoscopic three-dimensional echocardiography could improve the visualization of three-dimensional echocardiography, facilitate the identification of the adjacent structures, decrease the time required for interventional manipulation. It may be a feasible, safe, and efficient tool for guiding transcatheter septal occlusion or the surgical interventions.     

A Randomized Trial of Chinese Medicine Lirukang Granule (利乳康颗粒) Combined with Psychological Intervention for Cyclomastopathy and Menoxenia

Objective:To observe the influence of therapy with Chinese medicine Lirukang Granule（利乳康颗粒）,LRKG) combined with psychological intervention on anxiety states and sex hormones in patients with cyclomastopathy and menoxenia.Methods:A total of 470 subjects were randomly assigned to three groups by the net-central randomization system,the treatment group（161 patients,treated with LRKG and psychological intervention）,the Chinese medicine group（157 patients,treated with LRKG）,and the psychological intervention group（152 patients,treated with psychological intervention）.The dose of LRKG was 12 g three times per day; psychological intervention included establishing relations,cognitive intervention and psychological persuasion, 30-40 min per session,once a week.The therapy duration for all groups was three months.The efficacy was compared and anxiety state/State-Trait Anxiety Invertory（STAI） scoring was measured before and after treatment.The serum estradiol（E₂）,progesterone（P）,prolactin（PRL） and follicle stimulating hormone（FSH） levels of 60 patients selected randomly from each group during the luteal phase were measured before and after treatment,and a group of 20 healthy women were evaluated for comparison.A follow-up was arranged for one year after treatment.Results:Thirty subjects were lost to follow-up.（1） Comparison of efficacy:the markedly effective rate and the total effective rate of the treatment group were 86.67%（131/150） and 98.00%（147/150）, respectively;of the Chinese medicine group,64.58%（93/144） and 90.27%（130/144）,respectively;and of the psychological intervention group,0%（0/146） and 3.42%（5/146）,respectively.The markedly effective rate and the total effective rate in the treatment group were significantly higher than those in the Chinese medicine and psychological intervention groups（P<0.05）.（2） Comparison of STAI scoring:STAI scoring was decreased dramatically in the treatment group after treatment compared with that of the Chinese medicine group（P<0.01）, but there was no significant difference compared with the psychological intervention group.（3） Comparison of levels of sex hormones:E₂,P,PRL and FSH of the three patient groups were disordered before treatment,and significantly different from healthy women（P<0.01）.After treatment,the levels of P and FSH of the treatment group were significantly increased（P<0.01）,E₂ and PRL were significantly reduced,which were also significantly decreased compared with the psychological intervention groups（P<0.01）.（4） Follow-up:the markedly effective rate and the total effective rate of the treatment group remained higher than those of the other two groups after one year of treatment（P<0.05）.（5） Adverse reactions:no obvious adverse reactions were found among the three groups.Conclusions:Therapy with Chinese medicine combined with psychological intervention was effective for short-term and long-term treatment of cyclomastopathy and menoxenia.The mechanism might be related to the regulation of sex hormones.     

Adjacent segment disease after anterior cervical decompression and fusion: analysis of risk factors on X-ray and magnetic resonance imaging

Background Adjacent segment disease （ASD） is common after cervical fusion.The aim of this study was to evaluate the risk factors for ASD on X-ray and magnetic resonance imaging （MRI）.Methods Patients included in this study had received revision surgeries after developing symptomatic ASD following anterior decompression and fusion.A control group that had not developed ASD was matched 1：1 by follow-up time and fusion segments.Plate-to-disc distances （PDDs）,developmental cervical canal stenosis on X-ray,cervical disc degeneration grading,and cervical disc bulge impingements on preoperative MRI were measured and compared between the ASD group and the control group.Results Thirty-four patients with complete radiographic data were included in the ASD group.The causative segments of ASD included nine cases of C3-4,18 cases of C4-5,three cases of C5-6,and four cases of C6-7.The ASD occurred at the upper adjacent segments in 26 patients and at the lower adjacent segments in eight patients.PDD distributions were similar between the ASD group and the control group.Developmental cervical canal stenosis was a risk factor for ASD,with an odd ratio value of 2.88.Preoperative cervical disc degenerations on MRI were similar between the ASD group and the control group.In the upper-level ASD group,the disc bulge impingement was （19.7±9.7）％,which was significantly higher than that of the control group of （11.8±4.8）％.Conclusions ASD was more likely to develop above the index level of fusion.Developmental cervical canal stenosis and greater disc bulge impingement may be risk factors for the development of ASD.     

