叶酸,维生素B6,B12对血浆同型半胱氨酸水平影响及对比研究

目诉：高同型半胱氨酸血症作为一种新的独立的动脉硬化和冠心病的危险因素日益受到人们的关注。本旨在探讨叶酸、维生素Ｂ６、维生素Ｂ１２,对血浆同型半胱氨酸水平的影响。方法：我们将６２例确诊为同型半胱氨酸血症的患随机分为观察组及对照组,观察组给予叶酸、维生素Ｂ、维生素Ｂ１２,对照组给予安慰剂,用药２周后复查血浆同型半胱氨酸水平,结果：观察组降低同型半胱氨酸水平的显效率为２１．９％,有效率５３．１％,总     

酸、同型半胱氨酸在冠心病中的诊断价值

目的 探讨尿酸、同型半胱氨酸对冠状动脉粥样硬化性心脏病的诊断价值。方法 94例患者行冠脉造影检查根据冠脉造影结果分为冠心病组（64例）和非冠心病组（30例）,冠心病组分为单支病变组、双支病变组,多支病变组,比较各组临床指标（年龄、性别、TC、TG、LDL-c、HDL-c）、血同型半胱氨酸、尿酸水平。结果 年龄、性别、各生化指标在各组间差异均无统计学意义（均P>0.05）。冠心病组SUA、Hcy平均水平分别为（397.38±72.63）μmol/L、（15.74±6.92）μmol/L,与非冠心病组相关指标的差异均有统计学意义（SUA：t=5.446,P<0.01;HCY：t=2.682,P<0.01。单支病变与非冠心病组,双支与单支病变组在Hcy 、SUA上差异无统计学意义,而冠心病多支病变组、双支病变组在Hcy、SUA水平均显著高于非冠心病组,差异具有统计学意义（p均<0.05）。且随冠脉病变支数的增加Hcy、SUA水平随之升高。结论 尿酸、血同型半胱氨酸水平对早期发现及早期干预冠心病有重要意义。     

同型半胱氨酸与中老年男性缺血性心脑血管疾病的相关性研究

目的探讨血浆同型半胱氨酸水平与中老年男性缺血性心脑血管疾病的相关性。方法前瞻性连续入选既往无冠心病及脑卒中病史的中老年男性343例,随访7年,记录患者一般资料及7年缺血性不良事件发生率。结果1)缺血性心脏病组的血浆同型半胱氨酸水平略高于未发生缺血性心脏病组,但差异无统计学意义(13.06μmol/L vs 12.38μmol/L,P0.05),而缺血性脑卒中组血浆同型半胱氨酸水平显著高于未发生组(14.25μmol/L vs12.18μmol/L,P0.05)。2)高同型半胱氨酸血症组发生缺血性心脏病例数高于对照组,但是差异无统计学意义(P0.05)。高同型半胱氨酸血症组发生缺血性脑卒中例数明显高于对照组(P0.05)。3)单变量Logistic回归分析,结果提示发生缺血性脑卒中的人群年龄大,体质指数高、肌酐高,有吸烟史、高血压史和高同型半胱氨酸血症。结论同型半胱氨酸与中老年男性缺血性心脏病的发病率无相关性,与中老年男性缺血性脑卒中发病率有显著相关性,但对预测缺血性脑卒中的危险度弱于传统致心脑血管疾病危险因子。     

体-肺动脉分流术在建立先天性心脏病动物模型中的应用进展

先天性心脏病是导致儿童死亡的一个重要病因,为研究先天性心脏病的病理生理机制,建立稳定可靠的动物模型相当重要,建立体-肺动脉分流是模拟左向右分流型先天性心脏病的关键技术.现从外科建立分流技术的发展出发,介绍体-肺动脉分流对于建立动物模型的意义,以及以介入方式建立此分流的发展和在不同模型中的应用.     

