胎儿左心室壁血管与心腔交通的研究

目的：从发生学角度探讨心肌血管重建术的供血机理。方法：本文采用不同胎龄的人胎心１３个，用墨汁灌注血管、组织切片染色法，观测左心室壁与心腔的血管交通状况。结果：显示人类胚胎早期的心脏，心室壁结构类似海绵状，心腔与心壁间存在着许多窦状通道。这类管道包括肉柱间隙、心肌窦样管等，其排列、配布及在心室壁的分布范围随着胎儿生长、结构重建而不断变化。其胚胎发育过程重复了种系发生的各个阶段。结论：提示激光心肌血管重建术从心腔直接供血，与人胚早期者相类似。     

Apoptosis in the pattern formation of the ventricular wall during mouse heart organogenesis

Apoptosis is an important mechanism in organogenesis, but its role in heart development has been poorly characterized. We have here studied apoptosis in the developing ventricular wall of mouse embryonic heart. Developing mice hearts on days 11 to 16 of gestation were studied using in situ end‐labeling of degraded DNA (TUNEL), immunocytochemistry of regulatory genes Bcl‐2 and Bax, and light and electron microscopy. TUNEL end‐labeled apoptotic cells were found in the ventricular wall on days 11 to 16 of gestation. The proportions of apoptotic cells of all cells in the ventricular wall differed between the trabecular and compact regions (P = 0.003) and between the days of gestation (P = 0.0001), the calculated apoptotic index was greater in the compact region at all ages except day 14. Ultrastructural analysis showed typical apoptotic shrinkage, chromatin degradation, and apoptotic bodies in several myoblastic and myocardial endothelial cells which were also positive by DNA end‐labeling. Immunocytochemical reaction for the apoptosis checkpoint proteins in the ventricular wall showed clearly more Bcl‐2 positive cells than Bax positive cells. The numerical densities of all cells in the compact and trabecular regions remained always higher in the compact region (P = 0.04) despite the fact that apoptosis was present in both areas at the same time. In conclusion, apoptosis takes place in the developing myocardial muscle as well as the myocardial endothelium during ventricular morphogenesis on days 11 through 16 and decreases clearly on day 16. We suggest that apoptosis and its regulatory factors are closely involved in the morphogenesis of the ventricular wall of the mammalian heart. Anat Rec 256:208–217, 1999. © 1999 Wiley‐Liss, Inc.     

多普勒组织成像技术对冠心病室壁运动的价值探讨

目的探讨多普勒组织成像技术（DTI）对冠心病室壁运动评分中的应用价值。方法55例临床确诊的冠心病患者和31例健康体检的正常对照者左室壁节段长轴及短轴方向运动速度进行检测,并与常规二维超声心动图（2DE）检查结果对照分析。结果冠心病组前间隔与左室后壁运动异常节段短轴方向运动速度与正常组相应节段波群比较,除心尖水平、后壁二尖瓣口水平和低位乳头肌水平的A波无显著差异外,其余各指标均有明显的减低（P〈0．01）;冠心病室壁运动异常节段长轴方向的收缩速度（S）及舒张速度（E和A）也明显低于正常组相应节段的速度（P〈0．01）。结论DTI将M型超声与多普勒超声技术结合起来,不仅可以评价心脏整体功能,而且还能够对局部室壁的运动速度进行分析,是一有价值的显像技术,值得进一步研究。     

Morphometric evaluation of the cardiac ventricular capacity of anencephalic fetuses

Anencephaly occurs in 1:1,000 to 1:20,000 infants who are potential donors in pediatric heart transplantation, so it is important to define any morphologic differences between the anencephalic and normal heart in newborns. The dimensions of the heart in anencephalics, however, may differ. For example, the absence of cerebral tissue in anencephalic fetuses may decrease the heart load resulting in a smaller heart. The position of the heart in the thoracic cavity of an anencephalic fetus may affect the size and shape of the heart. This study compares the ventricular volumes and the inlet and outlet lengths of right and left ventricles in 11 normal and 11 anencephalic fetuses of gestational ages between 27 and 35 weeks. There was no statistically significant difference between the right ventricular volumes of normal and anencephalic fetuses, however, the difference between the left ventricular volumes was found to be almost statistically significant (P = 0.07). No statistically significant difference was found between the right and left ventricular volumes of normal fetuses; in anencephalic fetuses left ventricular volumes were found to be significantly smaller than right ventricular volumes (P = 0.05). The outlet length of the right ventricle and the inlet and outlet lengths of left ventricle in anencephalic fetuses were found to be short in comparison with those of normal fetuses (P = 0.01, P = 0.008, P = 0.01). It is proposed that anencephalics, because of these morphologic differences, should be reconsidered as possible donors for heart transplantation.     

