Surgical treatment of mitral insufficiency using annuloplasty suture technic

In 1991 a simple and cheap technique was introduced for mitral valve repair at our department. After repairing the mitral leaflets, where indicated a posterior leaflet annuloplasty was performed with a semicircular suture and the annulus fixed for the appropriate size by tying the stitch. Between July 1991 and December 1995 86 patients underwent the above procedure (average age 56.8 +/- 10.4 years). 45 patients had primary mitral valve disease (myxomatous degeneration, rheumatoid disease, endocarditis), the other 41 had functional mitral regurgitation secondary to severe aortic valve or coronary artery disease. Echocardiography showed severe mitral regurgitation in 77% of the patients. In 45 cases the mitral valve itself was also repaired (valvotomy, quadrangular resection, wedge resection, etc.) in 29 cases the aortic valve was replaced as well, while 24 patients required additional revascularisation of the myocardium. The 30 day mortality was 3.5%. One week after surgery echocardiography was performed at all patients and showed acceptable mitral valve area (2.28 +/- 0.39 cm2). In 28 cases mild mitral regurgitation was found, the other valves were competent. All but 3 patients were followed up (96.4%). There were 6 late deaths (3 cardiac, 2 non cardiac, 1 embolic, 7.2% late mortality). During the follow up period (31.7 +/- 11.2 months) 5 patients required mitral valve replacement for severe recurrent mitral regurgitation (6.0%). In two cases new chorda rupture caused the recurrence, in an other case the suture had torn out of the annulus due to inadequate surgical technique. In the last two cases the annulus had dilated with intact Prolene annuloplasty stitch present, 86.8% of the survivors were in NYHA class I. or II. Our results suggest that mitral valve repair in selected cases can be performed without using expensive annuloplasty rings. The suture used for annuloplasty should be strong, non absorbable and non stretchable. Since 1994, when we started using GoreTex suture instead of Prolene no more patients required reoperation for annuloplasty failure.     

Randomized placebo-controlled trial of long-term treatment with sibutramine in mild to moderate obesity.

OBJECTIVE: The researchers assessed the long-term weight reduction efficacy, tolerability, and safety of sibutramine used once daily in conjunction with behavior modification to treat mild to moderate obesity. STUDY DESIGN: This was a double-blind randomized placebo-controlled parallel-group comparative study of sibutramine 10 mg or 15 mg (or placebo) once daily for 1 year, given with dietary advice. POPULATION: A total of 485 obese men and women with uncomplicated obesity were included (mean age=42 years, mean body mass index=32.7 kg/m2). OUTCOMES MEASURED: The outcomes were mean weight loss, percentage losing more than 5% or 10% of their body weight, and adverse drug effects. RESULTS: Among patients completing the study, those taking sibutramine 10 mg or 15 mg had greater mean weight loss compared with placebo at 12-month assessment (P < or = .001). Changes in body weight from baseline to end point were -1.6 kg for those taking placebo, -4.4 kg for those taking sibutramine 10 mg (P < or =.01, last observation carried forward [LOCF]), and -6.4 kg for those taking sibutramine 15 mg (P < or =.001, LOCF). For placebo patients, 20% lost 5% or more of their body weight compared with 39% of patients taking sibutramine 10 mg and 57% taking sibutramine 15 mg. Only 7% of the patients taking placebo lost 10% or more of their body weight, compared with 19% taking sibutramine 10 mg and 34% taking sibutramine 15 mg (P <.001 for both 10 mg and 15 mg vs placebo, and for both > or =5% and > or =10%). CONCLUSIONS: Sibutramine 10 mg or 15 mg once daily given with dietary advice produces and maintains statistically and clinically significantly greater weight loss than dietary advice alone (placebo) throughout a 12-month treatment period, and is safe and well tolerated.     

