Use of saline contrast echo timing to distinguish intracardiac and extracardiac shunts: failure of the 3- to 5-beat rule

Patent foramen ovale (PFO) is thought to be associated with cryptogenic stroke and migraine headache. Saline contrast echocardiography (SCE) is the gold standard for identifying the presence of right-to-left shunt, whether from PFO or pulmonary arteriovenous malformation (PAVM). The timing of left heart contrast entry during SCE is used to distinguish a PFO from a PAVM, a method that is not as specific as previously thought. In this report, we describe a patient with a SCE demonstrating the early appearance of left heart bubbles during good effort Valsalva injections that is ultimately proven to be due to a PAVM. The case illustrates the limited specificity of left heart contrast timing during SCE as the sole criteria for differentiating intracardiac and extracardiac shunts.     

Rescue of CardioSEAL PFO closure device malposition with Amplatzer PFO closure device at time of initial implantation.

This case report describes a patient undergoing patent foramen ovale (PFO) closure for recurrent transient ischemic attacks. A CardioSEAL device was placed, but immediately prolapsed into the left atrium in an unstable position. We describe a novel percutaneous technique that allowed capture of the CardioSEAL device and closure of the PFO.     

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。     

Late free atrial wall rupture after percutaneous atrial septal defect closure and transvenous pacemaker implantation

We report a remarkable case of right atrial rupture, 3 years after transcatheter closure of a secundum atrial septal defect, and 7 months after permanent transvenous two‐chamber pacemaker implantation. The etiology of the rupture remains unclear, but the presence of the two intracardiac devices is probably not coincidental. © 2008 Wiley‐Liss, Inc.     

Cardiac perforation and tamponade 3 months after transcatheter PFO closure by STARFlex device: A case report

Percutaneous Patent Foramen Ovale (PFO) closure after paradoxical embolism has become established as a safe, effective and validated procedure. The use of dedicated devices by experienced operators allows for low complication rates and good clinical results in the prevention of paradoxical embolism recurrence. This has led to a widespread use of the technique. However, late complications have been reported after the implantation of different types of devices. We report the first case of cardiac tamponade due to atrial wall erosion, which occurred three months after the implantation of a STARflex device (Nitinol Medical Technologies, Boston, Massachusetts, USA) in a 57 year‐old‐patient Transoesophageal echocardiographic images and surgical views of the perforation related to the device are presented. This report describes treatment of a late complication that arose following implantation of a STARflex device. © 2008 Wiley‐Liss, Inc.     

Age is not a predictor of patent foramen ovale with right-to-left shunt in patients with cerebral ischemic events

BACKGROUND: Patent foramen ovale (PFO) with or without atrial septal aneurysm (ASA) is highly associated with cerebral ischemic events in young patients. The prevalence of PFO and ASA in elderly patients with cerebral ischemic events is not well described. OBJECTIVE: Our study is to evaluate the frequencies of PFO with right-to-left shunt (RLS) and ASA in elderly patients and to determine whether age is a predictor of flow-reversed PFO with RLS in cerebral ischemic events. METHODS: A prospective registry for all consecutive patients with cerebral ischemic events who were evaluated by transesophageal echocardiography (TEE) for the detection of possible cardiac source of embolization was established and maintained in a university hospital. Patients' demographics including age, gender, ethnic origin, cerebrovascular risk factors, and all positive TEE data were collected from July 2000 to August 2001 for statistical analysis. A univariate and multivariate stepwise logistic regression analysis was performed. RESULTS: In older patients the prevalence of PFO with RLS, PFO, and ASA was 25/118 (20%), 28/118 (24%), and 38/118 (32%), respectively, as opposed to younger patients, in whom it was 35/119 (30%), 39/119 (33%), and 38/119 (32%), respectively. Older patients had higher frequencies of hypertension (59; 69%), CAD (25; 21%), and prior history of stroke (23; 20%) as opposed to younger patients. Younger age (<60 years), gender, smoking history, hypertension, hyperlipidemia, CAD, and prior history of stroke were not associated with higher prevalence of PFO with RLS. Patent foramen ovale was associated with ASA (P < 0.001) and LVH (P < 0.019) in patients with TIA and stroke. In multivariate analysis only ASA (P < 0.001) remained significant with PFO, with RLS controlling for age, gender, and LVH. CONCLUSIONS: PFO with RLS and ASA are frequently present in elderly stroke and/or TIA patients and age is not a predictor for PFO. Transesophageal echocardiography should be considered for all stroke and/or TIA patients irrespective of their age.     

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。     

The relative locations of the supraorbital,infraorbital, and mental foramina: A cadaveric study

The purpose of this study is to investigate the applicability of the current surgical guideline stating that the main facial foramina that transmit cutaneous nerves to the face (supraorbital notch/foramen, infraorbital foramen, and mental foramen) are equidistant from the midline in European and Hispanic populations. Previous studies suggest this surgical guideline is not applicable for all ethnicities; however, to our knowledge, no data have been published regarding the accuracy of this guideline pertaining to the Hispanic population. An experimental study was performed on 67 cadavers donated to the Human Anatomy Program at UT Health San Antonio. The supraorbital, infraorbital, and mental foramina were dissected and midline structures including the crista galli, internasal suture, anterior nasal spine, and mandibular symphysis were identified. The distance from each foramen to midline was recorded using a digital caliper. For all cadavers/ethnicities studied, the supraorbital, infraorbital, and mental foramina were 25.32 mm, 29.57 mm, and 25.55 mm to the midline, respectively. Thus, the infraorbital foramen is located significantly more lateral compared to the supraorbital (p < 0.0001) and mental foramina (p < 0.0001). After dividing the sample based on ethnicity, this relationship was also true for the European sample and tended to be true for the Hispanic sample. Significant anatomical variations exist in the current surgical guideline stating that the supraorbital foramen, infraorbital foramen, and mental foramen are equidistant from the midline. Clinicians may need to adjust their methodology during surgical procedures of the face in order to optimize patient care.     

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。