Entrapment of pacemaker lead by a large netlike Eustachian valve within the right atrium

Summary During pacemaker implantation in a patient with permanent atrial fibrillation, it remained impossible to advance a passive fixation lead with fins through the right atrium. However, a lead with a retractable screw easily passed the right atrium and was positioned in the right ventricle. Transesophageal echocardiography revealed an extensive net–like perforated Eustachian valve within the right atrium that had caused entrapment of the anchor fins during lead implantation. Remnants of embryonal structures within the right atrium should be considered a rare possible barrier during pacemaker implantation.     

生物瓣膜失功能原因分析

目的对植入人体内1年以上损坏的生物瓣膜作损坏原因的临床分析。方法1993年6月至2004年6月,共41例(47只)生物瓣膜失功能病人行再次手术换瓣。两次换瓣间隔时间1~16年,平均(9.7±4.1)年。对失功能生物瓣膜进行标本观察及病理学检测。结果47只带支架生物瓣膜中,瓣架无一损坏,42只瓣膜发生瓣叶撕裂或穿孔,35只有不同程度的钙化现象,且在瓣环表面和瓣脚周围有纤维组织增生,2只瓣膜有赘生物及血栓形成;47只生物瓣膜中损坏较重的瓣膜送病理学检查发现大量吞噬细胞和单核细胞浸润。结论生物瓣膜早期损坏以破损撕裂为主,晚期以钙化和破损撕裂等多种因素的复合病损结果出现。     

二维超声心动图对主动脉瓣关闭不全病变鉴别诊断价值

本文报道用二维超声心动图对主动脉瓣关闭不全124例进行病变鉴别诊断。就其图象特征结合X线所见,心音图等进行了鉴别诊断的探讨。其中,有风湿性心脏病111例;感染性心内膜炎4例;冠状动脉粥样硬化性心脏病5例;马凡氏综合征2例;左室假腱索2例。认为此项检查对主动脉瓣关闭不全病变鉴别诊断有一定的价值。     

参附注射液对家兔心脏骤停-心肺复苏模型循环恢复的影响

目的观察参附注射液对家兔缺氧型心脏骤停-心肺复苏 (CA- CPR)模型循环恢复的影响.方法 30只家兔随机分为三组,每组 10只;夹闭气管复制缺氧型 CA- CPR模型.预防组 (A组 )夹管前 10min、自主循环恢复后 8、 15min分别静注参附注射液,治疗组 (B组 )自主循环恢复后 8、 15、 22min静注参附注射液,对照组 (C组 )静注生理盐水,时间同 A组;监测夹管前后家兔的心电图、平均动脉压 (PAP)的变化,并记录开始 CPR至自主循环恢复时间和自主呼吸恢复时间、肾上腺素用量、撤呼吸机时间;自主循环维持 4h,并计算 4h存活率.结果三组 CPR成功率、 4h存活率相近;在自主循环恢复时间方面 A组明显快于 C组,在自主呼吸维持时间、肾上腺素用量、撤呼吸机时间方面则两组相近.结论参附注射液可明显缩短家兔缺氧型 CA- CPR模型的自主循环恢复时间,对促进 CA的循环恢复具有积极意义.     

影响终末期肾衰竭患者心脏扩大的因素

目的了解成都铁路分局医院血液进化中心终末期肾衰竭并维持性血液透析患者心脏扩大的影响因素,以便提高患者的血液透析质量和生存率。方法回顾本血液净化中心收治的216例终末期肾衰竭并维持性血液透析2月以上患者,根据心脏彩色多普勒检查,分为心脏扩大与心脏未扩大2组,对可能影响心脏扩大的因素:年龄、血液透析病程、每周血液透析时间、高血压、容量超负荷、血红蛋白水平、低蛋白血症等用SPSS10.0软件作Logistic回归分析。结果终末期肾衰竭并维持性血液透析患者216例,心脏扩大者183例,未扩大者33例,心脏扩大的发生率为84.72%。心脏扩大与容量超负荷呈显著正相关,P=0.002,OR值42.619;心脏扩大与高血压呈正相关,P=0.026,OR值15.353;心脏扩大与血红蛋白水平呈负相关,P=0.043,OR值0.934。心脏扩大与年龄、血液透析病程、每周血液透析时间和低蛋白血症无相关关系。结论终未期肾衰竭并维持性血液透析患者心脏扩大发生率高,而容量超负荷、高血压、血红蛋白水平是影响它的关键,高血压及容量超负荷是促进心脏扩大的独立危险因素,血红蛋白水平下降亦是促进心脏扩大的独立危险因素。     

