经皮球囊肺动脉瓣成形术治疗单纯性肺动脉瓣狭窄32例

目的 总结1995～2001年我院用经皮球囊肺动脉瓣成形术治疗单纯性肺动脉瓣狭窄32例的经验。方法 本院住院患者32例,单纯性肺动脉瓣狭窄采用经皮球囊肺动脉瓣成形术治疗。结果 本组32例右室收缩压:术前(93.5±28.5)mmHg,术后(42±9.0)mmHg;跨肺动脉瓣压力阶差:术前(76±30)mnHg,术后(24.5±8.5)mmHg;术后跨肺动脉瓣压力阶差<25mmHg达90.6％。结论 经皮球囊肺动脉瓣成形术治疗单纯性肺动脉瓣狭窄是安全有效的,病例和手术方法的选择,精确测定肺动脉瓣直径和选择大小合适的球囊是手术成功的重要环节。     

经皮双球囊肺动脉瓣成形术(附8例报告)

报道经皮双球囊肺动脉瓣成形术8例,全部术前诊断均为单纯先天性肺动脉瓣狭窄,不伴有其他心内畸形。男5例,女3例,年龄以6～55岁。双球囊直径比肺动脉瓣环直径平均大50±35％,最大达89％,每次扩张充盈时间5～10s。术前右室—肺动脉收缩压差4.4～17.6kPa,平均9.7士4.2kPa,术后降至3.2±1.9kPa,有7例平均压差降至2.6±1.1kPa。本组无重要并发症,除1例外疗效均好。文中尚介绍了双球囊导管操作方法和疗效评判标准,并就适应证,狭窄口定位及球囊选择作了讨论。     

常见先天性心脏病介入治疗中国专家共识四、经皮球囊肺动脉瓣与主动脉瓣成形术

经皮球囊肺动脉瓣成形术已成为肺动脉瓣狭窄的首选治疗方法,先天性主动脉瓣狭窄亦可通过球囊扩张方法得到缓解.典型肺动脉瓣狭窄跨瓣压差≥ 40 mmHg,主动脉瓣狭窄跨瓣压差≥ 60 mmHg是球囊成形术的适应证.球囊成形术成功的关键在于谨慎选择合适的患者,熟练地掌握操作方法,严格挑选球囊的类型、大小和长度,避免损伤腱索和瓣...     

经皮穿剌下腔静脉球囊成形术治疗布—加综合征(附6例报告)

经皮穿刺下腔静脉球囊成形术治疗布一加综合征6例.男4例,女2例,年龄26～48岁,平均年龄37岁.其中膜性狭窄3例,节段性狭窄2例(1例并有膜性狭窄),完全性膜性梗阻1例.经血液动力学、下腔静脉DSA 造影及临床观察,治疗效果良好.下腔静脉—右房连续测压收缩压由0.3～3.5kPa 下降为0.狭窄段管径由0～8mm(平均4.0mm)恢复至12～19.8mm(平均15.1mm).患者临床症状改善,下肢浮肿消失.本文对经皮穿刺下腔静脉球囊成形术适应症、方法、效果及并发症进行了讨论.     

应用冠脉技术成功治疗重度肺动脉瓣狭窄一例

我国于20世纪80年代中期开展经皮球囊肺动脉瓣成形术(PBPV)技术,现已成为治疗先天性肺动脉瓣狭窄(PS)的首选方法。但对于重度狭窄瓣口面积极小的婴幼儿,常规的球     

经皮球囊导管肺动脉瓣成形术

单纯肺动脉瓣狭窄是常见的先天性心脏病之一,占先天性心脏病的6.8%。过去,传统的外科手术是其唯一有效的治疗方法。1979年,Semb等首先报道了气囊导管肺动脉瓣切开术,其方法将一充有CO_2气体的气囊自肺动脉拉向右心室,藉以分离狭窄的肺动脉瓣。此法未被广泛采用。1982年,Kan等应用经皮血管腔内血管成形术原理成功地治疗了一例肺动脉瓣狭窄,并将此方法称为经皮球囊肺动脉瓣成形术(简称BPV)。鉴于该项技术操作简便,安全有效,已被许多国家医学界所注目和应用。     

