Delayed presentation of traumatic ventricular septal defect and mitral leaflet perforation

A case of intracardiac stabbing is reported. The victim sustained injuries disproportionate to his initial presentation. These included a ventricular septal defect and mitral valve leaflet perforation. The need for immediate referral to a cardiothoracic unit and the importance of the use of echocardiography is stressed. This enables the safest and most appropriate management of potentially lethal injuries.     

A case of unicuspid aortic valve associated with a single coronary artery and ventricular septal defect

The patient was a 26-year-old man who had undergone patch closure of a ventricular septal defect at 2 years of age. After this surgery, his condition was satisfactory until he visited our hospital for treatment of paroxysmal supraventricular tachycardia in November 2000. Echocardiography revealed moderate to severe aortic valve regurgitation and dilatation of the left ventricle and ascending aorta. These echocardiographic abnormalities were attributed to a bicuspid aortic valve. Coronary angiography suggested the presence of a single coronary artery originating from the left Valsalva sinus. We performed Bentall’s operation in January 2003. The intraoperative findings revealed that the aortic valve consisted of an extensively calcified single cusp, and there was a single coronary artery originating from the left Valsalva sinus. Because adult patients with a unicuspid aortic valve are rare, and no cases of unicuspid aortic valve associated with a single coronary artery have been reported, we herein report this case with a review of the literature.This paper was presented at the 19th meeting of the Chubu Chapter of the Japan Society of Ultrasonics in Medicine.     

室间隔缺损封堵后迟发房室传导阻滞1例

患儿,女,5岁,2006-11-06南昌大学第二附属医院确诊为室间隔缺损伴膜部瘤形成,体质量17 kg.常规建立右股动脉-左心室-室间隔缺损-右心室-右股静脉轨道,送7F输送鞘管至左心室,先选直径6 mm对称性封堵器,后因易拉入右心室,改用直径8mm对称性封堵器封堵成功.封堵后第4天出现完全性房室传导阻滞,立即安置临时心脏起搏器并使用甲基强地松龙8 mg[0.5 mg/(kg·d)]静脉点滴7 d,同时每天静脉点滴白蛋白2 g/d,营养心肌,共10d,第9天患者恢复左前分支阻滞和完全性右束支阻滞,1个月后心电图无变化.此例结果说明封堵后所发生的并发症是暂时的,非材料宿主生物相容性反应.     

经导管封堵术治疗室间隔缺损

室间隔缺损(VSD)是最常见的先天性心脏病,约占先天性心脏病的20%,传统的外科手术曾被认为是治疗VSD的金标准,但有一定的危险性和致死率.近10年来经导管封堵治疗VSD得到迅速发展,且Amplatzer封堵器已在临床广泛应用,是目前最常用的关闭肌部和膜周部VSD的封堵器.经导管封堵VSD术安全、有效,肌部和膜周部VSD的封堵治疗较外科手术并发症少和死亡率低.     

Regional functional depression immediately after ventricular septal defect closure.

Left ventricular ejection is depressed immediately after repair of ventricular septal defect (VSD). Postrepair functional depression seen after VSD closure could result from a reduction in preload. However, other mechanisms could be at work. Functional depression could also be caused by closure of a low-impedance path for left ventricular ejection, the introduction of a stiff akinetic patch, or the operation itself. We reasoned that functional depression mediated by changes in preload or afterload should symmetrically affect end-diastole and end-systole, whereas depression resulting from changes in septal mechanics should be localized. We, therefore, performed segmental wall-motion analysis on intraoperative echocardiograms from patients undergoing VSD and atrial septal defect repair. After VSD closure, there was an asymmetric change in left ventricular end-systolic segment length and a decrease in fractional segment shortening localized to the septal and lateral walls, whereas patients with atrial septal defect had a symmetric increase in fractional shortening. These results suggest that acute functional depression after VSD repair is a result of localized impairment of septal function.     