参附注射液预处理及后处理对体外循环心脏瓣膜置换术后患者认知功能的影响

目的 观察参附注射液（SFI）预处理及后处理对体外循环心脏瓣膜置换术后患者认知功能的影响。     

基因治疗在心脏外科的作用

尽管基因治疗在实验研究方面已做了大量的工作 ,但实际上临床治疗成功的尚不多。现复习这一领域的近期文献 ,并讨论基因治疗的一些限制和潜在的问题 ,强调在心脏外科作基因治疗临床试验之前必须提请考虑的问题和规则。     

Myocardial perfusion SPECT reconstruction: Receiver operating characteristic comparison of CAD detection accuracy of filtered backprojection reconstruction with all of the clinical imaging information available to readers and solely stress slices iteratively reconstructed with combined compensation

BACKGROUND: Past receiver operating characteristic (ROC) studies have demonstrated that single photon emission computed tomography (SPECT) perfusion imaging by use of iterative reconstruction with combined compensation for attenuation, scatter, and detector response leads to higher area under the ROC curve (A(z)) values for detection of coronary artery disease (CAD) in comparison to the use of filtered backprojection (FBP) with no compensations. A new ROC study was conducted to investigate whether this improvement still holds for iterative reconstruction when observers have available all of the imaging information normally presented to clinical interpreters when reading FBP SPECT perfusion slices. METHODS AND RESULTS: A total of 87 patient studies including 50 patients referred for angiography and 37 patients with a lower than 5% likelihood for CAD were included in the ROC study. The images from the two methods were read by 4 cardiology fellows and 3 attending nuclear cardiologists. Presented for the FBP readings were the short-axis, horizontal long-axis, and vertical long-axis slices for both the stress and rest images; cine images of both the stress and rest projection data; cine images of selected cardiac-gated slices; the CEQUAL-generated stress and rest polar maps; and an indication of patient gender. This was compared with reading solely the iterative reconstructed stress slices with combined compensation for attenuation, scatter, and resolution. With A(z) as the criterion, a 2-way analysis of variance showed a significant improvement in detection accuracy for CAD for the 7 observers (P = .018) for iterative reconstruction with combined compensation (A(z) of 0.895 +/- 0.016) over FBP even with the additional imaging information provided to the observers when scoring the FBP slices (A(z) of 0.869 +/- 0.030). When the groups of 3 attending physicians or 4 cardiology fellows were compared separately, the iterative technique was not statistically significantly better; however, the A(z) for each of the 7 observers individually was larger for iterative reconstruction than for FBP. Compared with results from our previous studies, the additional imaging information did increase the diagnostic accuracy of FBP for CAD but not enough to undo the statistically significantly higher diagnostic accuracy of iterative reconstruction with combined compensation. CONCLUSIONS: We have determined through an ROC investigation that included two classes of observers (experienced attending physicians and cardiology fellows in training) that iterative reconstruction with combined compensation provides statistically significantly better detection accuracy (larger A(z)) for CAD than FBP reconstructions even when the FBP studies were read with all of the extra clinical nuclear imaging information normally available.     

瓣膜病合并肝功能不全患者的体外循环管理

目的 回顾52例瓣膜病变合并肝功能不全的行瓣膜置换术的患者，总结体外循环(CPB)经验。方法 CPB采取中度低温，保持较高的灌注压力。预充液加入白蛋白。心肌保护用高钾含血停搏液灌注。结果 结果CPB时间50～135min，主动脉阻断23～98min，心脏自动复跳率94％，无全心辅助和左心辅助，围术期死亡6人。结论 术中加强心肌保护的同时重视肝保护，可减轻术后心功能衰竭和肝功能衰竭，降低并发症和死亡率。     

完全型房室间隔缺损合并法洛四联症心内矫正术

目的总结心内矫正术治疗完全型房室间隔缺损合并法洛四联症(CAVSD-TOF)的经验. 方法从1985年1月至2002年5月,共行CAVSD-TOF心内矫正术12例,年龄6～16岁(11.1±2.8岁),采用右心房、右心室纵切口,前7例采用三片法补片,后5例用二片法补片修补房室间隔缺损,左侧房室瓣裂隙采用间断缝合,右心室流出道用跨瓣补片加宽. 结果术后早期死亡4例,前7例死亡3例,后5例死亡1例,死亡原因为严重低心排血量3例,灌注肺1例.长期随访6例,随访时间3个月至13.5年,无任何症状,NYHA心功能Ⅰ级或Ⅱ级. 结论 CAVSD-TOF采用右心房、右心室纵切口,二片法补片修补房室间隔缺损,常规间断缝合左侧房室瓣裂隙,跨瓣补片加宽右心室流出道能取得较良好的效果.