二尖瓣成形术治疗二尖瓣后瓣脱垂伴重度关闭不全后收缩期前向运动征1例

<正>患者男,48岁,活动后胸痛伴头晕、恶心及心悸等3个月;10余年前因“胆囊结石”接受“单孔腹腔镜胆囊切除术”。查体：脐上缘见长2.5cm横行手术瘢痕,二尖瓣区闻及2/6级收缩期杂音。实验室检查未见明显异常。经胸超声心动图（transthoracic echocardiography,TTE）：左心房前后径44mm,左心室舒张末期内径54mm,室间隔厚度9mm;左心室射血分数66%;二尖瓣后瓣P1收缩期脱向左心房侧,超过瓣环水平,二尖瓣偏向房间隔大量反流;提示二尖瓣后瓣脱垂伴重度关闭不全。     

实时三维经食管超声心动图对二尖瓣脱垂瓣器结构与反流程度的定量研究

目的  应用实时三维经食管超声心动图（RT-3D-TEE）评估二尖瓣脱垂病变瓣器结构改变与反流程度之间的相关性。方法  纳入于我院就诊行经胸超声心动图检查确诊为二尖瓣脱垂伴反流的患者40例,另选取10例作为对照组。50例患者均行RT-3D-TEE检查并采集二尖瓣三维图像,使用4D Auto MVQ脱机工作站进行图像后处理和定量分析。结果  瓣环三维面积、瓣环二维面积、瓣环周长、前后直径、前外-后内侧直径、非平面角度、总瓣叶面积、后叶面积随反流程度增加而增大,瓣高联合比随反流程度增加而减小,组间差异均有统计学意义（P < 0.05）。瓣环三维面积、瓣环二维面积、瓣环周长、前后直径、总瓣叶面积与反流程度呈极强相关关系（r=0.847、0.843、0.845、0.854、0.854,P < 0.05)。A Total是导致重度二尖瓣反流发生的危险因素（P < 0.01,B=1.576,OR=4.834）。总瓣叶面积（截点值=8.9 cm²）预测重度二尖瓣反流的敏感度为91.7%,特异性为87.5%,曲线下面积为0.948（P < 0.01）。结论  二尖瓣瓣环大小、扁平程度、瓣叶大小与反流程度呈正相关。总瓣叶面积是导致二尖瓣脱垂患者二尖瓣反流程度加重的危险因素。     

冠状动脉自发夹层1例并文献复习

目的 总结自发性冠状动脉夹层的发病机制、病因及诱因、临床表现、诊断,治疗及相关研究进展,提高对其认识及诊断检出率。方法 回顾性分析1例冠状动脉自发夹层所致急性心肌缺血梗死的患者资料,并进行相关文献复习。结果 患者以胸痛入院,心电图示急性下壁ST抬高心肌梗死,心肌酶、肌钙蛋白I增高,诊断为急性心肌梗死。复查心电图迅速恢复正常。冠状动脉造影术,见右冠状动脉开口狭窄约为70%,近中段自发夹层,行经皮冠状动脉球囊扩张术（PTCA）+冠状动脉内支架植入术,术后观察病变处无狭窄,支架完全覆盖夹层,TIMI血流3级。结论 急性自发性冠状动脉夹层,病情进展迅速,早期死亡率高,故快速诊断并避免误诊意义重大,应尽早完善相关影像学检查,早期明确诊断。     

青年女性自发冠状动脉夹层导致急性心肌梗死1例并文献复习

目的 探讨自发性冠状动脉夹层的临床特点,以期提高对该病的诊治与认识。方法 回顾性分析1例青年女性自发性冠状动脉夹层导致急性心肌梗死患者的临床资料,并以“自发性冠状动脉夹层”、“急性心肌梗死”以及“青年女性”等关键词,通过检索中国知网、PubMed及万方数据库,筛选公开发表的相关中英文文献,以分析自发性冠状动脉夹层的临床特点。结果 本例为青年女性,35岁,因间断胸痛就诊,心电图检查提示I、aVL及V2-V5导联ST段抬高,肌钙蛋白T升高(>2 000 ng/L),冠状动脉造影结果示左主干(LM)自开口可见夹层,延伸至左前降支(LAD)远段及回旋支(LCX)中段,管腔全程受压,近段血管部分不能显影,经血管内超声(intravenous ultrasound, IVUS)指导下行经皮冠状动脉介入(percutaneous coronary intervention, PCI)治疗,随访1个月并复查冠状动脉造影(coronary angiography, CAG)患者治疗效果良好。结论 自发性冠状动脉夹层是导致急性冠脉综合征的罕见病因,其疾病特点及治疗方法与冠状动脉粥样硬化不同,诊断具有...     

Well-functioning double-orifice mitral valve in a young adult

We report the case of a rare congenital anomaly, a double-orifice mitral valve, in a 23-year-old woman who was asymptomatic and had no history of heart disease. Transthoracic and multiplane transesophageal echocardiography revealed 2 functionally normal orifices of equal size, the least frequent anatomic presentation of this anomaly. We prescribed antibiotic prophylaxis because of the concomitant presence of a mildly stenotic bicuspid aortic valve and recommended annual follow-up examinations to monitor both lesions for possible progression.     