高同型半胱氨酸血症与血脂异常的相关性研究

目的研究高同型半胱氨酸血症患者同型半胱氨酸水平与血脂异常的相关性。方法对2017年2月到12月北方某市某体检机构参与体检的58 297例对象的资料进行回顾性研究。通过卡方检验分析体检人员同型半胱氨酸水平的差异,并采用Logistic回归分析控制年龄、性别及体质指数(BMI)等对结果的影响。结果 Logistic回归显示,男性、高甘油三酯是高同型半胱氨酸血症的危险因素,其对应的OR值为:男性OR=3.861(95%CI:3.265～4.564),高甘油三酯血症OR=1.302(95%CI:1.034～1.639)。另外,随着载脂蛋白AⅠ含量的增加,患者患高同型半胱氨酸血症的风险下降,OR值为0.682(95%CI:0.515～0.904)。结论高甘油三酯血症可能是高同型半胱氨酸血症的危险因素。患者患高同型半胱氨酸血症的风险随载脂蛋白AⅠ含量的增加而下降。     

不同微创小切口与胸骨正中切口治疗儿童先天性室间隔缺损的临床对比研究

目的 本项研究通过对比右胸前外侧切口、胸骨下段小切口与胸骨正中切口治疗先天性室间隔缺损,探讨和评价两种手术路径的优劣,以期进一步提高临床治疗效果。 方法 回顾性分析2015年3月至2016年12月间,我院共198例患者行先天性室间隔缺损修补术,根据手术方式不同分为三组：胸骨下段小切口组（lower mini-sternotomy LMS Group, n=66), 右胸前外侧切口（right lateral thoracotomy RLT Group, n=59), 以及胸骨正中切口（standard median sternotomy SMS Group, n=73）。所有患者均常规建立体外循环,收集术前一般临床资料,及术中体外循环时间、主动脉阻断时间及ICU停留时间等临床资料。 结果 所有患者均顺利完成手术,无死亡及二次开胸止血。微创切口手术患者均顺利完成手术,术中无中转为正中开胸手术治疗;LMS 组、RLT组及正中开胸组患者体外循环时间分别为：37.73±11.46mins, 41.3±13.97mins,36.99±10.84mins,三组间比较无明显统计学意义(p=0.078); 主动脉阻断时间分别为:23.85±9.78mins, 22.54±9.08mins,19.23±6.92mins,三组间比较有明显的统计学意义(p=0.009). 与LMS组及RLT组患者相比较,SMS组患者的切口最长,约7.45±1.54cm,而 LMS 组患者为 5.58±0.8cm,RLT组, 5.96±1.48cm,三组间比较有明显的统计学意义 (p<0.001)。 结论：右胸前外侧切口、胸骨下段小切口行先天性室间隔缺损修补术疗效确切,安全性好,更为美观,在一定条件下可替代胸骨正中切口方式     

基因突变在先天性房间隔缺损和室间隔缺损发育形成中的作用研究

对于先天性房间隔缺损、室间隔缺损通过外科和介入手术治疗可大大提高患者生存率,但对其发育畸形的根本原因仍属于探索阶段。目前现有的研究表明,先天性心脏病是由于控制人体心脏发育的基因在时间(发育阶段)和空间(组织特异性)上的表达调控失误而引起的。现即从现有的基因水平研究对基因突变在先天性房间隔缺损和室间隔缺损发育形成中的作用研究作一综述,为从基因方面早期筛检、诊断、治疗先天性房间隔缺损、室间隔缺损提供参考。     

