Transesophageal echocardiography as a quality control tool in thoracoscopic cardiac surgery:4-years' experience

Background The utilization value of intraoperative transesophageal echocardiography in cardiac surgery is more and more important. However,the role of intraoperative transesophageal echocardiography on quality control during thoracoscopic cardiac surgery has not been comprehensively studied. Methods A retrospective study of transesophageal echocardiography application on patients underwent thoracoscopic cardiac surgery from2012 to 2015 was conducted in a single cardiovascular center. General anesthesia and peripheral cardiopulmonary bypass were standardized for all patients. All procedures were performed through 3 holes made in the right chest wall. Transesophageal echocardiography monitoring was routinely utilized in each patient. Results A total of 1387 patients underwent thoracoscopic cardiac surgery were involved in the study. The mean age of patients was 42.8±15.3 years with a female predominance(60.6%). The most common procedures were mitral valve replacement(n=507,36.6%),atrial septal defect repair(n=425,30.6%),and mitral valve plasty(n=294,21.2%). Other main procedures included correction of partial anomalous pulmonary venous connection,cor triatriatum,ventricular septal defect or partial atrioventricular canal,removal of left or right atrial myxoma,and tricuspid valve plasty or replacement. Transesophageal echocardiography monitoring was useful at every stage of surgery without any major associated complications. Forty-four patients(3.2%)required surgical re-interventions immediately following transesophageal echocardiography evaluation. The reasons included unsatisfactory valve plasty,paravalvular leak,prosthetic dysfunction and residual shunting. The incidence of surgical re-intervention,as well as the mortality,decreased annually with increased surgical volume. Conclusions Intraoperative transesophageal echocardiography plays an important role in the quality control of thoracoscopic cardiac surgery.[S Chin J Cardiol 2019;20(2):69-78]     

全腔镜下经二尖瓣改良扩大Morrow术同期行二尖瓣成形术1例△

<正>肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)是肥厚型心肌病的重要类型之一,约2/3患者可出现收缩期左心室流出道的动态的梗阻,是导致心力衰竭及心源性猝死的危险因素~([1])。对于药物治疗后症状无法缓解的患者,行室间隔肥厚心肌切除术(Morrow Procedure)以减轻左心室流出道梗阻是目前首选的治疗方案~([2])。传统的经主动脉入路安全并有效,在数十年来已得     

新疆某高等医学院校基层党务干部队伍建设研究

目的为切实解决高校党务干部队伍建设与发展中存在的突出问题,努力建立一套更加健全完善的高校党务干部队伍建设长效机制,从而推动高校党建工作、业务工作和高校的建设发展迈上一个新台阶。方法通过问卷及专家访谈对党务干部的基本情况、思想状况、党务干部的素质、培训教育情况、党务干部队伍建设存在的问题等情况进行调查。结果 1学校党务干部的思想状况总体上是好的,有61.23%党务干部热爱党务工作,具有较高的积极性和主动性;2学校党务干部的综合素质较好,但在创新意识和创新能力（69.96%）、综合协调能力（48.56%）、科学决策能力（43.62%）等方面欠缺;3通过调查,认为对党务干部队伍选拔任用最为合适的方式为公开选拔（77.37%）和竞争上岗（66.67%）;456.79%的人认为学校党务干部队伍建设存在重使用、轻培养,相对忽视党务干部队伍建设。结论 1对党务干部队伍建设存在的问题从党委抓党建工作责任制、党务干部培训、完善党务干部职称评定等方面提出对策建议;2建立、健全高校党务干部退出机制,解决干部能＂上＂能＂下＂的问题。     

心脏手术体外循环前后桡动脉压力与股动脉压力的变化规律

目的探讨心脏手术体外循环(CPB)前后桡动脉压与股动脉压力的变化规律。方法监测50例心脏手术患者切皮前、CPB停机5 min、1 h、2 h、4 h和8 h等不同时点的桡动脉和股动脉平均压以及心指数(CI)、体循环阻力指数(SVRI)、中心静脉压(CVP)。结果在CPB前所有患者桡动脉与股动脉平均压比较无明显差异,而在CPB停机早期有7例患者桡动脉平均压小于股动脉平均压且超过10 mm Hg,个别患者超过20 mm Hg。结论心脏手术CPB后早期,在有些患者桡动脉压力低估了中心动脉的压力,而股动脉压力更能反映中心动脉的压力。