成人动脉导管未闭合并心内畸形34例外科治疗

目的：探讨成人动脉导管未闭(PDA)合并心内畸形的外科治疗经验。方法：回顾分析了1993年1月至2003年6月间外科治疗的34例成人PDA合并心内畸形的临床资料。结果：32例痊愈，1例死于术后低心排综合征，1例死于出血，死亡率5.9％；随访复查心脏B超，导管无再通，房室间隔无残余分流。结论：体外循环下经肺动脉切口缝闭PDA，同期行心内畸形矫治术，加强术后处理，可取得良好的手术效果。     

80例婴幼儿先天性心脏病心内直视手术术后并发症的防治

进行婴幼儿先心病心内直视手术８０例，年龄１３天－３岁，体重３－１０公斤，病种是室间隔缺损，肺动脉狭窄，完全性肺静脉异位引流，部分性房室管畸表，法乐四联症，室缺并动脉导管未闭，右室双腔民，右位心产室缺，房缺，右旋心并法乐四联症，三房心，肺静脉狭窄，Ｔａｕｓｓｉｎｇ－Ｂｉｎｇ病，房缺并动脉导管未闭等１３种。     

心导管检查并发症的护理

心导管检查可能发生各种并发症,影响检查的顺利进行,并给病人带来危害。因此,检查过程中应密切观察病情及心电图(EKG)的变化,防止和及时地治疗各种并发症是很重要的。所以临床上护士熟悉其可能发生并发症及其护理要点则具有重要意义。一、临床资料本组58例为先天性心血管疾病的患者,男26例,女32例;年龄最小者1岁半,最大者54岁。临床诊断室缺(VSD)14例,房缺(ASD)13例,动脉导管未闭(PDA)9例,室缺加动脉导管未闭(VSD+     

超声心动图引导复合先天性心脏畸形介入治疗

目的：探讨超声心动图在复合心脏畸形介入治疗监测中的价值。方法：4例复合心内畸形患者进行了介入治疗，包括1例间隔缺损合并动脉导管未闭，1例鲁登巴赫综合征及2例法乐三联症。超声心动图术前测量其缺损大小，周缘情况及瓣膜狭窄程度；术中经食道或经胸超声监测瓣膜狭窄球囊扩张的效果及观察封堵器封堵效果。结果：经胸超声检测的瓣膜及张前后压力阶差与心导管压力阶差密切关联。4例患者因房缺周缘较好，均未用球囊测量房缺伸展戏，在超声所测房缺最大戏基础上加3－5mm选择封堵器封堵房缺取得封堵牢固及无残余分流的良好效果。结论；超声心动图在复合心内畸形的介入治疗中对瓣膜扩张疗效的判断，缺损大小的确定，封堵器的选择及封堵效果的观察方面起到指导性作用。     

经导管介入治疗小儿动脉导管未闭的体会

目的：评价经导管介入治疗小儿动脉导管未闭(PDA)临床疗效。方法：从1996年8月至2001年5月应用Rashkind双面伞法、Sideris纽扣式补片法、弹簧圈法以及Amplatzer蘑菇伞堵闲法关闭6例PDA患儿。结果：6例均一次性堵闭成功，术后即刻造影有小量残余分流2例，其中1例术后24h心脏彩超显示小量残余分流消失；其它4例术后即刻造影均无残余分流。结论：经导管应用弹簧圈法及Amplatzer蘑菇伞法堵闭PDA，临床疗效可靠、安全，可作为治疗小儿PDA的首选。     

介入法治疗动脉导管未闭结扎术后残余漏3例分析

目的 探讨介入法治疗动脉导管未闭结扎术后残余漏的临床效果.方法 先天性心脏病-动脉导管未闭术后残余漏患者3例,应用国产华医圣杰PDA封堵器行动脉导管未闭封堵术.结果 3例均封堵成功.术后即时造影及术后24 h心脏超声检查未见残余分流.结论 应用介入法治疗动脉导管未闭结扎术后残余漏是一种安全有效的治疗方法.     

房缺合并动脉导管未闭肺动脉高压的体外循环操作配合

房间隔缺损合并动脉导管未闭、肺动脉高压患者体外循环中极难维持动静脉的回流与灌注的平衡。房缺本身是一组自左向右分流的先心病,肺循环流量增多,因而左心回流量亦随之增多。动脉导管未闭也是一     

先心病双氧水声学造影方法及护理

我院自1988年以来对先心病患者行B超显像下双氧水声学造影85例。室缺41例(合并肺动脉高压5例),房缺13例(合并肺动脉高压2例),动脉导管未闭9例(合并室缺1例,房缺2例),法四14例     

动脉导管未闭合并心内畸形15例围术期护理

1999年8月～2007年3月,我们收治15例动脉导管未闭(PDA)合并心内畸形患者,在围术期进行精心护理,效果满意.现将围术期护理体会报告如下.     

郭氏法修补动脉导管未闭合并心内复合畸形

动脉导管未闭(Patent ductus arteriosus,PDA)或合并心内复合畸形手术难度较大,以往常行单纯结扎或分两次手术,我院自1988年5月至1994年10月采用郭氏[1]方法为7例动脉导管未闭或合并室间隔缺损(Ventricular septal defect,VSD)及肺动脉高压患者,在深低温微流量体外循环直视下施行PDA+VSD直视修补术.报道如下.     

