Success determining factors in percutaneous transluminal balloon valvuloplasty of pulmonary valve stenosis

Twenty-two percutaneous transluminal balloon valvuloplasty procedures were performed on 21 patients with congenital pulmonary valve stenosis. The peak systolic pressure gradient was immediately reduced from 79.1 +/- 7.4 to 22.2 +/- 1.8 mmHg, (P less than 0.0001) and follow-up cardiac catheterization at 5.3 +/- 0.4 months in 19 patients revealed no further significant change in gradient (23.5 +/- 3.2 mmHg). The best results were obtained when balloons larger than the pulmonary annulus were used, i.e. an immediate residual transvalvular gradient of 22.0 +/- 2.2 mmHg with a balloon/annulus ratio greater than 1, as opposed to 44.2 +/- 5.4 with a balloon/annulus ratio = 1 (P less than 0.001). The angiographically determined cusp thickness of the stenotic pulmonary valves was significantly greater than that of the control group of 24 patients without pulmonary valve stenosis (1.21 +/- 0.09 vs 0.59 +/- 0.02 mmHg, P less than 0.00001). The relationship between this parameter and the residual transvalvular gradient at follow-up was found to be significant (r = 0.77, P less than 0.001). It is concluded that balloon size is a determinant factor in achieving good results with percutaneous balloon valvuloplasty although cusp thickness, a factor to which scant regard has hitherto been paid, also plays a significant role in the residual transvalvular gradient measured at follow-up.     

聚二乙醇酸与Degrapol对肌成纤维细胞粘附、生长的影响

目的　寻找一种更加理想的人工降解材料 ,为改进人工降解材料提供理论依据。方法　比较聚二乙醇酸( PGA)与 Degrapol对肌成纤维细胞粘附、生长、繁殖及产生胶原的影响。结果　 1细胞种植 2周和 6周 ,PGA组的细胞计数明显多于 Degrapol组 ( P<0 .0 1) ;2 6周 PGA组胶原含量明显高于 Degrapol组 ( P<0 .0 1) ;3 2周肌成纤维细胞粘附于 PGA上 ,分布广泛 ;6周后 PGA降解 ,胶原含量丰富。而 Degrapol则部分降解 ,胶原含量较少。结论　Degrapol作为一种新型人工降解材料 ,若用于构建组织工程心脏瓣膜 ,在细胞亲和力等方面尚有待进一步改进     

脉动真空灭菌器内室气体流向监测报警装置的研制

本文针对XGI型脉动真空灭菌柜出现的蒸汽倒流故障设计出一种内室气体流向监测报警装置，对管道中的蒸汽流向和空气流向进行监测。当出现倒流现象时，报警装置发出报警信号，提醒工作人员采取措施排除故障。经在两台灭菌柜上使用，证明此方案是一种行之有效的方法。     

Transjugular percutaneous inoue balloon mitral commissurotomy in a patient with inferior vena cava obstruction after liver transplantation.

Percutaneous transvenous mitral commissurotomy was performed successfully via the transjugular approach in a patient with severe rheumatic mitral stenosis and obstruction of the inferior vena cava due to prior liver transplantation. This case demonstrates the advantage of the jugular approach in patients with difficult anatomy.     

吸入一氧化氮对心瓣膜置换术后肺动脉高压患者血流动力学的影响

目的：观察吸入一氧化氮（ＮＯ）对心瓣膜置换术后肺动脉高压患者血流动力学的影响。方法：选择９例心瓣膜置换术后伴肺动脉高压的病人，吸入ＮＯ０．００３％，观察三个时象点：吸入ＮＯ前；开始吸入ＮＯ后１５分钟；停止吸入ＮＯ后１５分钟。结果：吸入ＮＯ能显著降低肺动脉压和肺循环阻力指数（Ｐ＜０．０１），停止吸入ＮＯ１５分钟后，肺动脉压和肺循环阻力指数恢复到原有水平。在整个观察过程中，心率、平均动脉压、中心静脉压、肺动脉楔压、体循环阻力指数和心脏指数均无显著变化（Ｐ＞０．０５）。结论：吸入ＮＯ具有选择性肺血管扩张作用，是治疗心瓣膜置换术后肺动脉高压的较理想药物。     

Traumatic or septic aortic regurgitation: diagnosis by oesophageal echocardiography

Severe aortic regurgitation was discovered in a young man 21 days after blunt chest trauma and after a prolonged febrile state with positive blood cultures. Using transoesophageal echocardiography (TEE), it was possible to make the differential diagnosis between traumatic rupture and endocarditis as the cause of valvular insufficiency. The use of TEE in the initial evaluation of severe thoracic trauma with an unclear clinical picture is recommended. This method is easy to use at the bedside and gives precise information on the aortic valve and the ascending aorta.     

Extracardiac Right Atrium-to-Right Ventricle Homograft for Uncorrectable Tricuspid Valve Disease

Surgically uncorrectable tricuspid valve disease in children is rare. However, when it happens the surgical options are very limited. Tricuspid valve replacement using a mechanical valve or stented bioprosthesis is impractical. Use of homografts in the “anatomic position” has its limitations. We report here the use of an extracardiac homograft connection between the right atrium and right ventricle in a 16-month-old boy in whom severe tricuspid valve stenosis developed after surgical repair of a complex ventricular septal defect associated with dextrocardia and anomalous systemic venous drainage. The patient remains well receiving no cardiac medication 12 months after the procedure.     

体外构建组织工程心脏瓣膜动物实验初步研究

目的探讨应用去细胞猪主动脉支架(decellularized porcine aortic valve scaffold，APAVS)与兔骨髓干细胞(rabbit bone marrow stromal cells，RBMSCs)体外构建组织工程心脏瓣膜的可行性。方法采用去垢剂-核酸酶消化法处理，去除猪主动脉瓣细胞成分，并做去细胞前后的形态学检查和生物力学测定；在去细胞支架上种植兔骨髓干细胞，行形态学检查和免疫组化测定。结果光镜及电镜证实，猪主动脉瓣膜中的细胞成分可完全去除，获得完整无细胞的纤维网状支架；瓣叶去细胞前后的断裂强度和断裂伸长率无明显变化；种植的RBMSCs可在ACPAV表面形成一层连续的细胞层。结论种植RBMSCs于ACPAV上，可体外构造组织工程人工心脏瓣膜。     

超微孔膨体聚四氟乙烯人工心脏瓣膜体外流体力学的评价

目的采用新型高分子材料制备人工心脏瓣膜,并对其体外流体力学特征作出评价。方法将片状超微孔膨体聚四氟乙烯材料缝制于弹性支架上做成人工心脏瓣膜,以Baxter人工双叶机械瓣作对照,对新型瓣膜进行了静态泄漏和定常流测试。结果两种瓣膜静态泄漏率无显著差异(P>0.05),定常流下高分子瓣膜跨瓣压差更低,两组间存在显著差异(P<0.001)。结论新型高分子人工心脏瓣膜体外流体动力学性能优于Baxter机械瓣。     

The posterior urethral valve uropathy: Results of treatment

Nineteen children treated for posterior urethral obstruction due to congenital valve in the University of Benin Teaching Hospital, Benin City, Nigeria, over a 9-year period have been analysed. Their ages ranged from birth to 12 years. Results show that associated kidney pathology may be irreversible even after successful excision of the valve. This determines the final prognosis, which is worse the younger the child at presentation.