心脏同步化治疗进展

Heart failure (HF) currently affects over 5 million Americans,with approximately 500 000 new cases diagnosed each year,with 5-year mortality rates approaching 50%. This is the most common cause of hospitalization in patients older than 65 years-old [1].     

心脏粘液瘤的外科治疗

目的：探讨心脏粘液瘤的外科治疗。方法：回顾性分析1997年-2006年收治心脏粘液瘤患者24例。结果：全部病例治愈,随访7年无复发。结论：细致、完整而彻底的手术切除是预防心房粘液瘤复发的关键。     

心脏黏液瘤31例临床特征与手术治疗分析

目的探讨心脏黏液瘤的临床特征和手术治疗方法。方法31例心脏黏液瘤患者,在低温体外循环下进行黏液瘤切除术。结果术后死亡1例,其余患者术后恢复好,临床症状消失,心功能恢复至I级。随访6个月～10年,未见肿瘤复发和远处种植转移。结论超声心动图是诊断心脏黏液瘤的有效方法;手术切除是心脏黏液瘤首选的治疗方法,一经确诊应尽快手术。     

71例心脏黏液瘤的临床诊断和治疗

目的研究心脏黏液瘤的临床特点,总结外科手术经验。方法回顾性分析1989年12月～2005年5月在解放军总医院行手术治疗的71例原发性和复发性心脏黏液瘤患者,其中男性29例,女性42例,年龄40.12±12岁(12～63岁),所有患者术前均经超声心动图检查明确诊断,合并心脏病变术中一并纠治,切除的肿瘤组织常规行病理学检查。结果71例患者中左房黏液瘤66例(92.9%),右房黏液瘤3例(4.2%),右室黏液瘤1例(1.45%),左室黏液瘤1例(1.45%);3例患者(4.2%)黏液瘤为术后复发;6例患者(8.6%)有栓塞史。绝大多数左房黏液瘤的临床表现与二尖瓣狭窄类似,右房黏液瘤及右室黏液瘤患者出现右心功能不全症状,左室黏液瘤患者出现左室流出道狭窄症状并在主动脉瓣听诊区闻及收缩期喷射样杂音。合并冠状动脉病变2例,风湿性二尖瓣狭窄2例,二尖瓣中重度关闭不全3例,三尖瓣重度反流4例。手术均在体外循环下进行,手术死亡1例,术后反复复发1例,其余患者均恢复良好。所有患者病理学检查均证实黏液瘤病变。结论超声心动图可准确诊断心脏黏液瘤,一旦确诊,均应立即手术;心脏黏液瘤术后可复发,需长期随访。     

Fully automatic geometry planning for cardiac MR imaging and reproducibility of functional cardiac parameters

Purpose:

To establish operator‐independent, fully automated planning of standard cardiac geometries and to determine the impact on interstudy reproducibility of cardiac functional parameters.

Materials and Methods:

Cardiac MR imaging was done in 50 patients referred for left‐ventricular function assessment. In all patients, first standard manual planning was performed followed by automatic planning (AUTO1) and repeat automatic planning (AUTO2) after repositioning the patient to investigate interstudy reproducibility. Cardiac functional parameters were assessed and cine scans were visually graded on a 4‐point scale from nondiagnostic to excellent.

Results:

Overall success rate of AUTO was 94% with good to excellent geometry planning in >94% of cine standard views. Comparing manual versus fully automated planning, a high agreement of cardiac functional parameters (Lin's concordance correlation coefficient, 0.91 to 0.99) with minimal percent bias (0.24 to 3.84%) was found. In addition, a high interstudy reproducibility of automatic planning was demonstrated (Lin's concordance correlation coefficient, 0.89 to 0.99; percent bias, 0.38 to 5.04%; precision, 3.46 to 9.09%).

Conclusion:

Fully automated planning of cardiac geometries could reliably be performed in patients showing a variety of cardiovascular pathologies. Standard cardiac geometries were precisely replicated and functional parameters were highly accurate. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

Mapping system for coregistration of cardiac MRI and ex vivo tissue sampling

Purpose:

To design a method suitable for obtaining tissue samples from regions of different function as ascertained by magnetic resonance imaging (MRI).

Materials and Methods:

In vivo MRI was used to create azimuthal projections of the heart from dilated cardiomyopathy transplant patients with the cardiac valves in the center and four concentric rings representing the septum and free wall. Tagged MRI could identify regions of different contractile strength that were then transferred onto the map projection. The resulting tissue sampling map was used to guide dissection of tissue samples from the explanted heart for analysis by electron microscopy (EM) as well as provide samples for subsequent mRNA analysis. Accuracy of the sampling was determined in a sheep heart using 17 fiduciary markers glued to the epicardial surface.