Influence of sibutramine on energy expenditure in African American women

OBJECTIVE: African American women have a high prevalence of obesity, which partially may be explained by their lower rates of resting energy expenditure (REE). The aim of this study was to examine the influence of acute sibutramine administration on REE and post-exercise energy expenditure in African American women. RESEARCH METHODS AND PROCEDURES: A total of 15 premenopausal, African American women (age, 29 +/- 5 years; body fat, 38 +/- 7%) completed a randomized, double-blind cross-over design with a 30-mg ingestion of sibutramine or a placebo. Each trial was completed a month apart in the follicular phase and included a 30-minute measurement of REE 2.5 hours after sibutramine or placebo administration. This was followed by 40 minutes of cycling at approximately 70% of peak aerobic capacity and a subsequent 2-hour measurement of post-cycling energy expenditure. RESULTS: There was no difference (p > 0.05) in REE (23.70 +/- 2.81 vs. 23.69 +/- 2.95 kcal/30 min), exercise oxygen consumption (1.22 +/- 0.15 vs. 1.25 +/- 0.15 liter/min), and post-cycling energy expenditure (104.2 +/- 12.7 vs. 104.9 +/- 11.4 kcal/120 min) between the sibutramine and placebo trials, respectively. Cycling heart rate was significantly higher (p = 0.01) during the sibutramine (158 +/- 14 beats/min) vs. placebo (150 +/- 12 beats/min) trials. DISCUSSION: These data demonstrate that acute sibutramine ingestion does not increase REE or post-exercise energy expenditures but does increase exercising heart rate in overweight African American women. Sibutramine may, therefore, impact weight loss through energy intake and not energy expenditure mechanisms.     

Two years experience with the Pericarbon stentless valve in Hungary

OBJECTIVE: In 1999 stentless heart valves were introduced for treatment of the aortic valve disease in elderly patients at the Department of Cardiac Surgery of the University of Debrecen. PATIENTS, METHODS: Between December 1999 and November 2001 63 patients underwent aortic valve replacement with Sorin Pericarbon stentless valve. The mean gradient was 80 +/- 11 mmHg, the left ventricular wall thickness was 15.5 +/- 0.7 mm and the ejection fraction was 54 +/- 8% preoperatively. 4 patients were in NYHA II, 47 in NYHA III and 12 in NYHA IV functional class. 42 patients had isolated aortic valve replacement, the remaining 21 patients underwent combined surgical procedure. The aortic x-clamp and perfusion times were 125 +/- 27 and 153 +/- 48 minutes respectively. Nine 21 mm, twenty-three 23 mm, seventeen 25 mm, twelve 27 mm and two 29 mm valves were implanted. RESULTS: The hospital mortality was 6% (four patients). Transient atrial fibrillation was the most frequent postoperative complication. 77% of the patients had uneventful recovery and left hospital one week after surgery. Transthoracic echocardiography was performed at all patients before discharge and in December 2001. The mean follow up time was 9.7 +/- 5.8 months. 86% of the patients were in NYHA I functional class at the time of the follow up. The mean and peak transvalvular gradients were 9.4 +/- 4.1 mmHg and 16.1 +/- 6.8 mmHg respectively. The left ventricular wall thickness has decreased significantly (12.5 +/- 1.1 mm). CONCLUSION: The Sorin Pericarbon stentless valve is an easily implantable valve replacement device. Due to the excellent hemodynamic properties and the unnecessary anticoagulation it could be safely used in elderly patients.     

Six-month treatment of obesity with sibutramine 15 mg; a double-blind, placebo-controlled monocenter clinical trial in a Hispanic population

OBJECTIVE: To evaluate the safety and efficacy of sibutramine 15 mg by mouth once per day in obese patients over a period of 6 months. RESEARCH METHODS AND PROCEDURES: A monocenter, double-blind, placebo controlled, parallel, prospective clinical trial was carried out. Sixty-nine male and female obese patients (body mass index [BMI] > 30 kg/m2) aged 16 to 65 years entered the trial. RESULTS: 22 of 35 patients in the sibutramine group and 9 of 34 patients in the placebo group completed the trial. The high dropout rate in the sibutramine group was due to adverse events in 3 cases, lack of efficacy (as judged by patients) in 7, loss to follow-up in 2, and an orthopedic device being worn in 1; in the placebo group the dropouts were ascribed to lack of efficacy (as judged by patients) in 17 cases and to loss to follow-up in 8 cases. Using the method of last observation carried forward, the weight loss in the sibutramine group was 10.27 kg (95% confidence intervals [95% CI] 7.66; 13.07) and 1.26 kg (95% CI 0.3; 2.23) in the placebo group. The BMI loss was 4.17 kg/m2 (95% CI 3.11; 5.22) in the sibutramine group and 0.53 kg/m2 (95% CI 0.13; 0.92) in the placebo group. The waist circumference reduction was 12.51 cm (95% CI 9.25; 15.77) in the sibutramine group and 3.26 cm (95% CI 1.38; 5.14) in the control group (p<0.05 by paired Student's t test for all the intragroup comparisons). Twenty-three sibutramine patients had 34 adverse events, the most frequent adverse events in the sibutramine group were upper respiratory tract infections (n = 6) and constipation (n = 6); 16 placebo patients had 21 adverse events. Three sibutramine patients withdrew their informed consent when they had adverse events. DISCUSSION: The results show that sibutramine induces significant loss of body weight and waist circumference. Cardiovascular function was not significantly affected by sibutramine. Sibutramine was well tolerated by most of the patients.     

