Gemella morbillorum endocarditis

A case of Gemella morbillorum (G.morbillorum) endocarditis of the mitral valve in a patient with previously normal heart valves is reported. The presentation was subacute, and the infection was complicated by perforation of the posterior mitral leaflet that necessitated valve repair. Gemella morbillorum infections are uncommon, and endocarditis is the most common presentation. G.morbillorum endocarditis is probably under recognized, and has not been reported from our region. The case is described, and problems in the identification of the organism are discussed.     

胸部CT显示梗阻性肥厚型心肌病引起肺部树芽征1例

患者咳嗽、胸闷、气促2月余,胸部CT表现为树芽征(tree-in-bud pattern,TIB)和磨玻璃斑片影,考虑感染引起的小气道病变可能,予以抗感染及对症治疗,患者症状无好转.入院后查氨基末端利钠肽前体(amino-terminal pro-brain natriuretic peptide,NT-proBNP)...     

Infective endocarditis due to Leptotrichia buccalis: a case report

A patient with Down's syndrome presented with infective endocarditis due to Leptotrichia buccalis. The source of the infection was not detected, but the predisposing factor was a complex cardiac malformation. The disease followed a subacute course, had a number of immunologic manifestations and was successfully treated with a 28-day course of penicillin G, given intravenously. L. buccalis has never been reported before as a cause of endocarditis.     

Infective endocarditis from Enterococcus faecalis complicating colonoscopy in Heyde's syndrome

A case of infective endocarditis from Enterococcus faecalis after colonoscopy in a patient with aortic stenoinsufficiency and bleeding intestinal angiodysplasia (Heyde's syndrome) is reported.A 77 year old man with aortic stenoinsufficiency presented with enterorrhagia and underwent a colonoscopy, which showed normal findings. Fifteen days later he developed a moderate degree of fever. Blood cultures were positive for E faecalis. An echocardiogram showed aortic valve vegetations, and infective endocarditis was diagnosed and successfully treated by antibiotics. Some months later, intestinal bleeding recurred and intestinal resection was performed. Histopathology showed angiodysplasia. In patients with Heyde's syndrome antibiotic prophylaxis should be considered before colonoscopy.     

肥厚梗阻型心肌病的手术治疗

目的评价手术治疗肥厚梗阻型心肌病的临床效果及意义。方法采集我院8例肥厚梗阻型心肌病患者行改良Marrow手术资料,所有患者术前进行超声评估梗阻部位和程度,术后7d再次经超声复查手术效果,并对比术前超声结果,出院后进一步随访。结果全组共死亡1例,死亡率1.25%。存活患者手术效果良好,梗阻解除彻底,峰值压差降低,术后平均随访10个月,90%的存活患者心功能为Ⅱ级以上,术前症状均明显减轻。结论外科手术治疗肥厚梗阻型心肌病具有良好的临床效果,对改善患者症状及生活质量有很大意义。     

Percutaneous septal ablation in hypertrophic obstructive cardiomyopathy

This article reviews etiology, pathogenesis, natural history, and current treatment options in hypertrophic obstructive cardiomyopathy with a special focus on percutaneous septal ablation which has evolved as an alternative to myectomy in patients with symptoms refractory to medical treatment. Literature data and the own series of 337 interventions planned and 312 procedures completed (in-hospital mortality and pacemaker implantation rates: 1.2% (4/312) and 7% (22/312)) are discussed. Overall satisfactory clinical results were seen in about 90% of the patients treated with septal ablation.     

肥厚梗阻型心肌病冠状动脉造影结果分析

目的 :分析肥厚梗阻型心肌病 (HOCM)患者冠状动脉造影的影像特征变化。方法 :经心脏彩色多普勒超声及心导管检查确诊的肥厚梗阻型心肌病患者 2 6例 ,男 18例 ,女 8例 ,行选择性冠状动脉造影及左室流出道压力阶差测定 ,并录像供术后测量冠状动脉直径及分析其形态学特征用。结果 :2 6例患者中表现为左冠状动脉优势者 7例 (2 6 .9% ) ,冠状动脉呈均势型者 2例 (7.7% ) ;冠状动脉内径粗大者16例 (6 1.5 % ) ,其中以左冠状动脉增粗者 14例 (87.5 % ) ,左主干、前降支、回旋支近端血管直径均较同期非肥厚梗阻型心肌病冠状动脉增粗 (P<0 .0 5 ) ;冠状动脉肌桥 5例 (19.1% ) ,发生于左前降支中段及第一间隔支近端 ;左室流出道压力阶差 (9.0 7± 3.88) k Pa。结论 :肥厚梗阻型心肌病患者冠状动脉内径较粗大 ,左冠脉优势及冠状动脉肌桥比例增多     