彩色多普勒对室间隔缺损术后残余分流的预后评估

室间隔缺损术后残余分流（室缺残余分流）是先天性心脏病室间隔缺损（或含室缺的其它先天性心脏病）手术治疗的常见并发症。彩色多普勒超声检查是诊断室缺残余分流最为敏感的无创检查方法。本文对我院2003年8月～2007年3月进行手术治疗后并发室缺残余分流的86例患者进行跟踪随访分析，旨在利用彩色多普勒超声检查对室缺残余分流的预后进行评估，为临床判断预后提供帮助。     

介入封堵治疗儿童室间隔缺损并主动脉瓣脱垂疗效分析

目的探讨不同类型室间隔缺损（ventricularseptaldefect,VSD）并主动脉瓣脱垂（aorticvalveprolapse,AVP）介入治疗的个体化治疗方案。方法28例VSD并AVP患儿行经皮封堵术,经胸超声心动图及左心室造影进行诊断及分类。结果15例为膜周流出道型,7例为隔瓣后型,6例为膜周部型;患者均伴有局限AVP;VSD直径2．5～9．2mm,20例缺损口上缘距主动脉瓣〈2mm;介入治疗成功率89．3％（25／28）;未出现三尖瓣、主动脉瓣狭窄及主动脉瓣穿孔,无Ⅲ度房窀传导阻滞等严重心律失常发生。结论介入治疗不同类型VSD并AVP安全、有效。     

室间隔缺损合并主动脉瓣脱垂及瓦氏窦瘤破裂的外科治疗

目的总结室间隔缺损合并主动脉瓣脱垂及瓦氏窦瘤破裂的治疗体会.方法 118例室间隔缺损患者中合并主动脉瓣脱垂80例,主动脉瓣关闭不全为（＋～＋＋＋）;合并瓦氏窦瘤破裂37例;合并动脉导管未闭3例,三尖瓣关闭不全4例;合并亚急性细菌性心内膜炎7例,合并主动脉-右心室通道1例.结果本组无术后早期死亡,无室间隔缺损残余分流,复查部分病例仍有主动脉瓣关闭不全（＋、＋＋）,2例亚急性细菌性心内膜炎术后3个月再次行主动脉瓣置换术.结论室间隔缺损合并主动脉瓣脱垂及瓦氏窦瘤破裂及早手术治疗总体效果好.术中加强心肌保护、正确处理是治疗     

室间隔缺损合并主动脉窦瘤内血栓形成超声表现一例

正患者,男性,34岁,出生后发现心脏杂音,儿时易感冒。近6个月出现活动后胸闷、气短。查体:心率80次/min,血压130/75 mmHg(1 mmHg=0.133 kPa);胸骨右缘第3、4肋间隙可闻及收缩期杂音;心电图正常。经胸超声心动图(transthoracic echocardiography,TTE)示:室间隔干下部缺损,左心室面缺损口大小约16 mm,主动脉右冠瓣及     

Three-dimensional echocardiographic demonstration of aortic wall erosion after percutaneous atrial septal defect closure

Although late complications of percutaneous closure of atrial septal defect (ASD), including cardiac erosion and thrombosis, are rare, they are the most lethal. Data are still lacking regarding the usefulness of new imagining modalities, such as three-dimensional echocardiography (3DE), for the detection of these complications. Here, we report the case of a 57-year-old woman in whom cardiac erosion was very well visualized by 3D transesophageal echocardiography (3D TEE) after percutaneous ASD closure.     

经胸超声心动图对行室间隔缺损封堵术患者肺动脉顺应性的研究

目的利用经胸超声心动图探讨肺动脉顺应性指数(pulmonary arterial compliance index,PACI)评价行室间隔缺损(ventricular septal defect,VSD)封堵术患者肺动脉顺应性的价值,分析PACI与患者年龄及术后肺动脉收缩压(pulmonary arterial systolic pressure,PASP)变化的相关性。方法选取适合介入封堵治疗的膜周部VSD患者74例,根据年龄分为>40岁组、20～40岁组与<20岁组,根据术后PASP值分为>40 mm Hg组、30～40 mm Hg组与<30mm Hg组,74例患者术前均采用超声心动图测量缺损直径、跨缺损分流压差与PASP,计算VSD面积指数与PACI,术后3个月再次测量PASP,并进行分析及对比。结果 >40岁组术前PACI明显低于20～40岁组与<20岁组,术后PASP高于20～40岁组与<20岁组,差异有统计学意义(P<0.05),3组VSD面积指数比较差异无统计学意义(P>0.05);术后PASP>40 mm Hg组PACI低于30～40 mm Hg组与<30 mm Hg组,VSD面积指数高于30～40mm Hg组与<30mm Hg组,差异有统计学意义(P<0.05)。结论 VSD患者术后PASP的恢复与年龄及PACI相关,PACI可作为评价行VSD封堵术患者PASP恢复程度的指标之一。     