A protracted outbreak of Staphylococcus epidermidis infections among patients undergoing valve replacement.

OBJECTIVE: To investigate a Staphylococcus epidermidis outbreak among patients undergoing cardiac surgery. DESIGN: Retrospective cohort study. SETTING: A 260-bed community referral center. PATIENTS: Case-patients were patients with S. epidermidis mediastinitis, endocarditis, or both after valve implantation at Hospital de La Ribera from January to June 2002. The study population included patients undergoing valve surgery at Hospital de La Ribera from January 2000 to June 2002. RESULTS: From January to June 2002, 8 cases of mediastinitis, endocarditis, or both occurred among 53 patients undergoing cardiac surgery. In the same months of 2000, there had been no cases among 22 patients, and in 2001, only 1 case among 47 patients (P = .095 and P = .034, respectively). In 2002, there were 4 cases of mediastinitis and endocarditis, 3 cases of mediastinitis, and 1 case of endocarditis, all following aortic valve replacement. The epidemic curve suggested a protracted outbreak. Patients with chronic obstructive lung disease were six-fold more likely to be case-patients (95% confidence interval, 1.6-23.8). The mean duration of surgery tended to be longer in non-case-patients (161.4 +/- 57.9 minutes) than in case-patients (123.7 +/- 23.7 minutes) (P = .06). CONCLUSION: The cause of this protracted outbreak was likely multifactorial. Reemphasis of existing policies was associated with resolution of the outbreak.     

盐酸西布曲明治疗单纯性肥胖的对照研究

目的评价盐酸西布曲明治疗单纯性肥胖患者的有效性和安全性.方法采用多中心、随机、双盲、安慰剂平行对照的研究方法.选择年龄18～65岁,体质指数(BMI)27～40的单纯性肥胖患者.口服盐酸西布曲明10mg/d或安慰剂1粒/d,24周.观察体重变化及临床和常规实验室检查结果以评价药物的疗效和安全性.结果有效病例233例,其中对照组113例,治疗组120例.从第4周起盐酸西布曲明组体重降低值即大于安慰剂组,至24周盐酸西布曲明组平均体重降低值为(6.8±3.1)kg,安慰剂组为(0.48±2.6)kg.治疗组不良反应的发生率高于安慰剂组,但症状轻微,易于耐受.结论盐酸西布曲明10mg/d,治疗单纯性肥胖是有效和安全的.     

Practical value of echo Doppler evaluation of aortic and mitral stenosis: a comparative study with cardiac catheterization

This retrospective analysis compares data derived by echocardiography and cardiac catheterization in the evaluation of aortic and mitral valve stenosis. Sixty-seven patients, aged 69 +/- 12 years, underwent 76 catheterization procedures. In all studies the Doppler recording was technically adequate. In 64 studies of patients with aortic stenosis, correlation was good between the gradient obtained at catheterization (peak 51 +/- 28 mm Hg, mean 48 +/- 24 mm Hg) and the Doppler gradient (peak 73 +/- 29 mm Hg, mean 41 +/- 17 mm Hg) (R = 0.78 peak, 0.77 mean). In 15 studies the aortic valve area, 0.8 +/- 0.2 cm2, calculated by the simplified continuity equation, correlated well with the catheterization valve area, 0.7 +/- 0.3 cm2, calculated by the Gorlin equation (R = 0.80). In 14 studies in mitral stenosis patients, the mean gradient at catheterization was 11 +/- 5 mm Hg compared to the Doppler gradient of 8 +/- 4 mm Hg (R = 0.58). The mitral valve area was 1.1 +/- 0.3 cm2 by the Gorlin equation and 1.2 +/- 0.3 cm2 by echo Doppler, using pressure half-time. When cardiac rhythm, the presence and severity of regurgitation, and the cardiac index were analyzed, none was shown to have demonstrable influence on the accuracy of the Doppler study. Doppler echocardiography can be used reliably to assess valvular stenosis in a clinical, noninvasive laboratory where routine tests are performed and interpreted by more than one individual.     

