经食管超声心动图分析左心耳内部形态结构对左心耳封堵术的指导价值

目的:探讨经食管超声心动图（TEE）分析左心耳内部形态结构对左心耳封堵术的指导价值。方法:选取行左心耳封堵术患者110例,术前均给予TEE检查,分析左心耳开口最大径、梳状肌至开口距离等参数。结果:110例患者左心耳封堵术均成功,出现残余分流19例,无残余分流91例;手术时间17~80 min,平均手术时间（45.49±13.30） min;辐射量560~2 100 mGy,平均辐射量（980.50±112.40） mGy;曝光时间520~1 950 s,平均曝光时间（890.50±120.40） s;ACP封堵器尺寸18~33 mm,平均（25.50±2.50） mm;TEE所测左心耳开口最大径为（23.12±2.24）mm,小于ACP封堵器尺寸（P<0.05）;TEE所测左心耳开口最大径与ACP封堵器尺寸呈正相关（r=0.426, P<0.05）;手术时间<45 min和≥45 min患者左心耳开口最大径、左心耳深度及开口与深度比值比差异无统计学意义（P>0.05）;手术时间<45 min患者梳状肌到开口距离为（16.60±3.22） mm,明显大于手术时间≥45 min患者（P<0.05）;梳状肌到开口距离与手术时间呈负相关（r=-0.524, P<0.05）。结论:TEE分析左心耳内部形态结构对左心耳封堵术有一定指导价值,值得临床使用。     

Giant cell myocarditis as a manifestation of drug hypersensitivity.

Adverse drug effects on the myocardium are often classified into toxic and hypersensitivity forms of myocarditis, each with distinct histologic findings. In contrast, giant cell myocarditis (GCM) is generally not associated with adverse drug reactions and has unique histopathologic features. We report four cases of adverse drug reactions in which the histologic findings were characteristic of GCM. The clinical recognition that GCM may be a manifestation of an adverse drug reaction is important, since the prognosis and treatment of this entity may be different from that of other forms of myocarditis.     

Juxtaposition of atrial appendages. Reinterpretation as an accessory appendage or atrial diverticulum

The pathological features of 13 cases with juxtaposition of the atrial appendages in the autopsy files of The Johns Hopkins Hospital were studied. The anomaly occurs most frequently in association with transposition of the great vessels, ventricular septal defect, patent foramen ovale, and obstructive lesions of the tricuspid and pulmonic valves. The malformation complex of tricuspid atresia, atrial and ventricular septal communication, and the transposition of the great vessels seems particularly common with juxtaposition of the atrial appendage. A recent case showed a small accessory right atrial appendage lying in juxtaposition to the left atrial appendage. In addition, a normally situated right atrial appendages in addition to well-formed accessory appendages lying in juxtaposition to the left atrial appendages. It seems that juxtaposition of the atrial appendages should be reinterpreted as an accessory appendage or atrial diverticulum.     

Mitral stenosis together with a giant cell myocarditis limited to the left atrium

A case is described in which mitral stenosis was associated with a giant cell myocarditis; the latter lesion was, however, localized to the left atrium. A quite high proportion of reported cases of giant cell myocarditis have occurred in association with rheumatic heart disease. The nature of this relationship is discussed and it is concluded that, in such cases, the giant cell reaction may represent an unusual myocardial response to rheumatic fever.     

An autopsy case of giant cell myocarditis probably due to a non-steroidal anti-inflammatory drug

An autopsy case of giant cell myocarditis (GCM) in a 74-year-old woman is presented. She suffered from hepatic dysfunction, skin eruption and disseminated intravascular coagulation due to the side-effects of a non-steroidal anti-inflammatory drug. After admission, heart failure progressed rapidly, and the patient died suddenly. At autopsy, her heart was slightly enlarged and the heart muscle was thickened with many small whitish nodules. She was diagnosed with GCM because of the infiltration of multinuclear giant cells, histiocytes, eosinophils and lymphocytes into the heart. We did not find any similar lesions in any other organs. Giant cell myocarditis, the etiology of which is not defined, is a rare disease with unfavorable prognosis. This case suggests the possibility of drug-induced GCM.     