Novel parameter for assessment of left atrial size in patients with hypertension: ratio of left atrial volume to left ventricular volume

Background Left atrial enlargement has been suggested as a more robust marker of diastolic dysfunction. We hypothesize that the ratio of left atrial volume to left ventricular volume （LAV/LVV） may be more reasonable to reflect left atrial enlargement in the patients with hypertension, because hypertensive patients have a characteristic of concentric remodeling of the left ventricle which is often accompanied with diastolic dysfunction. The aim of this study was to determine if the LAV/LVV can be used as a new parameter to assess left atrial size in hypertensive patients and the relationship between the LAV/LVV and diastolic dysfunction. Methods Ninety-one patients with hypertension and forty-three normal controls were studied. The hypertensive patients were assigned to the normal wall （NW） and hypertrophic wall （HW） groups. The left atrial diameter （LAD）, LAV, left atrial volume index （LAVi）, LVV and LAV/LVV were measured and calculated by 2-dimensional echocardiography and real time 3-dimensional echocardiography. All of the above parameters were used to evaluate the size of the left atrium. The ratio of peak E velocity of mitral valve inflow to peak E＇ velocity of lateral mitral annulus （E/E＇） was measured by pulse Doppler and tissue Doppler. This parameter was used to evaluate diastolic function. Results The LAD, LAV, LAVi, LAV/LVV and E/E＇ in hypertensive groups were significantly higher than those in the normal group （P 〈0.05 or 0.01）, and those in the HW group were significantly higher than those in the NW group （P 〈0.05 or 0.01）. The E/E＇ had a positive correlation with LAV, LAVi and LAV/LVV. The correlation coefficient between E/E＇ and LAV/LVV was relatively higher than that between E/E＇ and LAD or LAVi. Conclusion LAV/LVV may be used as a new index to evaluate left atrial size in hypertensive patients with diastolic dysfunction.     

Magnetic resonance study of the structure and function of the hippocampus and amygdala in patients with depression

Background The hippocampus and amygdala exhibit structural and functional alterations in patients with depression. The objective of this study was to investigate the structural and functional relationships between these core regions. Methods Based on the severity of their condition, 60 patients and 20 healthy controls were equally divided into four groups （mild group, moderate group, major group and health controls group）, scanned by T1-MR, functional magnetic resonance imaging （fMRI）, and susceptibility weighted imaging （SWI）. Structural image, BOLD image, and SWI image were collected for processing and analysis. The characteristics of the depression and controls were checked by analysis of variance test, and the difference between groups was checked by Dunnett＇s test. Results The volume of hippocampus and amygdala varied with the severity of the condition. The signal obtained under the stimulation of negative events was linearly decreased in the mild, moderate and major groups revealed by fMRI. The length and diameter of the lateral ventricle vein was reduced in the mild group, whereas the number of branches increased. In the moderate and major groups, the reduction in the length, diameter and increase in the number of branches of the lateral ventricle vein were greater. Conclusion The alterations of the volume, fMRI, and cerebral veins in these core regions may account for the causal relationship between structure and function.     