Acamprosate and relapse prevention in the treatment of alcohol dependence: a placebo-controlled study

The objective of this study was to compare acamprosate with placebo in the treatment of alcohol-dependent patients during a 6-month post-detoxification treatment and a 3-month medication-free follow-up. Patients (n = 330) were detoxified and randomized to treatment with acamprosate (1998 mg/day) or placebo within an out-patient programme including medical counselling, psychotherapy and self-help groups. The main outcome criterion was drinking behaviour as assessed by: abstinence/relapse ratio, cumulative abstinence duration (CAD) and the period of continued abstinence. Anxiety, depression and craving were also monitored. Intention to treat (ITT) statistical principles were followed. Twenty-five per cent of patients dropped out over the first 6 months. At the end of the treatment period, the abstinence rate was 57.9% for acamprosate and 45.2% for placebo (P = 0.03). The CAD was 110+/-77 days for acamprosate and 89+/-77 days for placebo (P = 0.016). Patients on acamprosate had a higher continuous abstinence rate and experienced less severe relapses. No differential effect was noted for anxiety, depression or craving. Treatment remained positive, but not significant, 3 months after termination of study medication. No significant difference in adverse events was noted between treatment groups. Acamprosate treatment over 180 days was consistently more effective than placebo to maintain abstinence and to diminish relapse severity.     

Effects of sibutramine plus orlistat in obese women following 1 year of treatment by sibutramine alone: a placebo-controlled trial

OBJECTIVE: This study assessed whether adding orlistat to sibutramine would induce further weight loss in patients who previously had lost weight while taking sibutramine alone. RESEARCH METHODS AND PROCEDURES: Patients were 34 women with a mean age of 44.1 +/- 10.4 years, weight of 89.4 +/- 13.8 kg, and body mass index (BMI) of 33.9 +/- 4.9 kg/m2 who had lost an average of 11.6 +/- 9.2% of initial weight during the prior 1 year of treatment by sibutramine combined with lifestyle modification. Patients were randomly assigned, in double-blind fashion, to sibutramine plus orlistat or sibutramine plus placebo. In addition to medication, participants were provided five brief lifestyle modification visits during the 16-week continuation trial. RESULTS: Mean body weight did not change significantly in either treatment condition during the 16 weeks. The addition of orlistat to sibutramine did not induce further weight loss as compared with treatment by sibutramine alone (mean changes = +0.1 +/- 4.1 kg vs. +0.5 +/- 2.1 kg, respectively). DISCUSSION: These results must be interpreted with caution because of the study's small sample size. The findings, however, suggest that the combination of sibutramine and orlistat is unlikely to have additive effects that will yield mean losses > or =15% of initial weight, as desired by many obese individuals.     

Effects of sibutramine on binge eating,hunger, and fullness in a laboratory human feeding paradigm

OBJECTIVE: The purpose of this study was to evaluate the effects of sibutramine vs. placebo on binge-eating behavior, hunger, and satiety in patients who had problems with binge eating. RESEARCH METHODS AND PROCEDURES: Seven adult subjects who had problems with binge eating (mean age, 42 years) were randomly assigned to receive alternating sibutramine and placebo in a double-blind placebo-controlled crossover study. This involved two 4-week dosing periods separated by a 2-week washout. RESULTS: Subjects lost weight on sibutramine but not on placebo. There was a significant difference in the number of kilocalories consumed between the sibutramine and placebo conditions, with a significant reduction of intake during binge-eating episodes on sibutramine. DISCUSSION: Sibutramine suppresses intake during binge-eating episodes. This effect is demonstrable in a human feeding laboratory paradigm.     