三尖瓣切开在婴儿室间隔缺损修补术中的应用及疗效分析

摘要 目的 探讨三尖瓣切开在婴儿室间隔缺损修补术中的应用及其对术后并发症发生率的影响。方法 回顾性分析561例1岁以下室间隔缺损修补术,根据术中暴露情况判断是否需切开三尖瓣修补VSD,分为3组。A组：VSD暴露清楚,不需切开三尖瓣;B组：VSD暴露不清楚,需切开三尖瓣;C组：VSD暴露不清楚,需切开三尖瓣,但未实施切开。采集术后12个月的心电图和多普勒超声心动图资料,记录Ⅲ°房室传导阻滞及三尖瓣返流程度、VSD残余分流情况及左心室EF值,并进行分析比较。。结果 主动脉阻断及体外循环时间、Ⅲ°房室传导阻滞发生率各组间比较未见统计学差异,A、B、C各组VSD残余分流分别为1.3%、1.7%、6.8%,三尖瓣返流发生率分别为7.0%、9.2%、25.0%,其中,C组明显高于A、B组,A、B组比较未见统计学差异。结论 必要的三尖瓣切开是安全的,可有效降低三尖瓣反流和VSD残余分流的发生率,但不增加术后Ⅲ°房室传导阻滞的发生率。随着手术患儿年龄降低,需实施三尖瓣切开的比例显著增加。     

自制单向活瓣在室间隔缺损并重度肺动脉高压病人畸形矫治中的应用

目的探讨单向活瓣补片加房间隔开窗术对先心病合并重度肺动脉高压(PH)病人手术治疗的可行性和疗效。方法回顾性分析采用单向活瓣补片加房间隔开窗术对20例室间隔缺损伴重度PH病人进行手术矫正的疗效和随访观察结果。结果术后早期7例病人肺动脉压明显下降,未出现跨活瓣片的分流;13例病人术后7d出现分流。死亡2例(1例死于心力衰竭,1例因上消化道出血死于术后13d),18例病例康复出院。术后出现分流的13例中,8例随访1个月~48个月,3个月仍出现跨活瓣片分流的4例,右向左分流3例,双向分流1例。术后6个月以上仍存在经活瓣片分流的1例,肺动脉收缩压(PP)/主动脉收缩压(PS)>0.75。7例术后未出现跨活瓣片分流者,术后3个月复查肺动脉压下降满意。结论单向活瓣补片允许术后特定情况下右向左分流,有效减轻右心室负荷,有利于早期右心功能恢复,达到保持体肺循环相对平衡,提高术后生存率。     

先天性心脏病膜周部室间隔缺损自愈性闭合情况观察

目的:观察先天性心脏病膜周部室间隔缺损(P-VSD)的自愈性闭合(SC)情况,探讨P-VSD的治疗时机。方法:选取经超声心动图确诊为单纯P-VSD的患儿112例(平均年龄4.7 d),根据有无膜部瘤形成分为膜部瘤形成组(n=59)和无膜部瘤组(n=53)。所有患儿在入选、出生1个月、出生6个月时行超声心动图检查,之后每半年检查1次,随访至6周岁,观察6年内P-VSD的SC率和SC时间。结果:P-VSD患儿6年内发生SC者共64例,其中≤3岁者52例,占≤3岁患儿的46.43%,>3岁者12例,占>3岁患儿的25.00%,3岁以前发生SC的情况较多。所有发生SC的患儿缺损大小平均为(3.9±1.5)mm,SC率为57.14%,SC时间为(2.3±1.5)岁,其中膜部瘤形成组49例,缺损大小平均为(4.0±1.5)mm,SC率83.05%,SC时间为(2.4±1.5)岁;无膜部瘤组15例,缺损大小为(3.5±1.2)mm,SC率28.30%,SC时间为(2.0±1.4)岁。膜部瘤形成组SC率显著高于无膜部瘤组(P<0.05)。26例P-VSD患儿在随访期间接受了手术闭合治疗,其中膜部瘤形成组7例,无膜部瘤组19例,接受手术治疗的患儿缺损明显大于发生SC的患儿[(6.2±1.0)mm对(3.9±1.5)mm,P<0.05]。结论:缺损较小的P-VSD患儿出生后6年内的SC率>50%,有膜部瘤形成的P-VSD患儿较易发生SC;缺损较大的P-VSD患儿SC率较低,建议手术治疗。     

The effects of iron treatment on viscosity in children with cyanotic congenital heart disease

Objective: This study was planned to determine the effects of iron treatment in children with cyanotic congenital heart disease.