乳腺癌保乳手术MRI影像学证据的多中心前瞻性研究

Background This multicenter prospective study aimed to assess the utility of dynamic enhanced magnetic resonance imaging （MRI） prior to breast-conserving surgery for breast cancer.Methods The research subjects were drawn from patients with primary early resectable breast cancer treated in the breast disease centers of six three-level hospitals in Beijing from 1 January 2010 to 31 December 2012.The participants were allocated to a breast-conserving surgery group （breast-conserving group） or a total mastectomy group （total mastectomy group）.Enhanced MRI was used to measure breast volume,longest diameter of tumor and tumor volume.The correlations between these measurements and those derived from histopathologic findings were assessed.The relationships between the success rate of breast-conserving surgery and MRI-and pathology-based measurement results were statistically analyzed in the breast-conserving group.Results The study included 461 cases in the total mastectomy group and 195 in the breast-conserving group.Allocation to these groups was based on clinical indications and patient preferences.The cut-off for concurrence between MRI-and pathology-based measurements of the longest diameter of tumor was set at 0.3 cm.In the total mastectomy group,the confidence interval for 95％ concurrence of these measurements was 35.41％-44.63％.Correlation coefficients for MRI and histopathology-based measurements of breast volume,tumor volume and tumor volume/breast volume ratio were r=0.861,0.569,and 0.600,respectively （all P ＜0.001）.In the breast-conserving group,with 0.30 cm taken as the cut-off for concurrence,the 95％ confidence interval for MRI and pathology-based measurements of the longest diameter of tumor was 29.98％-44.01％.The subjective and objective success rates for breast-conserving surgery were 100％ and 88.54％,respectively.Conclusions There were significant correlations between dynamic enhanced MRI-and histopathology-based measurements of the longest diameter of breast lesions,breas     

经导管堵闭治疗继发孔型房间隔缺损

目的 :观察经导管堵闭治疗继发孔型房间隔缺损 (ASD)的疗效。方法 :经胸超声心动图 (TTE)和心导管检查诊断为ASD ,从股静脉插入球囊导管至ASD ,测量ASD径后 ,从股静脉插入长鞘管经右心房 (RA)至左心房(LA) ,沿鞘管插入房间隔堵闭器 (ASO)至LA ,在透视和TTE引导下推出ASO堵闭ASD。结果 :32例病人用导管法治疗 ,2 8例堵闭成功 ,手术结束时TTE显示无残余分流。出院前重作TTE ,RA径由 (39.4± 5 .8)mm降至 (33.7± 4 .2 )mm(P <0 .0 0 1) ,右室径由 (4 5 .3± 6 .8)mm降至 (37.1± 4 .5 )mm (P <0 .0 0 1)。 2例因无合适的ASO改行开胸手术。 2例术中ASO脱落 ,外科手术取出ASO并修补ASD。未见其它并发症。结论 :经导管堵闭ASD具有创伤小 ,成功率高 ,安全性好的优点 ,适用于大多数ASD患者。     

应用Amplatzer封堵器治疗房间隔缺损和疗效观察

经导管置入Amplatzer封堵器治疗继发孔型房间隔缺损(ASD),评价其初步疗效。方法5例患者术前经胸超声心动图检查示ASD平均直径14.2mm(7～17mm),经食管超声心动图(TEE)检查示ASD平均直径13.4mm(6～17mm),术中用球囊测量ASD伸展径平均17.5mm(7.7～24mm)。患者均在透视及TEE监视下经导管置入Amplatzer封堵器封堵ASD。术后即刻、1天、1、3、6、12个月分别行超声心动图、心电图检查,评价疗效。结果5例封堵器置入均获成功。1例术后随访6个月、3例随访12个月,均无残余分流、血栓栓塞;右室直径由术前的平均32.6mm减少到术后1个月的28.5mm、6个月的24.7mm、12个月的24.5mm。结论经导管置入Amplatzer封堵器治疗继发孔房间隔缺损是操作简便、患者创伤小、安全、有效的方法。     

经胸超声指导房间隔瘤并继发孔型房间隔缺损的介入封堵

目的:探讨经胸超声心动图指导房间隔膨出瘤(atrial septal aneurysm,ASA)并继发孔型房间隔缺损(atrial septal defect,ASD)封堵治疗中的价值.方法:采用经胸超声心动图(transthoracic echocardiography,TTE),必要时结合经食管超声心动图(transesophageal echocardiography,TEE)诊断14例ASA合并ASD成年患者(男3例,女11例).房间隔瘤均突向右房,基底部宽度13～24(18.5±3.9)mm;膨出深度7～11(9.7±1.8)mm.合并单孔ASD 10例,多孔ASD 4例,彩色多普勒显示左向右分流.所有患者均在X线和术中TTE监测下行介入封堵治疗;术后采用TTE随访,评价其疗效.结果:14例患者均成功进行了介入封堵治疗,共植入国产ASD封堵器14枚.术后即刻无残余分流.随访6～12月,经TTE 未见残余分流,封堵器位置固定,无移位等并发症发生.11例(79%)患者心脏大小恢复正常,其余患者心脏有不同程度缩小.结论:ASA并发ASD的患者可行封堵治疗,但有其特殊性,经胸超声心动图在病例选择、术中引导和术后随访等方面具有重要价值.     