中老年先天性心脏病手术评价

目的：评价中老年先天性心脏病的手术疗效。方法：1989～1998年共手术治疗40岁以上的先心病患者117例，最大年龄62岁。其中单纯房缺69例，房缺合并瓣膜病变20例，动脉导管未闭12例，室缺15例，法乐氏四联症1例。所有患者均有不同程度胸闷、气急症状。除4例房缺行经导管闭合术外，其余患者均行外科手术到治。结果：手术死亡1例，死亡率0.8％。随访6～120个月，晚期死亡1例，原因不明。讨论：先心病患者，只要考虑到术后血流动力学有改善，手术纠治是必要和安全的，年龄因素不是手术的先决。     

经胸超声心动图引导Amplatzer封堵器治疗 PDA、ASD、VSD的临床价值

目的 探讨经胸超声心动图(transthoracic echocardiography，TTE)在指导Amplatzer封堵器封堵动脉导管未闭(patent ductus arteriosus，PDA)、房间隔缺损(atrial septal defect，ASD)及室间隔缺损(ventricular septal defect，VSD)中的应用价值。方法 应用TTE对5例PDA、15例ASD及6例VSD行经导管封堵术。结果 23例患者成功地进行了封堵，术中及术后均无并发症，无残余分流。2例ASD及1例VSD未完成封堵。总的成功率为88．46％(23／26)。结论 TTE对于应用Amplatzer封堵器封堵PDA、ASD及VSD术前病例选择、指导选择封堵器型号以及在放置封堵器过程中和术后疗效评价起着重要作用，是一种有效的监测方法。     

超声心动图在房间隔、室间隔缺损和动脉导管未闭Amplatzer封堵术中的应用研究

目的探讨超声心动图在Amplatzer封堵器封堵房间隔缺损(ASD)、室间隔缺损(VSD)及动脉导管未闭(PDA)中的应用价值.方法应用经胸超声心动图(TTE)或/和经食管超声心动图(TEE)对21例ASD、9例VSD和12例PDA患者行经导管Amplatzer封堵术治疗.结果41例患者Amplatzer封堵术成功,术中及术后均无并发症,1例巨大PDA合并肺动脉高压近期存在少量残余分流.结论超声心动图对于Amplatzer封堵ASD、VSD、PDA术前病例选择、术中指导监测、选择封堵器型号与术后疗效评价及随访均有重要价值.     

超声心动图在介入治疗动脉导管未闭、房间隔缺损及室间隔缺损中的作用

目的 评价超声心动图在动脉导管未闭(PDA)、房间隔缺损(ASD)及室间隔缺损(VSD)介入治疗中的作用。方法 经导管闭合6例PDA、8例ASD及3例VSD患者，术前、术中、术后进行经胸或／和经食道超声心动图检查。结果 6例PDA、8例ASD及3例VSD在经胸超声引导下均成功置入封堵器且无并发症。仅1例ASD、1例PDA术后即刻存在少许残余分流，分别于1周及3个月后消失。结论 超声心动图对于用封堵器封堵PDA、ASD及VSD术前病例选择，术中指导监测，封堵器型号的选择与术后疗效评价等均有较大的价值。     

经胸超声指导Amplatzer封堵器介入治疗先心病的应用价值

目的探讨经胸超声(TTE)指导Amplatzer封堵器介入治疗房间隔缺损(ASD),室间隔缺损(VSD)及动脉导管未闭(PDA)的应用价值。方法术前应用TTE筛选封堵术适应症33例先心病,其中23例ASD、6例VSD、4例PDA。术中用TTE监测指导释放封堵器,即刻观察疗效。术后进行定期随访。结果21例ASD、5例VSD、4例PDA封堵成功,2例ASD及1例VSD封堵失败,总成功率为90.91%(30/33)。21例ASD 病例中,14例选用TTE测量缺损最大径与球囊测量最大伸展径比较,TTE测量缺损最大径与球囊测量最大伸展径比较有明显相关性(r=0.563,P<0.05)。7例选用TTE测量缺损最大径基础上加3-4 mm作为封堵器大小的选择。筛选6例膜周部VSD,5例封堵成功,1例封堵失败。VSD例数虽少,但发现VSD形态变化多,VSD右室面形态各一。筛选4例PDA封堵成功。30例成功封堵术封堵即刻无残余分流为93.33%(28/30),6.67%有低速少量分流(2/30)。术后一周复查心脏均有一定缩小,6个月复查心脏恢复至正常范围。结论TTE可用来筛选ASD、VSD、PDA封堵术病例,术中检测指导Amplatzer封堵器定位和释放,观察即刻疗效,治疗可靠;术后进行疗效评价有较大价值。     