Echocardiographic prediction of surgical reparability in degenerative mitral regurgitation due to leaflet prolapse: a review

ABSTRACT

Introduction: Despite current guidelines provide recommendations for the optimal management of degenerative mitral regurgitation (MR), this condition remains often undertreated with delay in surgical referral and dismal effect on outcomes.

Areas covered: This review focuses on the role of echocardiography in guiding mitral valve (MV) surgical repair in degenerative MR due to leaflet prolapse.

Expert opinion: A stepwise protocol-driven echocardiography shared by referring physician and surgeon may help to guide referral to surgical repair in degenerative MR. This protocol particularly is useful to identify the ideal patho-anatomy for a successful and durable repair especially when early surgery is proposed and to refer the patient to centers of excellence in case of complex anatomy. Nearly 100% repair rate can be achieved when the surgical technique is adapted to the lesions seen in each valve. Three-dimensional echocardiography predicts repair complexity may be useful and should therefore be implemented. However, the current literature is far from comprehensive deriving from small, single-center studies. Therefore, reproducibility and external validation, especially with newly developed quantitative automated software, are still needed.     

ST-segment elevation myocardial infarction in Kawasaki disease: A case report and review of literature

BACKGROUNDKawasaki disease (KD) is an acute self-limiting febrile vasculitis that occurs during childhood and can cause coronary artery aneurysm (CAA). CAAs are associated with a high rate of adverse cardiovascular events.CASE SUMMARYA Korean 35-year-old man with a 30-year history of KD presented to the emergency room with chest pain. Emergent coronary angiography was performed as ST-segment elevation in the inferior leads was observed on the electrocardiogram. An aneurysm of the left circumflex (LCX) coronary artery was found with massive thrombi within. A drug-eluting 4.5 mm 23 mm-sized stent was inserted into the occluded area without complications. The maximal diameter of the LCX was 6.0 mm with a Z score of 4.7, suggestive of a small aneurysm considering his age, sex, and body surface area. We further present a case series of 19 patients with KD, including the current patient, presenting with acute coronary syndrome (ACS). Notably, none of the cases showed Z scores; only five patients (26%) had been regularly followed up by a physician, and only one patient (5.3%) was being treated with antithrombotic therapy before ACS occurred.CONCLUSIONFor KD presenting with ACS, regular follow up and medical therapy may be crucial for improved outcomes.     

A giant aneurysm of the circumflex coronary artery with fistulous connection to the coronary sinus: a case report

Non-atherosclerotic coronary artery aneurysms are rare and most of them remain asymptomatic. We report a case who has a giant circumflex coronary artery aneurysm with fistulisation into the coronary sinus. The patient presents with dyspnea and palpitation due to atrial fibrillation with rapid ventricular response. The diagnostic contributions of echocardiography, coronary angiography are discussed. The hemodynamic effects of this anomaly are reviewed.     

Acute myocardial infarction as the first sign of infective endocarditis: a case report

Infective endocarditis is a bacterial or fungal infection of the heart valves or endocardial surface, and it frequently forms vegetation and can lead to systemic embolism. Dislodged vegetation rarely results in coronary artery embolism (CAE) and subsequent acute myocardial infarction. A 43-year-old male patient was emergently brought to our hospital for suspected acute myocardial infarction. Coronary angiography was performed and it showed embolism in the left circumflex artery. Thrombus aspiration was performed during coronary angiography. Echocardiography showed formation of vegetation in the posterior leaflet of the mitral valve and multiple blood cultures showed Listeria monocytogenes. Infective endocarditis was diagnosed. Three weeks later, debridement of subacute bacterial endocarditis, mitral valve replacement, and tricuspid valvuloplasty were successfully conducted. Our findings suggest that CAE should be considered in the differential diagnosis of acute myocardial infarction. Aspiration of coronary embolus during coronary angiography followed by surgical intervention of diseased heart valves is a plausible strategy for managing CAE in infective endocarditis.     

Prenatal diagnosis of a right coronary artery to right atrial fistula with a giant coronary artery aneurysm: A case report

Coronary artery fistula (CAF) is a rare cardiac anomaly. Here, we diagnosed a right coronary artery-right atrium fistula with giant coronary artery aneurysm (CAA) via fetal echocardiography at 35 weeks' gestation. An urgent caesarean delivery was performed at 36 weeks' gestation because CAA caused mitral obstruction, and fetal atrial flutter was present. Following delivery, we performed aneurysm ligation because the new-born developed atrial tachycardia. The intraoperative findings confirmed the sonographic findings. To the best of our knowledge, prenatal ultrasound diagnosis of CAF and giant CAA has not been reported in the literature. We focus on the ultrasonic characteristics and differential diagnosis in this literature.     