经皮双球囊肺动脉瓣成形术一例报告

80年代以来,做为介入性心脏病学的核心——气囊成形术已日益广泛地应用于心血管疾病的治疗,其疗效与传统外科手术相似,但免除了开胸之痛苦。1989年4月14日,我们应用双球囊导管对1例先天性肺动脉瓣狭窄的患者施行了经皮球囊瓣膜成形术(PBPV),获得成功,现报告如下:     

经皮球囊成形术治疗二尖瓣狭窄93例

应用乳胶尼龙网球囊导管治疗风湿性心脏病二尖瓣狭窄９３例，女６３例，男３０例，平均年龄３８岁。成功９０例结果表明：经皮球囊二尖瓣成形术是治疗二尖瓣狭窄的有方法之一。     

球囊导管血管成形术治疗锁骨下动脉狭窄

经皮经腔球囊导管成形术治疗11例锁骨下动脉狭窄。11例有13处狭窄病变,PTA 成功9例,其中7例的狭窄消失或明显改善,2例减轻。血压由PTA 前的平均11.12/7.02kPa 升高至PTA后的16.88/10.48kPa。临床症状消失或减轻。PTA 成功的9例随访1～12月(平均5.9月)。除1例1年狭窄复发外,其余均无症状。本组无并发症.     

心腔内遗留导丝取出一例体会

心腔内遗留导丝取出一例体会吴学胜，王英，王连民，李福玉，侯义华患者女，１０岁。以先天性心脏病肺动脉瓣狭窄入院，行经球囊肺动脉瓣成形术。术中当球囊导管在肺动脉瓣狭窄处扩张后，因肺动脉瓣球囊扩张导管测压不理想，遂将直径为０．０３８时，长２６０ｃｍ的交换导...     

经皮肺动脉瓣球囊成形术与外科治疗单纯性肺动脉瓣狭窄的对比研究

目的　探讨经皮肺动脉瓣球囊成形术 (PBPV)替代外科手术治疗单纯性肺动脉瓣狭窄(IVPS)的可行性。方法　外科组包括 3 1例IVPS患者 ,PBPV组为同期接受PBPV的 14 6例IVPS患者。比较 2种方法的疗效和费用等情况。结果　PBPV组技术成功率为 10 0 % ,无严重并发症发生 ;外科组3 1例全部手术成功 ,无死亡 ,术后出现中量胸腔积液 2例 ,肺不张 1例 ,气胸 1例 ,重度三尖瓣关闭不全 1例。两组间术前、术后及随访中的肺动脉瓣跨瓣压差 (PG)值无显著性差异 ;两组的平均总费用相似 (P >0 .0 5) ,但西药费外科组显著高于PBPV组 ,器材费PBPV组明显高于外科组 (均P <0 .0 5)。结论　PBPV术疗效与外科手术相当 ,但较外科手术有更好的效价比 ,更易被患者所接受 ,PBPV术可以替代外科手术 ,成为治疗IVPS的首选方法     

Percutaneous pulmonary valvuloplasty with a double-balloon technique

Percutaneous pulmonary valvuloplasty with a double-balloon technique was used in eight patients, aged 10-40 years, in whom valvuloplasty with a single 20-mm balloon resulted in inadequate dilatation of the stenosis. The diameters of the additional balloon varied from 10 to 20 mm. Balloons were inflated manually at about 30-45 psi (206.7-310.1 kPa) and deflated immediately after disappearance of the balloon waist. The mean peak systolic pressure gradient was 85 mm Hg +/- 37 before valvuloplasty, and it decreased to 38 mm Hg +/- 28 afterward (P less than .05). Double-balloon dilation and simultaneous computed tomography were done in two cardiac specimens from adult cadavers. At inflations at 30 and 45 psi (206.7 and 310.1 kPa), the outflow tract was elongated, and the balloons also deformed into ovoid shape at the lower pressure. The double-balloon technique appears to be safe and effective for relief of pulmonary valvular stenosis in those cases in which single-balloon technique is inadequate, especially in older children and adults.     