经导管堵闭治疗继发孔型房间隔缺损

OBJECTIVE: To evaluate the effect of transcatheter closure treatment for secundum atrial septal defect(ASD). METHODS: ASD was established by transthoracic echocardiogram (TTE) and transvenous cardiac catheterization. A balloon catheter was inserted at ASD and was inflated to measure the ASD stretched diameter. Then, a long sheath was inserted to the left atrium (LA) from the right atrium( RA), Thereafter a proper auto-expanded atrial septal occluder (ASO) was inserted to the tip of the sheath. Under the fluoroscopic and TTE guidance, the ASO was expanded. Once the position of ASO was optimal, it was released. RESULTS: From May 1999 to July 2002, 32 patients were treated with this method. Among them, 28 patients (87.5%) obtained satisfactory results. At the end of the operation, TTE could not find out any residual shunt. Before discharging the patients, TTE showed the diameter of the right atrium and the right ventricle were decreased from (39.4 +/- 5.8) mm to (33.7 +/- 4.2) mm and from (45.3 +/- 6.8) mm to (37.1 +/- 4.5) mm respectively (P < 0.001 for both). The operation failed in 4 patients (12.5%). Two patients did not get proper ASO for them in the early period of our work. ASO slipped off from the defects in another 2 patients during the operation. There were no other complications. CONCLUSION: Tanscatheter closure is suitable for most patients with ASD. It is safe and less invasive with few complications.     

应用Amplatzer封堵器治疗多孔的房间隔缺损及其初步疗效评价

目的应用Amplatzer封堵器治疗多孔的继发孔型房间隔缺损(ASD),并对其疗效进行初步评价。方法7例多孔ASD病人,男性3例,女性4例,年龄12-36岁(16.6±7.3)岁,体重38-65(40.1±9.5kg)。所有病例均于X线透视和术中超声心动图监测下置入一个Amplatzer封堵器同时闭合大小缺损。术后重复TTE、ECG及X线平片检查以评价疗效。结果7例患者封堵器置入均获成功。除1例术中发生短暂性ST段抬高外,无其他严重并发症。早期3例根据球囊测量值选择封堵器,余4例根据TTE测量值选择封堵器,采用封堵器直径为18-34(24.4±7.0mm)。术后即刻TTE检查显示7例患者大缺损均获完全闭合,但有2例患者其小缺损存在微量到少量残余分流。术后24h复查提示1例仍存在少量分流。随访至3个月时分流消失。结论经导管置入Amplatzer封堵器治疗多孔的ASD是一安全有效的方法,近期疗效满意,中远期疗效尚需进一步观察。     

经导管封堵治疗成人巨大房间隔缺损的临床疗效及其安全性

目的通过对巨大型房间隔缺损(atrial septal defect,ASD)封堵术后的随访观察,评价经导管封堵ASD的临床疗效与安全性。方法选择在我科成功进行经导管封堵治疗、ASD直径在30mm以上并完成1年以上随访的87例患者为研究对象,分别记录患者术前、术中及术后随访资料,分别术后3d、1、6个月及1年各查心电图及经胸超声心动图(TTE)1次,并对所有资料进行回顾性分析。结果 87例ASD患者TTE测量ASD直径30~38(33.8±1.85)mm,置入封堵器直径36~42(39.2±1.38)mm。术中2例发生一过性Ⅰ度及Ⅱ度房室传导阻滞,1例发生一过性窦性心动过缓。在长达1年的随访期间,所有患者右心房、右心室内径均明显缩小(P<0.05),左心室舒张末期内径则逐渐增大,但仍在正常范围。随访1年时,2例患者遗留完全性右束支传导阻滞,无严重并发症发生。结论经导管封堵巨大ASD安全、有效,术后右心房及右心室可逐渐恢复正常,达到根治ASD之目的。     