Thrombosis and infarction of the left atrial appendage in an infant: a case report

A case of thrombosed and infarcted left atrial appendage is presented. These findings occurred in a 28-day-old infant who died of pneumonia due to Hemophilus influenzae. Congenital abnormalities of the atrial appendages including hypoplasia, right and left isomerism and juxtapositions, and aneurysmal dilatations with and without pericardial defects are relatively uncommon. Acquired defects are also uncommon, and are often iatrogenic in nature. This report describes the case of a thrombosed and infarcted left atrial appendage in a 28-day-old infant.     

Serial right ventricular endomyocardial biopsy in rapid-onset severe heart failure due to giant cell myocarditis.

Giant cell myocarditis (GCM) is a serious condition that warrants immediate diagnosis and treatment. It often presents as rapidly progressive heart failure and/or malignant ventricular arrhythmias. Here, we describe a 34-year-old patient with myasthenia gravis who presented with GCM 2 weeks after resection of a thymoma. A cardiac biopsy confirming the diagnosis was done within 3 days after admission. After institution of an aggressive immunosuppressive drug regimen, implantation of an implantable cardioverter defibrillator, and intensive cardiac rehabilitation, the patient recovered dramatically. In control biopsies after 4 weeks and 6 months, no more giant cells were found. We conclude that, in the case of nonischemic acute heart failure in young patients, a biopsy should be performed as soon as possible to prevent an unfavourable outcome of this often fatal disease.     

Giant cell myocarditis: clinical and pathological features in an Indian population

BackgroundGiant cell myocarditis (GCM) is a rare disorder that is known primarily from North American, European, and Japanese case series. The clinical and pathological features of GCM in India have not been reported.MethodsWe reviewed the pathology records from 1994 to 2010 from a tertiary care referral hospital in Mumbai for all cases of pathologically confirmed GCM. Gross and microscopic histological features and clinical characteristics of the GCM cases were described and qualitatively compared to GCM case series from other regions of the world.ResultsThe 12 cases of GCM constituted 0.005% of all autopsies and 0.8% of myocarditis cases. Gross pathological features included variably dilated chambers in 8/12 cases with multifocal involvement of the myocardium. Three had regional hypertrophy associated with marked lymphocytic infiltrate. There were unique cases of a posterior wall rupture with hemopericardium and a case with multiple epicardial inflammatory sessile polyps. A novel possible trigger was suggested by a positive serologic test for leptospirosis in one case. The clinical features including age, gender, presenting symptoms, and prognosis resemble those reported in autopsy-based case series from other regions.ConclusionsGCM affects patients in India at approximately the same rate as in Europe and Japan. The clinical and histological features of GCM are similarly severe and suggest a heart-specific autoimmune reaction.     

Incidentally found,growing congenital aneurysm of the left atrium

A left atrial aneurysm is a very rare cardiac anomaly that usually develops in the left atrial appendage. It usually develops congenitally, and has a risk of life-threatening complications. Here, we report a case of a growing aneurysm of the left atrium that was incidentally found in a 42-yr-old woman. Eighteen years prior, an abnormal cardiomegaly was found on a chest radiography for a pre-operative study. The chest radiography at this time demonstrated a more prominent cardiomegaly than the previous radiography findings. The left atrial aneurysm was diagnosed by echocardiography and cardiac catheterization. Although asymptomatic, she underwent a successful surgical excision to allay the possibilities of rupture, arrhythmia, heart failure, or thromboembolism. The surgical findings demonstrated an 8 x 15 cm sized saccular aneurysm at the left atrial appendage, and the pathologic findings showed three myocardial layers. The patient has been asymptomatic during the 15 months of follow-up. In conclusion, a congenital left atrial aneurysm can grow with time, even in asymptomatic cases, and an aneurysmectomy is a curative treatment, which can eliminate the potential complications.     

The role of left atrial receptors in the diuretic response to left atrial distension

1. The diuretic response to distension of the whole left atrium caused by obstruction of the mitral orifice has been compared with the effects of distension (by means of small balloons) of the left pulmonary vein/left atrial junctions.