Co-occurrence of Proteus syndrome and ventricular tachycardia cardiac arrest in a teenager

Proteus syndrome is an extremely rare overgrowth condition caused by a somatic variant of the AKT1 gene. It can involve multiple organ systems though rarely is there symptomatic cardiac involvement. Fatty infiltration of the myocardium has been described but has not been reported to cause functional or conduction abnormalities. We present an individual with Proteus syndrome who suffered a sudden cardiac arrest.     

Visualization of left ventricular Purkinje fiber distribution using widefield optical coherence microscopy

Background: The distribution and connection of ventricular Purkinje fibers are known to be associated with idiopathic left ventricular arrhythmias. Unusual anatomy is one of the important factors associated with catheter ablation success rate. With the widefield high-speed, swept-source optical coherence microscopy (OCM) and light microscope, we visualized the left ventricular Purkinje fiber distribution. Methods: Left ventricular walls of five adult ovine hearts were incised from the mitral annulus to the apex. Using the widefield OCM technique and light microscopy, we observed the distribution, direction, depth, and dividing patterns of the Purkinje network with multiple tangential angles and without tissue destruction. Results: Widefield OCM was used to characterize the ovine heart Purkinje network system in a 4 × 4 mm² field. Left ventricular Purkinje fibers traveled in the sub-endocardial area near the left-sided peri-membranous septal area and ran like a wide hair bundle. The distal branching fibers penetrated to the endocardium and connected to the contractile muscle. In this distal area, Purkinje fibers were connected to each other, forming multiple layers. Some Purkinje fibers were directly connected within the false tendon between the papillary muscles or between the trabeculations. Some free-running Purkinje fibers were directly connected to the papillary muscle from the left bundle. Conclusion: Using widefield OCM, we were able to observe the left bundle and its branching patterns in ovine left ventricle without tissue destruction. This might be applied to future cardiac ablation procedures.     

心室壁动脉分布的图象分析及其临床意义

用大体解剖、血管铸型、X 线造影方法,观测了108例心冠状动脉行程以及其中100例成人心冠状动脉分布于心室壁的状况。冠状动脉供应范围具有个体差异,变化最多的是在心膈面。对其中38例成人心膈面的冠状动脉分布范围用图象分析仪进行分析,国人右冠状动脉分布范围超过左冠状动脉者为多数占81.6%:左冠状动脉分布范围大于右冠状动脉者占10.5%;左、右冠状动脉分布相当者占7.9%。其分布面积:左冠状动脉平均为2935±1375mm~2;右冠状动脉为4875±1887mm~2,从图象分析结果看,亦是右冠状动脉分布占优势.说明国人心膈面缺血性疾患进行诊断时,应对右冠状动脉给予更多的注意。     

Effect of hyperchylomicronemia and hyperprebetalipoproteinemia on the vascular wall in rats of various ages

The effect of hyperchylomicronemia and hyperprebetalipoproteinemia on the vascular wall was studied in rats aged 6–10 and 26–30 months. The animals were given an intravenous injection of blood serum from rats which themselves had previously been injected intraperitoneally with Triton WR1339. Inclusions of chylomicrons and liporoteins of very low density were found electron-microscopically in the endothelium of the old rats only. Swelling of the Golgi complex and mitochondria and dilatation of the cisternae of the endoplasmic reticulum in the endothelial cells of the young rats indicated activation of intracellular metabolism. The study of biosynthesis of certain classes of lipids in the aorta under these conditions showed inhibition of biosynthesis of free cholesterol, the intensity of which was the same in rats of different ages. Increased phospholipid biosynthesis was observed only in the young animals.Laboratory of Pathological Physiology, Institute of Gerontology, Academy of Medical Sciences of the USSR, Kiev. (Presented by Academician of the Academy of Medical Sciences of the USSR N. N. Gorev.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 84, No. 12, pp. 664–667, December, 1977.     