Magnesium for the treatment of nocturnal leg cramps: a crossover randomized trial

BACKGROUND: Nocturnal leg cramps are a common health problem in the ambulatory setting. Our objective was to evaluate the efficacy of magnesium in the treatment of nocturnal leg cramps. METHODS: Our study was a crossover randomized double-blind placebo-controlled trial. We included patients from a large university-based ambulatory clinic in Buenos Aires, Argentina, with at least 6 cramps during the previous month. A total of 93 subjects took part in a 4-week washout period with placebo. Those who were still eligible (n = 45) were randomized to receive either (1) an oral dose of 900 mg magnesium citrate twice daily for 1 month, followed by a matching placebo for 1 month, or (2) the placebo first, followed by magnesium. Both groups had a 4-week washout period with placebo between each treatment month. Forty-two patients completed the 4-month study. The main outcome was the number of nocturnal leg cramps, and the secondary outcomes were duration, severity, and sleep disorders caused by those cramps. RESULTS: There were no significant differences between magnesium and placebo in any of the evaluated outcomes. The mean number of cramps was 11.1 (standard deviation [SD] +/- 7.3) for placebo versus 11.8 (SD +/- 7.6) for magnesium (P = .59). We observed a significant period-effect bias: All patients improved over time regardless of the treatment sequence they received. CONCLUSIONS: Magnesium was not effective for the treatment of nocturnal leg cramps. The period-effect bias probably occurred because of a combination of the natural history of this condition, a regression to the mean, and a true placebo effect.     

经导管主动脉瓣置换术对主动脉瓣狭窄患者肺动脉压力及左心收缩功能的影响

目的研究经导管主动脉瓣置换术对主动脉瓣狭窄患者肺动脉压力及左心收缩功能的影响。方法选取2017年6月至2018年6月我院收治的76例主动脉瓣狭窄患者,均行经导管主动脉瓣置换术治疗,记录患者手术相关情况,对比分析患者手术前后肺动脉压力及左心收缩功能情况。结果手术即刻成功率为100%,所有患者均未发生严重并发症及心脏不良事件。与术前比较,术后1周患者的肺动脉压力及左心收缩功能均明显改善(P<0.05)。结论经导管主动脉瓣置换术对主动脉瓣狭窄患者肺动脉压力及左心收缩功能具有积极影响,利于其预后改善。     

Congenital aortic valve stenosis with left ventricular dysfunction: effect of percutaneous valvuloplasty

Two girls aged 6 and 15 years with severe congenital valvular aortic stenosis and left ventricular (LV) dysfunction underwent successful balloon aortic valvotomy (BAV). Both patients had severe symptoms at the time of initial evaluation. The electrocardiograms showed LV hypertrophy and cardiac enlargement (cardiothoracic ratio 0.7 and 0.65) was evident in the chest roentgenograms. Immediately after BAV, the aortic valve peak-to-peak gradients decreased from 60 to 8 mmHg and 120 to 30 mmHg respectively, the LV end-diastolic pressures decreased from 47 to 13 mmHg and 40 to 15 mmHg, the LV ejection fractions improved from 40 to 65% in the second girl. On follow-up (30 and 36 ms respectively), both patients were asymptomatic with normalization of LV function and without a change in the residual gradient a cross the aortic valve.     

Sibutramine treatment in obesity: predictors of weight loss including rorschach personality data

OBJECTIVE: To study personality and clinical factors in weight loss by sibutramine (Meridia and Reductil), an anti-obesity drug enhancing satiety. RESEARCH METHODS AND PROCEDURES: The subjects were 30 obese patients [43 +/- 12 years (mean +/- SD), BMI 40 +/- 4 kg/m(2)]. The treatment comprised 15 mg of sibutramine administered daily and monthly dietary advice. Weight loss after 6 months of treatment was evaluated. For psychological assessment, the Rorschach method (Comprehensive System) and the Beck Depression Inventory were used. RESULTS: A multiple linear regression model including the Rorschach predictors' physical demand states (animal movement, designated as FM) being intrusive or difficult to hold and a dependency orientation (food contents) could explain 47% of 6 months of weight loss. A model including initial weight loss in addition to the Rorschach predictors explained 58% of the 6-month weight loss. DISCUSSION: The personality factors predicted greater weight loss. In particular, patients with difficulties concerning physical demand states, which would include hunger, could have reduced their eating behavior with enhanced satiety, resulting in greater weight loss. Enhanced satiety could also have helped patients with a dependent need for food to limit food intake. Being enrolled in a treatment program could also have provided essential support for patients with dependency needs. Furthermore, initial weight loss was a predictor of greater weight loss in sibutramine treatment, in accordance with prior research.     