2. Distension of the pulmonary vein/atrial junctions caused an increase in heart rate and a diuresis similar to but smaller than that caused by mitral obstruction.

3. Section of both ansae subclaviae prevented the increase in heart rate produced by distension of the pulmonary vein/left atrial junctions but had little effect on the diuretic response either to pulmonary vein distension or to mitral obstruction.

4. A diuretic response to mitral obstruction could be demonstrated after all nerves from the lungs had been cut but not after the vagus nerves had been cut at levels likely to interrupt the majority of afferent fibres from left atrial receptors.

5. The results support the view that stimulation of left atrial receptors is a major factor in the production of a diuretic response to mitral obstruction.

     

Morphology of the left atrial appendage

Background: When examining the left atrial appendage by transesophageal echocardiography, differences in size and shape of the left atrial appendage are to be observed. The study was carried out with the aim of investigating the morphology of the left atrial appendage and to find associations with pathologic cardiac findings. Methods and results: In 220 cases (106 female, 114 male, mean age 72 ± 13 years) a cast of the left atrial appendage was made after the post mortem examination by using synthetic resin. In 198 cases an ECG was available (sinus rhythm n = 143, atrial fibrillation n = 55). The casts were described in respect to course and ramifications of the principal axis. The casts were measured concerning orifice diameters, outline, and volume. Most frequently (42%) the course of the principal axis was angulated below 100°. More than five ramifications of the principal axis were found in 56% of the casts. The volume ranged from 770–19,270 mm³ (mean 5,220 ± 3,041). When comparing the clinical and autopsy-data of the patients with the morphology of the casts, associations could be found between the volume of the casts and atrial fibrillation (7,060 mm³ as compared to 4,645 mm³ in sinus rhythm, P < 0.01), left ventricular hypertrophy (5,740 mm³ as compared to 4,639 mm³ without hypertrophy, P < 0.01), myocardial scars (5,923 mm³ as compared to 4,891 mm³ without scars, P < 0.05), closed foramen ovale (5,515 mm³ as compared to 4,037 mm³ with patent foramen ovale, P < 0.01), and left atrial appendage thrombi (8,566 mm³ as compared to 5,027 mm³ without thrombi, P < 0.01). Conclusion: Left atrial appendages are formations greatly varying in volume and shape. This variability should be considered when interpreting images of the left atrial appendage, and in particular when diagnosing thrombi. © 1995 Wiley-Liss, Inc.     

Mesothelial/monocytic incidental cardiac excrescence.

Mesothelial/monocytic incidental cardiac excrescence (MICE) is a very uncommon lesion. Diagnosis is incidental and may simulate thrombotic lesions. One of the hypotheses with regard to the etiology of this lesion is a previous cardiac procedure especially mitral valve repair or commissurotomy. Herein, we describe a MICE incidentally found in a patient who underwent mitral valve replacement, as a thrombotic lesion on the left atrial auricle. Histopathologic examination suggested MICE lesions and immunohistochemical stains confirmed it.     

高血压合并阵发性房颤患者心脏超声临床特点

目的:观察分析高血压合并阵发性房颤患者的心脏超声特点,为临床准确诊断提供依据。方法:选取2019年08月至2020年08月我院收治的51例高血压合并阵发性房颤患者作为研究组,同时选取51例单纯高血压患者作为常规组,所有患者均接受心脏超声诊断确定有无二尖瓣返流;同时观察心脏收缩期右房上下径、左房前后径、室间隔厚度、舒张期左心室末期内径、左室射血分数、早期二尖瓣血流速度/心房收缩时二尖瓣充盈峰速(Early mitral valve velocity/Mitral valve filling peak velocity during atrial contraction,E/A)。结果:研究组与常规组血压、腰围、BMI指数、血脂、血糖以及血尿素氮无差异(p>0.05);研究组二尖瓣返流病例数多于常规组(P<0.05);研究组E/A、室间隔厚度、收缩期左房前后径均高于常规组(P<0.05),而收缩期右房上下径、舒张期左心室末期内径、左室射血分数无差异(P>0.05)。通过Logistic分析发现,二尖瓣反流、室间隔厚度、收缩期左房前后径与阵发性房颤相关(P<0.05)。结论:高血压合并阵发性房颤的心脏超声特点包括:室间隔厚度增加、左心房扩大、二尖瓣返流等,与单纯高血压差异显著。     

