Patent ductus venosus

BACKGROUND: Patent ductus venosus is extremely rare with only 14 cases reported in the world literature. We present a case of patent ductus venosus. METHODS AND RESULTS: A 29-year-old male was admitted with melaena stool caused by gastric haemorrhagic ulcers. Laboratory data disclosed severe anaemia; however, liver function tests were normal. Serum ammonia was also within the normal range. Serological viral markers for hepatitis B or C were all negative. The abdominal ultrasonography and computed tomography indicated a 12 mm diameter shunt located in the left lobe of the liver, which connected the portal vein with the left hepatic vein. After treatment for gastric ulcers, percutaneous transhepatic portography was performed and an enormous shunt connecting the umbilical portion of the portal vein with the left hepatic vein was revealed. CONCLUSIONS: Histological findings of the liver biopsy showed that portal venules could not be observed in the portal areas and that no fibrosis or inflammatory cell infiltration were shown. Because of the anatomical position of the shunt, the case was diagnosed as patent ductus venosus.     

沉默型动脉导管未闭的血流动力学特征及治疗探讨

目的　探讨沉默型动脉导管未闭 (patentductusarteriosus ,PDA)的血流动力学特征及治疗。方法　对临床结合超声心动图诊断的 7例沉默型PDA病人进行心导管检查 ,术后 3个月、6个月及每年随访一次。结果　 7例病人肺动脉平均压平均为 (16 0± 2 4 )mmHg ,肺循环和体循环血流量比 (Qp/Qs)为 1 0 8± 0 0 2 ,左向右分流量平均为 (0 32± 0 0 8)L/min ,左向右分流量占肺循环血流量比例平均为 0 0 98± 0 0 2 4。PDA最窄处平均直径为 (0 9± 0 2 )mm。 7例病人均未行外科手术和介入治疗。平均随访 9 5个月 (临床、心电图、超声心动图 ) ,未发现房室腔增大、肺动脉压增高 ,无感染性动脉内膜炎和心内膜炎发生。结论　沉默型PDA的左向右分流量很少 ,对病人的血流动力学影响小。沉默型PDA病人是否需要治疗尚无定论。     

经特殊途径封堵动脉导管未闭3例的临床分析

目的:通过特殊途径放置封堵器治疗动脉导管未闭（PDA）。方法:3例PDA患者,均并发下腔静脉肝下段缺如、奇静脉开放,1例同时并发镜像右位心,经股静脉不能直接到达右心房而采用颈内静脉、锁骨下静脉和降主动脉3种不同的途径封堵PDA。结果:3例均封堵成功,术后5min主动脉弓降部造影显示封堵完全,术后1d、3个月、6个月复查超声心动图无残余分流。结论:可通过特殊途径经心导管封堵并发下腔静脉肝下段缺如的PDA患者。     

Coarctation and related aortic arch anomalies in hypoplastic left heart syndrome

The aortic arches of 34 specimens with hypoplastic left heart syndrome were studied in order to establish the frequency, the nature and the clinical implications of aortic arch anomalies. A localized aortic coarctation was present in 23 specimens. The coarcation was located preductally in 2 and paraductally in 21 cases. The degree of obstruction caused by the coarctation varied considerably. In only 6 cases (1 preductal and 5 paraductal) was the obstruction judged to be severe. One of these cases had an additional aneurysm of the aortic wall proximal to the coarctation. An aberrant relation of the ductus arteriosus and the aortic arch was found in 2 specimens without localized coarctation. In the remaining 9 specimens the aortic arch appeared normal. The aortic arch anomalies were mostly present in specimens with a severely hypoplastic ascending aorta. Clinicians, when preparing infants with hypoplastic left heart syndrome for surgical palliation, should always suspect associated aortic arch anomalies, especially when there is severe hypoplasia of the ascending aorta. Coarctation of the aorta will require additional surgical treatment.     

Inadvertent stenting of patent ductus arteriosus with Amplatzer Vascular Plug.

We report a 12-month old patient who presented for murmur evaluation after percutaneous closure of type C patent ductus arteriosus (PDA) using a 10 mm Amplatzer Vascular Plug (AGA Medical Corporation, Golden Valley, MN) at an outside institution. Echocardiography revealed a large left-to-right shunt through the implanted device, inadvertently stenting the PDA instead of closing it. The patient underwent repeat catheterization with successful coil implantation within the Amplatzer Vascular Plug, completely eliminating the large residual ductal shunt. Although challenging, this case illustrates the technique of implanting coils within this occlusion device. This case also illustrates that occlusion of type C PDA utilizing the Amplatzer Vascular Plug may not only result in incomplete occlusion but also create a potentially worse clinical situation in which the PDA is stretched larger and stented open. Without consideration of simultaneous coil implantation within this device, use of the Amplatzer Vascular Plug might be contraindicated in type C PDA, because there may be no way to ensure successful closure by the Vascular Plug alone.     