小儿膜周部室间隔缺损封堵术后心电图长期随访

目的 长期随访儿童经导管介入封堵膜周部室间隔缺损(ventricular septal defect,VSD)后心电图(ECG)各值,了解ECG改变规律及其转归.方法 对患膜周部VSD并成功介入封堵的290例患儿进行术后ECG随访.所有患儿术前术后均检查ECG,术后分别于1、3、6个月及1、2、3、5、8年复查ECG,电脑自动测算心率(V)、P-R间期、QRS间期、QT间期及校正的QT(QTc)值,观察心律及ST-T的变化.结果 随访时间:1~96个月[平均(40.16±29.2)个月].行多因素分析发现小儿膜周部VSD引起心电改变的危险因素是年龄在6周岁以内,膜部瘤样VSD,选择封堵器大于VSD直径3 mm以上者.封堵术后290例中115例(39.7%)出现各种轻重不等的ECG改变,进入5年以上长期随访的200例中持续ECG改变者43例(21.5%).但这些患儿均无症状,生长发育良好.随访80例经过应用激素和营养心肌治疗者中仅17例仍存在ECG的改变(21.3%),未经过治疗的35例,持续存在ECG改变者有26例(74.3%).随访5年以上仍需特别关注并定期随访的ECG改变者有25例(25/200例,12.5%).持续ECG改变组与术前组及无ECG改变组的各值对比,均有显著差异.对于出现重度房室传导阻滞(AVB)的患儿及时放置临时起搏器以及激素和营养心肌等治疗的病例预后较好.结论 本组随访提示封堵膜周部VSD慎重选择封堵器型号至关重要.对封堵术后ECG出现异常改变者,应用激素、果糖和维生素等营养心肌治疗,对心律失常的恢复或缓解有帮助.封堵术后早期发生ECG改变大部分轻微或可恢复,对一些明显的ECG改变,随访中未发现有转为三度AVB并影响患儿生长发育的病例,但对于一些ECG值的改变需要更长期随访以了解其转归和预后.     

超声心动图在室间隔缺损封堵术中的应用价值

目的探讨超声心动图在室间隔缺损(VSD)封堵术前筛选、术中监视引导及术后随访的应用价值.方法采用超声心动图对11例VSD,1例心肌梗死室间隔肌部穿孔患者,术前测量VSD形状与大小,术中监测封堵过程,术后随诊封堵效果.结果 VSD膜周部5例、隔瓣后型3例、膜周嵴下型2例、嵴内漏斗部1例、心肌梗死室间隔肌部穿孔1例,共安置13个封堵器,其中1例患者有两个相距较远的缺损,安置了2个封堵器,被封堵的VSD直径为3～8 mm,平均(5.2±0.8)mm,选用封堵器直径应比VSD测值大2 mm,最大封堵器直径为10 mm.10例患者封堵术后即刻观察,穿隔分流消失,术后1周复查,封堵器位置良好、稳定,无经封堵器残余分流;1例有微量残余分流,术后24 h超声心动图复查分流消失;1例少量残余分流,术后即刻复查最大分流速度为1.2 m/s(低于险值2 m/s),于6个月后复查仅见微量残余分流.结论超声心动图在VSD封堵术适应证的筛选,封堵器释放时间的确定,释放时即刻疗效的评价及术后随访中具有重要价值.     

Spontaneous closure of a traumatic ventricular septal defect after blunt trauma documented by serial echocardiography.

A ventricular septal defect (caused by blunt chest trauma) that closed spontaneously over a period of 5 years was documented by serial echo-Doppler examinations. The shunt was relatively small and the patient was without symptoms from the time the lesion was discovered until its closure. In the absence of cardiac decompensation or pulmonary hypertension, a conservative approach, including serial echo-Doppler examinations, can be justified.