Results:

Tagged MRI identified areas of “normal” (%S_c ?11), “poor” (%S_c ?4) and “failed” contraction (%S_c +3). The mapping method we developed enabled straightforward sampling of these regions after surgical excision. EM showed good tissue preservation while the test of accuracy using the fiduciary markers showed a sampling accuracy of 0.3 ± 3.7 mm. This was similar to the resolution of tagged MRI images themselves.

Conclusion:

The methods we have developed can accurately guide tissue sampling for ex vivo tissue analysis. J. Magn. Reson. Imaging 2011. © 2011 Wiley Periodicals, Inc.

     

心脏停搏18例抢救分析

目的探索心脏停搏时的抢救方法。方法 18例患者在住院期间突发心源性猝死,心电监护显示出现多种心律失常,在救治中出现心脏停搏。立即行心肺复苏术(CPR),对停搏的心脏进行复跳,主要包括胸外持续按压,肾上腺素静推和静滴,安置临时起搏器等综合治疗。结果复苏早期:17例心跳恢复,1例死亡;复苏晚期:14例存活,3例死亡。复苏成功率为77.8%。结论心源性猝死突发时对心脏停搏的抢救是抢救心源性死亡一个重要环节,持续胸外按压,静推和持续静滴肾上腺素,促使心脏尽快起搏,并及时安置临时起搏器等是有效的抢救方法。抢救时心跳的复苏时间及患者原有的心衰是影响复苏的重要因素。     

维持性血液透析患者心脏结构及功能特点分析

目的探讨维持性血液透析(MHD)患者的心脏结构及功能特点。方法选择血液透析3年以上的MHD患者72例,检测血生化指标:总蛋白(TP),白蛋白(Alb),三酰甘油(TG),胆固醇(Tch),血肌酐(Scr),血红蛋白(Hb),血磷(P),C反应蛋白(CRP)及全段甲状旁腺激素(iP TH)。所有患者在治疗前及治疗3年后均进行心脏彩超检查,测定左心室舒张末期内径(LVDd),左心室收缩末期内径(LVDs),左心房内径(LAD),左心室后壁厚度(LVPWT),室间隔厚度(IVST),左心室射血分数(LVEF),根据Devereux公式计算左心室心肌质量指数(LVMI)。结果 (1)治疗后LVDd,LVDs,LVPWT及LVMI值高于治疗前,而LVEF较治疗前降低,表明透析3年以后,心脏结构发生改变,心功能进一步恶化。(2)随着血浆Scr,P,CRP,iP TH及Hb水平的改变心脏结构和功能也发生变化,说明钙磷代谢紊乱、微炎症状态、营养状态及尿毒症毒素与MHD患者心脏结构和功能有一定相关性。结论 MHD患者普遍存在左心室肥大,透析3年后,这种现象更为严重,Hb,P,Scr,CRP及iP TH与心脏结构和功能改变有一定关系。     

Magnetization-prepared cardiac imaging using gradient echo acquisition

Magnetization-prepared 2DFT and 3DFT gradlent echo techniques are presented for acquisition of black blood cardiac images. Both methods incorporate RF pulses for blood saturation, centric or centric-like view ordering, data acquisition during late dlastole, and breath-holding. In a series of 13 volunteer studies, these methods have consistently provided good visuallzation of intraventricular structures.     

膈肌下抬挤复苏法对心搏骤停猪肺潮气量的影响

 目的 观察膈肌下抬挤心肺复苏方法 对心搏骤停猪潮气量的影响.方法 健康家猪8头,窒息法建立猪心跳骤停模型后行膈肌下抬挤法复苏,测定并比较8头猪在基础状态下和心搏呼吸停止行膈肌下抬挤心肺复苏时的潮气量值,计算每分通气量;记录自主循环恢复时间和6 h存活率.结果 膈肌下抬挤心肺复苏法产生的潮气量达到基础值30%左右,与基础状态相比,差异有统计学意义(P<0.05);每分通气量大于基础值,差异有统计学意义;自主循环恢复时间均在3 min内;6 h存活率为100%.结论 在心肺复苏早期,膈肌下抬挤能产生少量肺通气.     

Self-gated cardiac cine MRI.

The need for ECG gating presents many difficulties in cardiac magnetic resonance imaging (CMRI). Real-time imaging techniques eliminate the need for ECG gating in cine CMRI, but they cannot offer the spatial and temporal resolution provided by segmented acquisition techniques. Previous MR signal-based techniques have demonstrated an ability to provide cardiac gating information; however, these techniques result in decreased imaging efficiency. The purpose of this work was to develop a new "self-gated" (SG) acquisition technique that eliminates these efficiency deficits by extracting the motion synchronization signal directly from the same MR signals used for image reconstruction. Three separate strategies are proposed for deriving the SG signal from data acquired using radial k-space sampling: echo peak magnitude, kymogram, and 2D correlation. The SG techniques were performed on seven normal volunteers. A comparison of the results showed that they provided cine image series with no significant differences in image quality compared to that obtained with conventional ECG gating techniques. SG techniques represent an important practical advance in clinical MRI because they enable the acquisition of high temporal and spatial resolution cardiac cine images without the need for ECG gating and with no loss in imaging efficiency.     