高血压患者心肌缺血性改变与左室后壁厚度的相关性研究

目的探讨高血压患者Holter上心肌缺血性改变与左心室后壁（LVPW）厚度之间的相关性。方法收集2005年5月至2008年9月在本院经查冠脉CTA及超声心动图排除冠心病的高血压患者共138例,首先根据Holter上有无发作性ST段压低将资料分为有缺血性改变与无缺血性改变两组,分析缺血性改变与LVPW厚度之间的相关性,并比较两组间LVPW厚度的大小;然后以单因素及多因素分析筛选Holter上缺血性改变的影响因素;最后建立ROC曲线评估LVPW厚度预测发生缺血性改变的价值。结果高血压患者Holter上有或无缺血性改变与LVPW厚度及收缩压（SBP）均呈正相关（r=0.429,P=0.000;r=0.274,P=0.034）,高血压伴有缺血性改变的患者其LVPW厚度与无缺血性改变的患者相比差异有统计学意义（z=-5.025,P=0.000）;伴有LVPW增厚的高血压患者出现Holter上缺血性改变的机率高于无LVPW增厚的患者（χ2=23.670,P=0.000）;多因素分析中只有LVPW厚度被筛选出来（OR=26.024,P=0.001）;以LVPW厚度预测心肌缺血的AUC为（0.760±0.044）,P=0.000。最佳分界值为9.5mm,以LVPW≥9.5mm来预测高血压患者Holter上出现缺血性改变,敏感性为63.6%,特异性为80.9%。结论高血压患者Holter上出现缺血性改变与LVPW厚度呈正相关;以LVPW预测高血压患者Holter上出现缺血性改变的特异性较高,但敏感性较差。     

Elastic-like tissue, a new component of the renal glomerular capillary wall in a cartilaginous fish

Summary Elastic-like tissue composed of tubular microfibrils continuous with, and disappearing into, amorphous material is present in the connective tissue space of the glomerular capillary wall of the river ray (freshwater elasmobranch) kidney. The amorphous material is stained by tannic acid but not by uranyl acetate. Structures with similar morphology and staining characteristics are also found in the subendothelial connective tissue layer of renal arteries in this species. Comparative ultrastructural observations of kidneys from marine rays show elastic-like tissue in the arterial wall but not in the glomerular vessels.Supported by grants from the National Science Foundation (DCB 8903369), the American Heart Association — South Carolina Affiliate and the Deutsche Forschungsgemeinschaft (Lu 354/1-1; Re 257/7-1). Appreciation is expressed to Ms. Jan King for histochemical staining expertise.     

Responses of the systemic circulation in the early period of traumatic shock induced by Cannon's method

Experiments on dogs showed that the erectile phase of shock induced by Cannon's method can be divided into two periods on the basis of changes in parameters of the systemic circulation. The first period has many features in common with defensive reactions in response to the appearance of danger and the action of powerful nonspecific stimuli and is characterized by an increase in the return of blood to the heart, an increase in cardiac output, and a decrease in peripheral vascular tone. The second period is characterized by commencing decompensation of functions of the cardiovascular system. The second period ends with the development of the torpid phase of shock.Department of Pathological Physiology, S. M. Kirov Military Medical Academy, Leningrad. (Presented by Academician of the Academy of Medical Sciences of the USSR V. K. Kulagin.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 88, No. 12, pp. 653–655, December, 1979.     

Effect of peridural heart block on the threshold of ventricular fibrillation in dogs

The threshold of ventricular fibrillation in animals with an intact heart and myocardial infarction was determined by injection of trimecaine into the peridural space at the T₁-T₂ level. The threshold of fibrillation was shown to be increased under these circumstances on account both of the resorptive action of trimecaine and the blockade of the sympathetic nerves to the heart.Laboratory of Clinical and Experimental Cardiology, I. P. Pavlov Institute of Physiology, Academy of Sciences of the USSR, Leningrad. (Presented by Academician V. N. Chernigovskii.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 86, No. 9, pp. 277–279, September, 1978.     

Digital boundary detection, volumetric and wall motion analysis of left ventricular cine angiograms.

A set of algorithms have been developed to automate the analysis of cine ventriculographic data by digital methods. The visual data in the form of a cine ventriculogram is converted to digital data and stored in packed form on magnetic tape. The analysis procedure then (1) detects the ventricular boundary, (2) smooths the rough ventricular outline, (3) detects the aortic valve position and (4) translates and rotates each ventricular outline to a common set of internal axes. The program calculates on a frame by frame basis ventricular volume, projected ventricular area and constructs an instantaneous polar analysis of wall position. It currently takes 27 sec of computer time to digitize and analyze one frame of data.