Serial echocardiographic and clinical evaluation of valvular regurgitation before, during, and after treatment with fenfluramine or dexfenfluramine and mazindol or phentermine.

OBJECTIVE: The prevalence of cardiac valvular regurgitation demonstrated by echocardiography in patients who took appetite-suppressant medication for weight loss has been assessed at 5%-30%. We studied 86 patients who had echocardiograms before treatment with appetite suppressants to determine the incidence of new cases and to evaluate the clinical implication of the echocardiographic findings. RESEARCH METHODS AND PROCEDURES: We studied 69 men [Mean+/-Standard Deviation (S) age 49+/-8] and 17 women (mean+/-S age 50+/-7) who had 233 echocardiograms before, during, and after a weight-loss program that used predominantly fenfluramine (or dexfenfluramine) with mazindol (or phentermine). Mean drug exposure was 17 months. Blinded echocardiographic readings were performed to identify and grade aortic regurgitation (AR) or mitral regurgitation (MR). RESULTS: Seven of 86 patients (8%) had pre-existing regurgitation with five (6%) meeting our case definition. Thirteen (16.5%) of initially normal patients developed valvular regurgitation and were new cases. Of the new cases, 12 were grade I/IV AR and one was both grade II/III MR and II/IV AR. All 13 patients were asymptomatic, and only two aortic insufficiency murmurs could be auscultated. There was significantly greater risk for developing valvulopathy for those who took medications longer than 6 months (p = 0.03), and no new cases were observed in patients exposed for less than 8 months. No increased risk associated with age, presence of hypertension, or exposure to fenfluramine-phentermine combination was demonstrated. Although there was a higher incidence of new regurgitation in women (31% vs. 13% for men), this was not statistically significant (p = 0.093). DISCUSSION: Some patients who had normal echocardiograms at baseline developed cardiac valvular regurgitation after exposure to fenfluramine or dexfenfluramine with mazindol or phentermine. The development of valvulopathy was significantly correlated with duration of exposure. The clinical implications of echocardiographically demonstrated regurgitation are uncertain, since there were only two audible murmurs and no other clinically relevant signs or symptoms among the patients.     

关于心脏瓣膜置换术后再次瓣膜手术的探讨

目的 分析心脏瓣膜置换术后再次瓣膜手术的原因,探讨手术时机的选择、手术方法及对结果的影响因素.方法 对2008年10月至2010年2月心脏瓣膜置换术后再次瓣膜手术的13例患者进行回顾性分析,术前NYHA心功能Ⅲ级4例,Ⅳ级9例.单纯二尖瓣置换术7例,单纯主动脉瓣置换术3例,二尖瓣并主动脉瓣置换术3例.结果 术后早期死亡1例,病死率7.7%(1/13),死亡原因为术后低心排血量综合征.术后因出血二次开胸止血和再次气管插管各1例,经抢救治疗后均好转,12例患者均于3～6周出院.随访6～15个月,无死亡病例发生,所有患者心功能恢复良好.结论 合理选择手术时机,术中尽早建立体外循环,加强心肌保护,术中、术后防止出血是提高心脏瓣膜置换术后再次瓣膜手术疗效的关键.

Abstract：

Objective To summarize the results of valve re-operative cases after cardiac valve replacement, to find the better re-operative time, and to estimate the re-operative methods and influencing factors of the operation. Methods Thirteen valve re-operative cases after cardiac valve replacement from October 2008 to February 2010 were retrospectively studied. According to NYHA classification, 9 cases belonged to class Ⅳ, and only 4 cases belonged to class Ⅲ preoperatively. Mitral valve replacement (MVR)was performed in 7 cases, aortic valve replacement (AVR) in 3 cases, MVR + AVR in 3 cases. Results The early-stage postoperative mortality was 7.7%( 1/13),and the reason was low cardiac output syndrome. Two cases who underwent re-operation and re-intubation respectively after operation for hemorrhage were improved after treatment. Twelve cases were discharged in 3-6 weeks after heart valve surgery and all were followed up for 6-15 months. The cardiac function of all the discharged patients recovered well and no death occurred during follow-up. Conclusion The key factors to reduce the death of re-operation are improving preoperative heart function,setting up extracorporeal circulation as soon as possible,consummating myocardial preservation,perfecting operating skills,correcting low cardiac output syndrome in time and preventing complications.     