关于中药命名规范化现状与发展的思考

通过文献研究对中药饮片和中成药命名规范存在的问题和原因进行回顾与分析,提出植物的不同基原、各地处方规范和国家标准不统一等是中药命名不规范的主要原因。尽管国家已出台的相关法规和指导原则推动了中药命名规范化的进程,但缺乏通用的中成药编码系统与标准,因此建议政府相关部门制定统一标准来实现中药命名规范化,为中药的合理使用和国际化,以及全球草药的统一监管奠定基础。     

基于经食管超声心动图的卵圆孔未闭形态与隐源性卒中的关系研究

目的 应用经食管超声心动图（tran s e so p h ageal e ch o card iograp hy,TEE）检查评估隐源性卒中 （cryptogenic stroke,CS）患者卵圆孔未闭（patent foramen ovale,PFO）的形态学特征,探讨PFO形态与 CS发生的关系。 方法 回顾性选取2015年3月-2020年1月于大连医科大学附属大连市中心医院行PFO封堵治疗的患 者95例,其中CS患者52例（CS组）,偏头痛患者43例（偏头痛组）。所有患者均于术前行TEE检查,静 息状态测量PFO宽度、PFO通道长度,评估PFO合并房间隔膨出瘤、永存下腔静脉瓣情况,Valsalva状态 测量PFO宽度,根据TCD发泡实验（contrast-enhanced transcranial Doppler,c-TCD）判断PFO右向左分流量, 以c-TCD双侧微泡栓子信号成帘状或淋浴型为大量右向左分流。比较CS和偏头痛患者PFO上述指标的 差异。 结果 CS组静息状态PFO宽度[1.6（1.1～2.0）mm]与偏头痛组[1.6（0.9～2.0）mm]比较,差异无统计学 意义,Valsalva状态PFO宽度（2.18±0.64 mm）大于偏头痛组（1.84±0.82 mm）（P =0.026）。CS组静息状 态PFO通道长度（9.63±4.42 mm）与偏头痛组（10.15±4.06 mm）比较差异无统计学意义,PFO合并房 间隔膨出瘤患者比例（44.2%）高于偏头痛组（20.9%）（P =0.017）,PFO合并永存下腔静脉瓣患者比 例（36.5%）高于偏头痛组（16.3%）（P =0.027）。CS组c-TCD大量右向左分流患者比例（90.4%）与偏 头痛组（76.7%）比较差异无统计学意义。logistic回归分析结果显示,Valsalva状态PFO宽度（OR 2.261, 95%CI 1.191～4.291,P =0.013）是CS发生的独立预测因子。 结论 Valsalva状态PFO宽度与CS发生有关,Valsalva状态PFO宽度是识别CS的有效参数。     

氨基末端脑钠肽前体预测早产儿症状性动脉导管未闭的价值

目的 探讨氨基末端脑钠肽前体(NT-proBNP)预测早产儿症状性动脉导管未闭(sPDA)的价值。方法 选择2014年6月至2015年4月出生、胎龄≤32周、48 h内超声心动图确定存在动脉导管的早产儿为研究对象,监测其临床表现,于生后3 d及5 d检测血清NT-proBNP水平并行超声心动图检查,根据患儿临床表现、超声心动图结果分为sPDA组及非症状性动脉导管未闭(asPDA)组,分析血清NT-proBNP水平与超声指标的关系,比较两组间相同日龄血清NT-proBNP水平,ROC曲线确定血清NT-proBNP水平预测sPDA的敏感性、特异性。结果 共69例早产儿纳入研究,其中sPDA组13例,asPDA组56例。血清NT-proBNP水平与动脉导管管径、左房内径与主动脉根部内径比值(LA/AO)呈正相关关系(分别r=0.856、0.713,均 PPCI:0.892~1.000,PCI:0.848~1.000,P结论 NT-proBNP可能是动脉导管分流量的量化指标;生后3 d 及5 d血清NT-proBNP水平的检测均有助于早期预测sPDA。     

Prenatal Sonographic Diagnosis of Premature Constriction of the Fetal Ductus Arteriosus After Maternal Self‐Medication With Benzydamine Hydrochloride

We report 3 cases of prenatal diagnosis of premature constriction of the ductus arteriosus after maternal benzydamine hydrochloride therapy (3‐mg lozenges) in third‐trimester pregnancies. In each case, fetal echocardiography revealed a dilated, hypocontractile right ventricle with severe tricuspid regurgitation and constriction of the ductus arteriosus. Although the effect of indomethacin and other nonsteroidal anti‐inflammatory drugs on prenatal ductal constriction is well known, readily available over‐the‐counter nonsteroidal anti‐inflammatory drugs such as benzydamine can have an equally deleterious effect and are best avoided in the third trimester of pregnancy.     

合肥市蜀山区0~12个月婴儿先天性心脏异常筛查分析

目的：分析合肥市蜀山区0~12个月婴儿先天性心脏异常发生状况。方法利用心脏彩色超声心动图对蜀山区4138名0~12个月婴儿进行筛查。结果4138名婴儿中,心脏异常婴儿642名,异常率为15．5%,男、女婴异常率差异无统计学意义(χ2=0．592, P>0．05);0~12个月婴儿心脏异常率随着月龄的增加逐渐降低,差异有统计学意义(χ2趋势=120．593,P<0．05)。婴儿心脏异常中,卵圆孔未闭最多,构成比为83．3%,其次为房间隔缺损,构成比为5．8%,第三为室间隔缺损,构成比为3．3%。结论防治先天性心脏异常,应从新生儿甚至胎儿抓起,实现早发现、早诊断、早治疗。