Method and Materials: A total of 39 patients with cyanotic congenital heart disease including 20 (51%) females, 19 (49%) males and whose mean age was 9.9?±?6.2 years, average weight was 33?±?18.4?kg were evaluated. Patients were categorized into two groups as having iron deficiency and no iron deficiency with respect to their ferritin levels. 4?mg/kg/day iron treatment with two valences was applied to the groups with iron deficiency for 3 months. Clinical and laboratory findings of both groups were assessed at the outset and 3 months later and viscosity measurements were carried out.

Results: Iron deficiency was identified in 21 (53.8%) out of 39 patients. Average Hb and Hct values following 3-month iron treatment increased from 14.8?±?2.4?g/dl to 16.0?±?2.0 (P?=?0.003) and from %45.8?±?7.5 to %47.6?±?7.2 (P?=?0.052), respectively. Average viscosity value, however, was 5.6?±?1.0?cP, it reduced to 5.5?±?1.0?cP value by demonstrating very little reduction (P?=?0.741). Nevertheless, O₂ sat value increased from 71.7 to 75% and complaints such as headache, visual blurriness, having frequent sinusitis decreased.

Conclusions: It was observed that iron treatment increased Hb and Hct levels in patients with cyanotic congenital heart disease without raising viscosity and it ensured improvement in clinical symptoms.     

三尖瓣环切开技术在膜周部室间隔缺损修补术中的应用

目的三尖瓣环切开(TVD)技术在膜周部室间隔缺损(VSD)修补术中的应用。方法总结1996年1月～2000年12月室间隔缺损修补术后患儿525例,应用三尖瓣环切开技术96例。结果TVD组比非TVD组年龄小、体重低,但术前合并其他畸形,术中主动脉阻断时间、体外循环时间、直接缝合率,以及术后死亡率两组之间没有显著差异。术后TVD组发生少量三尖瓣反流(TI)32例,非TVD组发生少量TI141例。术后TVD组发生小量残余分流(RS)22例,非TVD组发生小量RS93例,TI和RS两组之间差异无统计学意义(P>0.05)。对两组中56例患儿进行随访3年,其中31例患儿RS自动闭合。结论TVD可以提高膜周部VSD的显露且手术并发症很低,不会增加TI、RS发生率。     

心脏彩超对房缺行封堵介入治疗的临床价值

目的分析心脏彩超对先天性心脏病继发孔型房间隔缺损行封堵术介入治疗的临床价值。方法随机选取我院行封堵术介入治疗的先天性心脏病继发孔型房间隔缺损患者128例,对其临床资料进行回顾性分析。结果术后对3天、1个月、3个月、6个月对患者行心脏彩超复查可知,128例先天性心脏病继发孔型房间隔缺损患者中,有125例患者手术均成功,成功率为97.7%。对其进行长达6个月的复查中均未出现脱落、残余血液分流现象。1例患者复查中出现封堵器脱落现象,2例患者因术前对其检测不当,术后出现轻度反流现象。结论心脏彩超对先天性心脏病继发孔型房间隔缺损诊断具有极其重要的决定性价值,可有效提高封堵术介入治疗的成功率,充分保证患者安全。     

Staged percutaneous atrial septal defect closure and pulmonic balloon valvuloplasty in an adult with congenital heart disease

Combined atrial septal defect and pulmonic stenosis, while a common occurrence in children, is relatively uncommon in adults. There is no widely accepted order in which the defects should be corrected. We report a case that highlights the hemodynamics and the technical dilemma of deciding which lesion to correct first. © 2008 Wiley‐Liss, Inc.     

Percutaneous closure of perimembranous ventricular septal defect associated with a ventricular septal aneurysm using the Amplatzer ductal occluder.

Amplatzer ductal occluders were used for percutaneous closure of perimembranous ventricular septal defects with associated ventricular septal aneurysm in three patients. The device was well positioned and the ventricular left-to-right shunt was significantly decreased in all three patients. The procedure was tolerated well without complications in each case.     