MRI cardiac tagging using a sinc-modulated RF pulse train.

A method of spatial modulation of magnetization using the RF pulse train is described for improved cardiac tagging. The method is based on a sinc-modulated RF pulse train in the presence of constant gradient. Such an RF pulse train yields a rectangular profile of saturated magnetization, and the bandwidth of the sinc envelope controls the width of the saturation tag. Compared to DANTE and SPAMM tagging techniques, this method offers sharper-edged tags and the ability to change the ratio of tag width to tag separation. The approach was implemented on a 9.4 T vertical bore NMR system and demonstrated with both phantom and in vivo mouse heart studies.     

Rapid cardiac imaging with turbo BRISK

A variety of variable and constant rate, sparse sampling strategies have previously been proposed to rapidly image dynamically changing objects. The majority of these strategies compile a k-space data set for any given time point by substituting k-space data from the most recently sampled time positions (extracted from the sparsely sampled set). The BRISK technique, is a variable rate, sparse sampling technique which additionally incorporates an interpolation scheme to more accurately represent k-space data at positions which were not directly sampled. Here, strategies are introduced that allow turbo concepts to be incorporated with BRISK. Simulations are conducted to compare the efficacy of the turbo BRISK acquisition and processing strategy against a constant rate, sparse sampling strategy with direct substitution of the most recently acquired k-space lines. It is shown that turbo BRISK generates images of similar quality in approximately half the time as the uniform sampling rate, sparse sampling strategy. Data from turbo BRISK acquisitions of multicardiac phase image sets, obtained on a normal volunteer and cardiac patients are presented.     

A 128-channel receive-only cardiac coil for highly accelerated cardiac MRI at 3 Tesla.

A 128-channel receive-only array coil is described and tested for cardiac imaging at 3T. The coil is closely contoured to the body with a "clam-shell" geometry with 68 posterior and 60 anterior elements, each 75 mm in diameter, and arranged in a continuous overlapped array of hexagonal symmetry to minimize nearest neighbor coupling. Signal-to-noise ratio (SNR) and noise amplification for parallel imaging (G-factor) were evaluated in phantom and volunteer experiments. These results were compared to those of commercially available 24-channel and 32-channel coils in routine use for cardiac imaging. The in vivo measurements with the 128-channel coil resulted in SNR gains compared to the 24-channel coil (up to 2.2-fold in the apex). The 128- and 32-channel coils showed similar SNR in the heart, likely dominated by the similar element diameters of these coils. The maximum G-factor values were up to seven times better for a seven-fold acceleration factor (R=7) compared to the 24-channel coil and up to two-fold improved compared to the 32-channel coil. The ability of the 128-channel coil to facilitate highly accelerated cardiac imaging was demonstrated in four volunteers using acceleration factors up to seven-fold (R=7) in a single spatial dimension.     

MRI of cardiac iron overload

Transfusion therapy has greatly improved the survival of transfusion dependent thalassemia major (TM) patients; however, the resultant iron load damages tissues including the heart, liver and endocrine organs. Among these, heart complication still remains the leading cause of mortality. Myocardial iron deposition can occur independently of other solid organ involvement; conversely, the heart may be spared despite heavy siderosis in other tissues. Iron chelation treatment diminishes the risk of hemosiderosis; however, the chelation treatment has its own toxicities and might not be available to all patients due to costs. Close monitoring of individual organ iron concentration and function is thus important for optimization of individual patient care. This review outlines the importance and clinical significance of recently available MRI techniques for monitoring cardiac iron load. J. Magn. Reson. Imaging 2012;36:1052–1059. © 2012 Wiley Periodicals Inc.     

Wnt信号通路在心脏发育中的功能

在分子水平探究心脏发育是研究先天性心脏病的先决条件,将对心脏疾病的诊疗以及心脏再生策略的研究具有重要意义。研究表明,Wnt信号通路分子在心脏的发育过程中有着多种作用。 Wnt蛋白是胞外生长因子,可以激活不同的胞内信号通路。该文就Wnt相关蛋白从心脏前体细胞早期分化到其后形态发生过程中对心脏发育的影响进行了综述。     

心脏锐器伤的救治

心脏锐器伤是致命性损伤,随着社会的发展,其发生率有增高的趋势。它属于外科急症,具有死亡率高、需要在事发地医院就地抢救的临床特点。本文复习国内外文献资料,对心脏锐器伤的流行病学特点与变迁、快速诊断的方法、抢救与后续治疗方面及亚临床的前瞻性研究等进行综述。