川崎病患儿冠状动脉巨大瘤并其内血栓形成1 例

患儿男,年龄18个月,因发热1周伴颈部淋巴结肿大入院,临床诊断:发热原因待查:川崎病可能。运用GE Vivid5彩超仪进行心脏检查:取主动脉短轴切面观察,左、右冠状动脉主干均呈瘤样扩张,以左侧为甚,形态呈“纺缍状”;左支内径约12mm,开口处内径7mm,左前降支内径3.2mm,右支主干内径约8mm,LCA/AO=0.86,RCA/AO=0.57,冠状动脉成像:左、右冠状动脉内均可见稀疏的红色血流信号,测得左冠状动脉主干内舒张期血流速度约20cm/s。右室稍大;三尖瓣口探及轻度反流信号。超声诊断:左冠状动脉巨大瘤,右冠状动脉瘤声像,提示:川崎病冠状动脉改变。患儿住院治…     

经胸超声心动图诊断二尖瓣脱垂的临床表现及诊断效能

目的探讨经胸超声心动图诊断二尖瓣脱垂的临床表现及诊断效能。方法选择46例疑似二尖瓣脱垂患者为研究对象,在手术前均接受经胸超声心动图检查,并经三维图像旋转、切割,确认具体二尖瓣膜脱垂区域,从而判断是否存在腱索断裂,并与手术结果作对照分析。结果经过手术,前叶分区定位中,脱垂患者共有13例,包括A1区4例,A2区5例,A3区4例;后叶分区定位中,脱垂患者共有13例,包括P1区4例,P2区4例,P3区5例。经胸超声心动图检出前叶分区定位中脱垂的有21例;后叶分区定位中脱垂的有16例。经胸超声心动图诊断二尖瓣各区域脱垂,A3和P3区的灵敏度高于A1、A2、P1、P2区;A1和P2区的特异度和准确度高于A2、A3、P1、P3区。经胸超声心动图诊断腱索断裂的灵敏度为100.00%,特异度为80.77%。结论经胸超声心动图可以高效地、快速地、准确地进行二尖瓣脱垂诊断。     

Left main coronary artery aneurysm associated with extensive coronary arterial calcification: case report and review

We present a 68-year-old male with left main coronary artery aneurysm and extensive coronary calcification involving the entire coronary arterial tree detected by coronary angiography and electron beam computerized tomography. With this article we also discussed the relationships between the pathogenesis of coronary atherosclerosis, coronary calcification, and coronary aneurysm formation.     

骨髓增生异常综合征转为急性嗜酸粒细胞白血病1例并文献复习

目的观察急性嗜酸粒细胞白血病(AEL)的形态特征、遗传特征、免疫表型及分子标记特征以提高对AEL的认识。方法对我院收治的1例难治性血细胞减少伴多系发育异常(MDS-RCMD)转为AEL患者的病历资料进行回顾性总结并复习相关文献。结果该例MDS-RCMD患者12个月后转为AEL;骨髓原始细胞占10.4%,嗜酸粒细胞占70.8%,其中嗜酸性早、中、晚幼粒细胞占69.6%;外周血嗜酸粒细胞占13.5%;骨髓原始细胞伴有复杂染色体异常、CD34、CD117、HLD-DR、CD33、CD38、CD13等阳性表达;FI1L1/PDGFRα和ETV6/PDGFRα融合基因阴性。按AML治疗2个月后患者死亡。结论该例AEL患者FI1L1/PDGFRα和ETV6/PDGFRα基因重排阴性,伊马替尼治疗无效。     

From atherosclerotic coronary ectasia to aneurysm: a case report and literature review

In contrast to Kawasaki syndrome the formation of coronary aneuryms caused by atherosclerosis has hardly been demonstrated. We report on a 56-year old patient, admitted to our hospital for cardiovascular evaluation before carotid surgery. He had no anginal pain, but a history of coronary artery disease with previous anterior myocardial infarction. Angiography revealed a collateralized LAD occlusion. Myocardial scintigraphy only demonstrated fixed perfusion defects. Surprisingly, MR imaging revealed large coronary aneurysms of the RCX and RCA. Angiographic follow up showed a rapid progression of ectatic towards aneurysmatic coronary lesions within 3 years. General pathophysiological mechanisms promoting ectatic coronary artery disease as a structural failure of the atherosclerotic remodelling process itself and chronic dilatatory stimuli due to endogenous and exogenous factors are discussed.     

Underrecognized pathogen; Staphylococcus warneri‐associated native mitral valve endocarditis in an immunocompetent host: A case report and literature review

Staphylococcus warneri‐related endocarditis is rarely reported, raising diagnostic challenges and is often associated with considerable morbidity and mortality. We describe a case of native valve endocarditis caused by S. warneri and complicated by a valve perforation in an immunocompetent patient to raise awareness of this emerging organism.     

A case of coronary-pulmonary artery fistula with coronary artery aneurysm detected for Kawasaki disease remote phase

Follow-up echocardiography showed two coronary-pulmonary artery fistulae and a coronary artery aneurysm in a 12-year-old boy who had been diagnosed with Kawasaki disease without persistent coronary artery lesion at the acute phase when he was 6-months-old. Left coronary arteriogram confirmed the fistulae and the 4.3 × 6.3 mm aneurysm. Results show that the fistula is associated with Kawasaki disease.