继发孔房间隔缺损的Amplatzer封闭器介入外科手术治疗的对比研究

目的　对继发孔房间隔缺损 (ASDⅡ )的Amplatzer间隔封闭器 (ASO)介入和外科治疗的疗效和安全性进行比较研究。方法　 1998年 5月～ 2 0 0 2年 12月接受ASO治疗的 72例和接受外科手术治疗的 6 6例ASDⅡ病人进行对比研究。结果　ASO组和外科组技术成功率分别为 97.2 % (70 /72例 )和 10 0 % ;ASO组的手术和住院时间明显短于外科组 (71.8± 11.6 )min和 (15 8.4± 31.8)min ;(8.8± 2 .3)d和 (2 6 .9± 9.9)d ,(P<0 .0 5 ) ;ASO组的手术并发症发生率明显低于外科组 (7.1%和 2 2 .7% ,P <0 .0 5 ) ;ASO组无病人接受输血 ,外科组接受输血率 89.1% (5 9/6 6例 ) ;ASO组费用明显高于外科组 (4 .4 5± 0 .5 3)万元和 (1.87± 0 .5 4 )万元 ,(P <0 .0 5 )。结论　继发孔ASD的ASO治疗在有适应症的范围内可替代外科手术 ,降低ASO费用有助于更广泛推广作用。     

经导管介入治疗继发孔型房间隔缺损的临床评价

目的　应用国产自膨式房间隔缺损封堵器 (ASO)经导管治疗继发孔型房间隔缺损 (ASD)并对其疗效进行初步评价。方法　 2 0例继发孔型房间隔缺损患者 (男 12女 8,年龄 8～ 6 1岁 )在透视及经胸超声心动图 (TTE)监视下采用房间隔缺损封堵器封堵ASD ,术后 2 4h、1个月、3个月、6个月及 9个月分别行经胸超声心动图 (TTE)评价治疗效果。结果　除 2例因房间隔缺损太大 (大于 4 0mm)外 ,全组患者封堵器置入均获成功 ,技术成功率 10 0 % ,选用的封堵器直径 2 4～ 38mm ,术中无任何严重并发症 ,无 1例存在残余分流 ,无 1例封堵器脱落 ,术后超声心动图及X线检查示所有患者肺血减少、心功能改善。结论　经导管应用国产自膨式房间隔缺损堵闭器治疗继发孔型ASD是一种安全、有效的非手术治疗方法 ,近、中期疗效可靠 ,值得临床推广应用。     

多平面经食管超声心动图在房间隔缺损伞堵术中的临床应用

目的 :探讨多平面经食管超声心动图 (MTEE)在Amplatzer封堵器封堵继发孔型房间隔缺损 (ASD)中的应用价值。方法 :应用MTEE筛选符合封堵条件的 2 4例ASD患者行导管封堵术。在超声和X线引导下 ,以ASD伸展径加 0～ 4mm为标准 ,选择相应型号的封堵器 ,导管送封堵器至缺损处 ,依次释放左房面伞、腰部及右房面伞 ,观察位置合适时撤出导管 ,完成手术。结果 :2 4例患者均成功的进行了封堵 ,所有患者术中及术后均无并发症 ,术后即刻无残余分流。MTEE测量的ASD最大直径显著小于ASD伸展径 [〔 2 0 .2± 5 .6 )mmvs (2 4 .5± 5 .4 )mm ,P <0 .0 1\〗 ,平均相差 4mm。所有患者术后 2 4h、1个月及 3个月经胸超声检查均无残余分流及其它并发症。结论 :MTEE指导Amplatzer封堵器导管介入治疗继发孔型ASD是一种安全、有效的监测方法 ,其在病例选择、选择封堵器型号及放置封堵器过程中起重要的作用。     

经胸超声心动图在房间隔缺损介入封堵术围手术期中的临床价值

目的 探讨经胸超声心动图(transthoracic eChocardiography,TTE)在封堵房间隔缺损(atrial septal defect,ASD)围手术期中的应用价值.方法 选择试验对象,应用TTE测量60例患者房间隔缺损大小,在TTE的检测下对ASD行经导管封堵,评价TTE在封堵ASD围手术期中的应用价值.结果 TTE成功引导57例患者封堵器置入,术中及术后均无并发症,无残余分流,总的成功率为95%(57/60).结论 TTE对于应用封堵器封堵ASD术前病例选择、指导选择封堵器型号、导管通道建立以及放置封堵器的全过程和术后疗效评价起着重要作用.