国产室间隔缺损封堵器的动物实验研究

目的观察国产室间隔缺损封堵器通过导管经心室植入动物体内后的封堵效果及组织学反应,评价其可行性、安全性及疗效。方法选用犬12只,在经心外膜超声的指引,非体外循环下建立室间隔缺损动物模型,直视下经导管植入国产室间隔缺损封堵器。术后15d、1、3、6个月分别处死动物,进行大体解剖、光镜及电镜观察。结果8只犬成功建立了室间隔缺损的动物模型并进行了封堵,均存活至观察终点,超声心动图随访无残余分流,生长发育无异常,无严重并发症发生,1～6个月的大体解剖可见封堵器表面被厚度不等的半透明、光滑的新生组织所覆盖,封堵器与室间隔组织结合紧密,光镜及扫描电镜检查证实为内皮细胞、纤维组织。各重要脏器无血栓栓塞及其它异常表现。结论国产的室间隔缺损封堵器具有良好的组织相容性,用外科方法修补室间隔缺损以及在超声心动图的指引下经心室植入室间隔缺损封堵器是可行的、安全的。     

Magnetic resonance imaging of complex congenital heart disease

Current MR techniques enable both anatomical and functional evaluations of the heart. Although it is rarely used as a primary diagnostic tool in pediatric cardiology, it can be used as a valuable adjunct to echocardiography and angiography. MRI is particularly useful in clarification of morphology of complex congenital heart diseases. It is the most accurate method of determination of visceral and atrial situs. It is easy to evaluate the systemic and pulmonary venous connections that are very important for the Fontan type of operation, especially in patients with visceral heterotaxy. It facilitates demonstration of diminutive pulmonary arteries in patients with pulmonary atresia. It clearly demonstrates juxtaposition of the atrial appendages that is often missed by echocardiography. The anatomy of the twisted atrioventricular connections is much more clear in MRI than in echocardiography. It enables en face imaging of ventricular septal defect that provides a surgical view. We find en face imaging particularly helpful in patients with double inlet left ventricle and transposition of the great arteries where the size of the ventricular septal defect governs the blood flow into the aorta. It is often advantageous to echocardiography in defining the type of univentricular atrioventricular connections by demonstrating the position and topology of the rudimentary chamber in difficult cases. In double outlet right ventricle, the spatial relationship of the ventricular septal defect to the great arterial valves can be clearly defined by visualizing the ventricular septal defect and the outlet septum in the same imaging plane.     

Familial recurrence of congenital heart disease in patients with ostium secundum atrial septal defect.

AIMS: Ostium secundum atrial septal defect (osASD) is one of the most common cardiac malformations. Few data are available on the familial recurrence of congenital heart disease (CHD), in particular, in a large group of patients with isolated osASD. The aim is to investigate the familial recurrence of CHD in up to third-degree relatives from a large sample of consecutively enrolled patients with osASD, taking into account the influence of degree of relatedness (as number of relatives). METHODS AND RESULTS: From January 1998 to December 2002, we enrolled 583 patients with osASD and 408 healthy subjects, referred to our tertiary centre. We hypothesized that a positive family history required at least one relative with CHD to constitute a risk factor. In this model of analysis, the null hypothesis is a similar familial history between cases and controls. Among 583 patients with osASD, 109 (19%) had at least one relative with CHD. Among the 408 healthy subjects studied, only 23 (6%) had a family history of CHD. A familial recurrence of CHD was demonstrated in 72 of 312 (23%) patients with isolated osASD and in 37 of 271 (13.6%) patients with non-isolated osASD. Familial recurrence of isolated osASD was demonstrated in 22 of 312 patients (7%) with an isolated osASD and only in six of 271 patients (2.2%) with non-isolated osASD. The familial recurrence risk of isolated osASD in patients with isolated osASD was higher in sibs, especially in sisters (33.3%). CONCLUSION: This study underscores the role of genetic factors in the determination of CHD, particularly osASD. Our results could represent the basis for further studies to calculate a 'value of family history' to adapt the familial recurrence to the real size of each family group. In this way, we could select families with a 'tendency' to develop CHD, particularly osASD. In these families, we could analyse the genetic pattern to establish abnormalities and the bases of CHD.