磁共振在常见左向右分流先天性心脏病中的 诊断价值探讨

目的　探讨磁共振 (MRI)在小儿常见左向右分流先天性心脏病 (先心病 )中的诊断价值。方法　 82例均行超声心动图及MRI检查 ,其中 6例作心血管造影 (ACG) ,5 7例行手术。结果　 82例中单纯室间隔缺损 (VSD) 6 0例 ,VSD合并房间隔缺损 (ASD) 11例 ,VSD合并动脉导管未闭 (PDA) 2例 ,ASD合并PDA 1例 ,VSD合并ASD、PDA 3例 ,ASD 2例 ,PDA 3例。MRI检查出超声心动图漏诊的伴有主动脉弓病变 18例。结论　小儿常见左向右分流先心病的MRI诊断结果与超声相符 ,能显示心外大血管异常是MRI的优势。     

Measurement of systolic time intervals during exercise using inductive plethysmography

Summary Measurement of systolic time intervals (STI) provides a noninvasive assessment of cardiac function in resting subjects. However, large motion artifacts often limit their application during exercise. To improve such measurements, we employed a new lightweight carotid arterial pulse transducer and minimized the artifacts by computerized signal averaging. The carotid pulse was recorded with an inductive plethysmographic transducer band (CIP) wrapped around the neck. STI derived from these measurements were compared to standard measurements from a funnel-shaped cup attached to the neck and connected to a pressure transducer (CUP) in 12 normal subjects at rest and with graded bicycle ergometry. To compare the techniques, CIP and CUP signals, together with the EKG and phonocardiogram, were connected separately to two microcomputer systems. The systems were triggered from the EKG and averaged the signals over 16 or 32 heart beats. Semi-automatic analysis of the averaged signals provided estimates of left ventricular ejection time (LVET), pre-ejection period (PEP) and electromechanical systole (QS₂). Motion artifact levels of the unprocessed signals were similar with both CIP and CUP methods but were greatly reduced by signal averaging. All LEVT values using CIP fell within 10% of CUP values. 85% of PEP values using CIP were within 20% of CUP values. Increasing exercise loads produced appropriate decreases in QS₂, LVET, PEP and PEP/LVET consistent with increased myocardial contractility. The CIP proved comfortable to wear and did not require critical positioning as did the CUP. Measurement of STI complements exercise pulmonary testing with useful information of cardiac function.     

Left ventricular function during sepsis

The prevalence and prognostic significance of left ventricular involvement in septic patients without shock was investigated. Systolic time intervals (STI) and preejection period/left ventricular ejection time ratio (PEP/LVET) were used to assess left ventricular function. Forty-nine patients, 22 of whom ultimately died, were studied. The group as a whole showed abnormal PEP/LVET ratio (0.40 +/- 0.02) that differed significantly (p less than .01) from reported normal values (0.345 +/- 0.002), demonstrating widespread left ventricular dysfunction in this population. In order to establish the prognostic significance of left ventricular impairment, the population was divided into two groups according to the PEP/LVET ratio. Group 1 (PEP/LVET less than or equal to 0.42) showed a mortality rate of 10/33 (30%), while group 2 (PEP/LVET greater than 0.42) had a significantly greater mortality (12/16 [75%], p less than .001). The test that has a sensitivity of 55%, a specificity of 85%, and a positive predictive value of 75% identifies a subset of septic patients with severe impairment of left ventricular function and high risk of dying.     

Difference in Autonomic Nervous Control between Ventricular Septal Defect and Atrial Septal Defect Based on Heart Rate Variability

Background: We hypothesized that patients with atrial (ASD) and ventricular septal defects (VSD) have similarly reduced heart rate variability (HRV) since both defects cause similar increases in pulmonary blood flow and right ventricular filling pressure. We examined the correlation between HRV and respiratory frequency (RSA) characteristics and left-to-right shunt ratio (Qp/Qs) measured by Doppler echocardiography.
Methods: The study included 83 patients with diagnoses of ASD (n = 43) or VSD (n = 40). The electrocardiogram and respiratory waves were recorded during Doppler echocardiography test, and HRV was measured to calculate the low frequency (LF), high frequency (HF), total frequency (TF), and RSA components, and the LF/HF, RSA/TF, and LF/RSA ratios. Qp/Qs was calculated from Doppler echocardiography and its relationship with HRV parameters was examined by multivariate analysis.
Results: There was a positive correlation between Qp/Qs and LF/RSA in the ASD group, and a negative correlation in the VSD group. In contrast, Qp/Qs correlated negatively with RSA/TF in the ASD group, and positively in the VSD group.
Conclusion: Different effects of respiratory vagal activity on HRV were observed in patients with ASD versus VSD.     

小儿急性心肌炎左室功能系统观察

我们对16例轻型心肌炎患儿用心机械图系统观察了发病6～12个月内的左室功能。结果发现发病第一个月PEP、ICT延长,LVET缩短,PEP/LVET、ICT/LVET升高,与对照组差异显著或非常显著,其中以PEP、PEP/LVET改变最明显。经正规治疗,以上指标多于3～4个月内逐渐恢复,PEP由79±6ms缩至69±9ms,PEP/LVET由0.265±0.02降为0.188±0.02。DTI无显著改变。说明轻型心肌炎发病一个月内左室收缩功能有所下降,至病程第三、四个月逐渐恢复正常。