滇南小耳猪人工瓣膜置换模型的建立

背景：猪和人的心脏解剖结构特点相似,是研究心血管疾病的理想模型。 目的：建立滇南小耳猪二尖瓣置换模型,应用心脏超声评估模型建立的可行性。 方法：成年猪10头,均于体外循环下经左心耳径路行二尖瓣置换,人工瓣膜为St.Jude双叶机械瓣,采用3种置换方式,并以心脏超声分析瓣膜置换后2周小耳猪心脏结构和功能的变化。 结果与结论：除1头因麻醉诱导期出现室颤死亡外其余均存活。心脏超声显示3种方式置换瓣膜后2周,猪心脏结构和功能与置换前无显著差异。人工机械瓣膜在猪体内的血流动力学和组织相容性均良好,二尖瓣置换前后猪的心脏结构及功能稳定。     

Giant left atrial myxoma causing drop attacks by prolapsing into the mitral valve

Atrial myxoma is the most common primary cardiac tumor. Its clinical presentation varies greatly from asymptomatic incidental mass to serious life-threatening cardiovascular complications. We herein describe the clinicopathological and imaging features of a huge left atrial myxoma protruding into the left ventricle during diastole and obstructing diastolic filling of the left ventricle thus causing drop attacks by prolapsing into the mitral valve. The patient (a 56-year-old female) underwent emergency surgery with complete removal of a 74 g weighing myxoma from the left atrium. She recovered without any complications. Awareness of this uncommon acute presentation of atrial myxoma is necessary for timely diagnosis and prompt surgical intervention to avoid irreversible cardiovascular complications.     

风湿性二尖瓣狭窄患者血液流变性变化与左心房内自回声现象的关系

目的 :探讨风湿性二尖瓣狭窄患者左心房内自回声现象 (SEC)与左心房血液流变学特点的关系。方法 :74例风湿性二尖瓣狭窄患者于经皮球囊二尖瓣成形术前采用彩色多普勒成像仪行食道超声检查 ,术中自左心房取血液标本进行血液流变学检查。结果 :74例患者中 ,发现SEC 2 4例(发现率 32 .4% )。SEC组HCT、ηp、ηb、IRCA、TK均高于无SEC组 (P <0 .0 5或 0 .0 1)。结论 :提示风湿性二尖瓣狭窄患者左心房内血液流变学异常可能是SEC形成的原因之一。     

左心耳封堵器体外疲劳耐久性试验方法

目的心房颤动是临床上常见的心律失常之一,左心耳封堵术是在传统药物治疗之外发展的通过微创介入封堵左心耳以达到预防血栓栓塞目的的新技术。左心耳封堵器在体内承受周期循环载荷可能会导致封堵器的固定盘发生疲劳断裂,威胁患者生命,并且血流对阻流膜的冲击造成阻流膜破裂导致封堵效果不佳。因此需要建立一种疲劳耐久性试验方法去评估封堵器在人体中的耐疲劳性能。方法首先根据医药行业标准YY 0808—2010确定疲劳试验采用直径控制法;然后确定在疲劳试验中左心耳封堵器的规格、振幅;最后进行疲劳试验获得封堵器在1900万次疲劳(内皮化时间点)和3.8亿次疲劳(10年疲劳时间点)后的状态。结果1900万次疲劳后,阻流膜无破损、缝合线无松脱掉落、金属部位无断裂,封堵器未移动;3.8亿次疲劳后,左心耳封堵器金属部位无断裂、无磨损。结论本研究可为研发和生产左心耳封堵器的企业及科研机构提供一种便捷、高效的疲劳耐久性评价方法。