MR elastography of the liver: preliminary results

PURPOSE: To develop a method for measuring liver stiffness with magnetic resonance (MR) elastography and to prospectively test this technique in healthy volunteers and patients with liver fibrosis. MATERIALS AND METHODS: This HIPAA-compliant study was approved by an institutional review board, and informed consent was obtained from each subject. First, to determine the feasibility of applying shear waves to the liver, a pneumatic acoustic wave generator was developed and tested by using a tissue-simulating gel phantom with ribs on one side and without ribs on the other. The effect of interposed ribs on stiffness measurements was tested. Then, liver stiffness was measured with MR elastography in 12 healthy volunteers (eight men, four women; mean age, 26.7 years; age range, 19-39 years) by using the subcostal approach and the transcostal approach and in 12 patients with chronic liver disease (six men, six women; mean age, 50.5 years; age range, 36-60 years) by using the transcostal approach. Various statistical analyses were performed to assess all measurements. RESULTS: Ex vivo, interposed ribs reduced shear wave amplitude but did not hinder stiffness measurements. In volunteers, the transcostal approach surprisingly yielded better shear waves in the liver than did the subcostal approach. The mean liver shear stiffness was significantly lower in volunteers (mean, 2.0 kPa +/- 0.3 [standard deviation]) than it was in patients with liver fibrosis (mean, 5.6 kPa +/- 5.0; median, 3.7 kPa; range, 2.7-19.2 kPa; P < .001). CONCLUSION: MR elastography of the liver is feasible and shows promise as a quantitative method for noninvasive assessment of liver fibrosis.     

Lung cancer detected in patients presenting to the Emergency Department studies for suspected pulmonary embolism on computed tomography pulmonary angiography

PURPOSE: To study the frequency and demographics of lung cancer on CT pulmonary angiography in patients with suspected pulmonary embolism referred from the Emergency Department. MATERIALS AND METHODS: Retrospective review of the medical records and radiology reports, clinical and imaging follow-up studies and pathological reports revealed 1106 CT pulmonary angiography studies referred from our Emergency Department during the 15-month period between March 2003 and June 2004. RESULTS: Five incidental lung cancer cases were found in 1106 studies from 1081 patients (0.47%). Pulmonary embolism was found in 95 patients (8.5%). Among the five incidental cases three patients were female and two were male (62-81 years old; mean 73 years, 17-130 packs year; mean 51 packs year). Tumor size ranged from 1.8 to 4.5 cm (mean 3.3 cm). The stagings of the lung cancers were IIIB in one patient and IV in four patients. CONCLUSION: Previously undiagnosed lung cancer was detected in 0.45% of patients among 1081 patients referred from Emergency Department, one of whom had coexistent pulmonary embolism. All five patients presented at advanced lung cancer stages of IIIB and IV.     

662例先天性心脏病经导管介入治疗效果分析

目的：分析常见先天性心脏病经导管介入治疗的效果。方法对经导管介入治疗的662例先天性心脏病患者的临床资料进行回顾性分析,其中动脉导管未闭（PDA）208例,房间隔缺损（ASD）230例,室间隔缺损（VSD）217例和肺动脉瓣狭窄（PS）7例。结果介入治疗总成功率为97.73%（647/662）,其中PDA、ASD、VSD封堵术成功率分别为98.56%、98.26%和96.31%,PS经皮球囊肺动脉瓣成形术（PBPV）成功率100%。各种类型的早期并发症总发生率为2.72%（18/662）,其中封堵器脱落3例,残余分流8例,Ⅲ度房室传导阻滞（III° AVB ）5例,严重血小板减少3例,心包填塞1例,与介入治疗无关死亡1例。平均随访6个月,PDA和VSD完全闭合率达到100%,ASD完全闭合率均达到99.12%,PBPV跨瓣压差进一步降低至正常范围,血小板减少和III° AVB在3星期内完全恢复。结论严格把握适应症和注意严重并发症的发生,经导管介入治疗常见先天性心脏病是一种安全有效的治疗方法,定期随访十分重要。     

Are two-dimensional CT measurements of small noncalcified pulmonary nodules reliable?