化学消融术治疗肥厚型梗阻性心肌病的体会

目的探讨肥厚型梗阻性心肌病经皮腔内室间隔消融术的临床意义及其并发症.方法5例肥厚型梗阻性心肌病患者完成经皮腔内室间隔消融术,观察比较术前术后数字指标及心电图变化.结果左室流出道压力阶差由术前65.10±18.32 mmHg降至术后的10.76±9.2 mmHg.室间隔厚度由术前25.66±3.17 mm降至术后的14.36±3.08 mm.心肌酶峰值时间为11.2±3.5 h.3例出现短阵加速性室速,后转为短暂Ⅲ度房室传导阻滞,2例为右束支传导阻滞,无异常Q波发生.结论经皮腔内室间隔消融术致心律失常发生率高,多为一过性,只要病例选择恰当,靶血管选择正确,手术是安全的.     

经导管室间隔心肌化学消融治疗肥厚梗阻型心肌病

目的：评价经导管室间隔心肌化学消融（PTSMA）治疗肥厚梗阻型心肌病（HOCM）的安全性和有效性。方法：观察6例HOCM病人用无水酒精进行PTSMA后的早期疗效和并发症。结果：PTSMA后左室流出道压力阶差显著下降，症状和心脏杂音减轻；但并发有酒精外溢，束支传导阻滞，房室传导阻滞和室性早搏。结论：PTSMA是一项相对安全和有效的治疗HOCM的新技术，春早期疗效令人满意。     

Surgical treatment of hypertrophic obstructive cardiomyopathy in the elderly

Three elderly patients with hypertropic obstructive cardiomyopathy which was successfully treated by surgery are described. The role of surgery in the management of older patients with this condition is discussed.     

肥厚梗阻性心肌病的外科治疗

目的 评价外科手术治疗肥厚梗阻性心肌病的临床疗效.方法 1996年10月-2007年12月,54例患者因肥厚梗阻性心肌病行外科手术治疗,男37例、女17例,年龄6～68(36±16)岁,体重27～83(60±14)kg.手术在全麻低温体外循环下完成,按常规经主动脉切口行室间隔心肌切除术(改良Morrow技术),其中3例患者因左室流出道狭窄解除不满意,二次转机行左室流出道疏通.同期行冠状动脉旁路移植术5例,二尖瓣置换术9例,二尖瓣成形术5例,主动脉瓣置换4例,三尖瓣成形术2例,动脉导管切缝术2例,主动脉瓣下隔膜切除术1例.围术期心脏超声心动图(UCG)或食道超声心动图(TEE)评价左心房(LA)、左心室(LV)、左室流出道流速及压差(LVOT)、左室射血分数(EF)、二尖瓣结构和功能.结果 全组体外循环时间40～290(107±52)min、主动脉阻断时间20～195(70±36)min、气管插管时间5～21(14±15)h、ICU住院时间11～183(45±34)h.与术前相比,术后LA大小(术前42±8、术后35±7)、左室流出道压差[术前(106±44)mm Hg、术后(24±19)mm Hg]、室间隔厚度[术前(27±6)mm、术后(19±5)mm]、左室射血分数(术前70±10、术后61±9)均显著下降(P<0.05).二尖瓣关闭好或仅轻度返流,SAM征消失.手术死亡4例(7.4%,4/54),主要死因:严重低心排综合征、严重心律失常及急性肾功能衰竭.主要并发症:完全性房室传导阻滞4例(其中3例安装永久起搏器)、完全左束支或左前分支阻滞26例,室内传导阻滞1,Ⅰ度房室传导阻滞4例.远期随访:所有生存患者症状消失,生命质量明显改善,心功能Ⅰ～Ⅱ级,无远期死亡或并发症.结论 肥厚梗阻性心肌病外科手术可满意的减轻左室流出道梗阻,提高患者的生命质量.     

梗阻性肥厚型心肌病无水酒精室间隔消融术中的并发症及处理

目的：总结梗阻性肥厚型心肌病（ＨＯＣＭ）无水酒精室间隔消融术中并发症及处理，以提高对其术中并发症的认识及处理的水平。方法：对１３ 例ＨＯＣＭ 患者行无水酒精室间隔消融术，注射无水酒精量为１．５～５ ｍ ｌ。消融成功率达１００％ 。结果：术中并发症９／１３ 例次，发生率６９．２％ ，其中以术中注无水酒精时血压下降为最严重，心绞痛最多见。结论：无水酒精室间隔消融术，虽有很好的临床效果，但也会引起一些并发症，如处理不当，甚至会造成死亡，应引起重视