PURPOSE: To evaluate the intra- and interreader agreement of two-dimensional computed tomographic (CT) measurements of pulmonary nodules less than 2 cm in diameter. MATERIALS AND METHODS: Three readers independently made three serial measurements of each of 54 pulmonary nodules measuring 3-18 mm that had been observed on standard-dose multisection CT images obtained in 24 patients who ranged in age from 36 to 81 years (mean age, 54.6 years). There were 14 women (58%), who ranged in age from 43 to 81 years (mean age, 58.9 years), and 10 men (42%), who ranged in age from 36 to 65 years (mean age, 48.5 years). The largest transverse cross-sectional diameter of each nodule was measured at picture archiving and communication system, or PACS, workstations by using high-spatial-resolution reconstructed CT images and identical window settings. Intra- and interreader agreement were determined by using methods described by Bland and Altman: the coefficient of repeatability for intrareader agreement, and methods derived from the 95% limits of agreement defined by Bland and Altman for interreader agreement. RESULTS: The repeatability coefficients were 1.70, 1.32, and 1.51 mm for readers 1, 2, and 3, respectively. The 95% limits of agreement for the difference among readers were -1.73 and 1.73. CONCLUSION: Two-dimensional CT measurements are not reliable in the evaluation of small noncalcified pulmonary nodules.     

Immunohistochemical expression of fibronectin and C5b-9 in the myocardium in cases of fatal ethanol intoxication

Data from the literature indicate that the pulmonary pressure rises in cases of ethanol intake. We have recently proposed a method for the detection of prevalent right ventricular damage in cases of fatal pulmonary thromboembolism and pulmonary fat embolism. In the present study, we compared the expression of the antibodies against fibronectin and C5b-9 in 19 cases of lethal alcohol intoxications (study group: 5 females, 14 males, mean age 46 years, mean blood ethanol concentration 3.5‰, min. 2.11‰, max. 5.31‰) to a group of 26 cases of fatal pulmonary thromboembolism (PE; group 2: 16 females, 10 males, mean age 56 years). Moreover, a group of 15 cases of hanging (group 3: 5 females, 10 males, mean age 50 years) as well as a group of 18 cases of myocardial infarction (group 4: 5 females, 13 males, mean age 61 years) were investigated as examples of typical cardiac damage due to global hypoxia during agony and ischemic damage, respectively. The results of this study show that fresh cardiac damage can be detected at both ventricles in cases of fatal ethanol intoxication with the antibody against fibronectin. The damage is prevalently localised at the right ventricle (RV), as already observed in cases of acute pulmonary hypertension determining right heart failure. The degree of damage at the RV in cases of ethanol intoxications is lower than the one observed in cases of fatal PE.     

Manual aspiration thrombectomy with a standard PTCA guiding catheter for treatment of acute massive pulmonary thromboembolism

PURPOSE: To evaluate the efficacy and safety of percutaneous manual aspiration thrombectomy for the treatment of acute massive pulmonary thromboembolism with hemodynamic impairment. MATERIALS AND METHODS: Over a period of 6 years and 9 months, 15 patients with hemodynamic impairment (4 men, 11 women; aged 27-79 years) were treated by manual clot aspiration with a standard, large-lumen percutaneous transluminal coronary angioplasty (PTCA) guiding catheter. RESULTS: After treatment, angiography demonstrated improvement of pulmonary perfusion in all patients (mean Miller score: before treatment 18.9, after treatment 12.1; P < 0.01). Mean pulmonary arterial pressure decreased from 29.6 to 22.5 mmHg (P < 0.01). The mean treatment time was 114.2 min. All of the patients survived and their clinical status improved. No patient had any significant complication. CONCLUSION: Percutaneous manual aspiration thrombectomy with a standard 8 Fr PTCA guiding catheter achieved rapid, safe improvement of the hemodynamic situation in cases of acute massive pulmonary thromboembolism, with low cost both in terms of time and money.     

Enhancement performance of a 64-slice triple rule-out protocol vs 16-slice and 10-slice multidetector CT-angiography protocols for evaluation of aortic and pulmonary vasculature

OBJECTIVE: To compare the enhancement of the pulmonary and aortic vasculature between a biphasic injection 64-slice, a single-phase injection 16-slice, and a single-phase injection 10-slice multidetector computed tomographic (CT) angiography (CTA) protocols. METHODS: With institutional review board approval and Health Insurance Portability and Accountability Act compliance, 50 patients (16 men, 34 women; mean age, 51.5 years; range, 30-75 years) with atypical chest pain from the emergency department were scanned using a triple rule-out protocol on a 64-slice CT scanner. Pulmonary enhancement was compared with 50 patients (21 men, 29 women; mean age, 65.6 years; range, 38-90 years) imaged with a single-phase 16-slice pulmonary angiography protocol. Aortic enhancement was compared with 24 patients (12 men, 12 women; mean age, 66.1; range, 34-92 years) who were imaged with a 16-slice aortic dissection CTA protocol and to 25 patients (15 men, 10 women; mean age, 50.8 years; range, 20-83 years) imaged with a 10-slice aortic dissection CTA protocol. A 2-tailed Student t test or sign test was used to assess significant differences from a vascular attenuation cutoff value of 250 Hounsfield units (HU). RESULTS: Individual mean pulmonary arterial and aortic attenuation values were statistically significantly less than 250 HU for the 16- and 10-slice protocols and statistically significantly more than 250 HU for the 64-slice protocols (P < 0.05). Mean pooled pulmonary attenuation values were more than 250 HU in 18% (9/50) of the 16-slice and in 93% (39/42) of the 64-slice protocols. Mean pooled aortic attenuation values were more than 250 HU in 18.4% (9/49) of the 10- and 16- and in 100% (42/42) of the 64-slice protocols. CONCLUSIONS: The triple rule-out 64-slice biphasic injection breath hold CTA protocol provides significantly higher attenuation of aortic and pulmonary vasculature compared with our current 10- and 16-slice protocols.     

Cerebral blood flow velocity and psychomotor performance during acute hypoxia

INTRODUCTION: The physiological effects of hypoxic environments can help determine safe limits for workers where cognitive and motor performance is important. We investigated the effects of a PIO2 of 15 kPa and 10 kPa on medial cerebral artery blood flow velocity (CBFV) and psychomotor performance. METHODS: Over 3 sessions, each involving 3 separate test batteries, 13 subjects breathed either 21 kPa PIO2 (control), 15 kPa PIO2, or 10 kPa PIO2. The tests measured reaction time, spatial orientation, voluntary repetitive movement, and fine manipulation. CBFV, PETCO2, PETO2, Sa02, and BP were recorded throughout. RESULTS: ANOVA analysis showed that 15 kPa PIO2 did not significantly change psychomotor test performance. The mean number of incorrect responses in the reaction time test significantly increased to 5.6 (SD - 4.0) while breathing 10 kPa PIO2, as did the mean number of errors (7.7 +/- 5.0) in the fine manipulation test. Only 10 kPa PIO2 affected CBFV, causing a significant increase in flow from 50 +/- 6.5 cm x s(-1) to 55 +/- 10.3 cm x s(-1). CBFV significantly increased during three psychomotor tests while breathing air; however, it did not increase further during psychomotor testing in hypoxia. DISCUSSION: A PIo2 of 15 kPa did not affect subject performance, and should not cause operational risk. At 10 kPa PIO2, accuracy and vigilance were slightly affected; however, the reduction in oxygenation was not great enough to cause major decrements. CBFV was not a good indicator of mental stress during hypoxia.