术中经食管超声心动图对心脏瓣膜置换术后即刻评估的价值研究

目的:研究术中经食管超声心动图对心脏瓣膜置换术(HVR)后即刻评估的价值。方法:选取168例行心脏瓣膜置换术患者,均在术中行经食管超声心电图检查,记录主动脉瓣环内径及钙化斑块情况,计算主动脉瓣内直径;观察并记录心脏收缩功能情况,血管内血栓、钙化及钙化斑块大小情况;术后观察人工瓣膜是否成功,重点分析心脏收缩、血容量及瓣膜闭合等情况。比较所有患者手术前后的瓣膜及心功能情况,分析术中经食管超声心动图对HVR术后即刻评估的价值。结果:经食管超声心动图三维检查检测的主动脉瓣环内径及钙化检出情况与手术病理结果相比,差异无统计学意义。在术中行经食管超声心动图发现,2例患者存在生物瓣瓣叶脱垂及缝线勒住生物瓣瓣脚情况,为在机体应力状态下人工瓣膜对合不良影响瓣叶功能,遂均更换相同型号瓣膜,更换后瓣环内反流消失。168例患者术后主动脉平均跨膜压差明显低于术前水平,左室射血分数及有效瓣口面积指数水平明显高于术前,差异有统计学意义(t=20.352,t=32.784,t=22.583;P<0.001)。所有患者均完成HVR,其中6例患者(生物瓣瓣叶脱垂1例、缝线勒住生物瓣瓣脚1例、拆除后离体检测碟片运动无异常的主动脉瓣机械瓣关闭不全1例、机械瓣碟片启闭不灵活且经调整碟片方向仍无改善的二尖瓣3例)更换新的人工瓣膜。所有患者术后恢复顺利,未发生院内死亡。结论:经食管超声心动图应用于HVR术中的临床价值较高,可及时确定人工瓣膜功能异常,协助判断内源性因素并给予及时补救,有助于为提高手术有效保障,对临床治疗效果进行真实性评估,有效提高HVR成功率。     

Combined dietary and pharmacological weight management in obese hypopituitary patients

OBJECTIVE: The high prevalence of obesity and cardiovascular risk factors in hypopituitarism affirms the need for effective weight loss intervention. In this study, we investigated the combined effect of sibutramine, diet, and exercise in obese hypopituitary patients (HPs). RESEARCH METHODS AND PROCEDURES: In an open-label prospective intervention trial, 14 obese well-substituted nondiabetic HPs and 14 matched simple obese controls were allocated to 11-month treatment with sibutramine (10 to 15 mg), diet (600 kcal/d deficit), and exercise. Anthropometric indices and body composition (obtained from DXA scan) were assessed monthly for the first 5 months and thereafter every second month for the next 6 months. RESULTS: Mean (+/-SD) weight loss at 11 months was 11.3 +/- 4.8 kg in patients vs. 10.7 +/- 4.7 kg in controls. The HPs exhibited the same improvements in body composition, waist circumference, blood lipids, and fasting glucose as the simple obese. In a multivariate model, baseline weight, duration of growth hormone replacement therapy, and duration of pituitary disease explained 79% (p = 0.001) of the variation in weight loss at 4 months in the HPs. Only baseline weight and waist circumference could predict weight loss at 11 months. DISCUSSION: HPs are not resistant to weight loss therapy. Almost all will achieve at least 5% weight loss, and 60% can lose >10% weight within 11 months. However, the long-term effect on risk factors associated with type 2 diabetes and cardiovascular disease as well as on mortality needs to be established.     

食管超声心动图对主动脉瓣畸形的术前诊断及临床意义

目的探讨经食管超声心动图(TEE)在主动脉瓣畸形手术前应用的价值。方法对37例经TEE诊断并手术治疗的主动脉瓣畸形患者进行分析,总结出主动脉瓣畸形的特点、心内结构改变的规律及超声结果在手术方案选择中的参考价值。结果二叶瓣畸形24例、三叶瓣畸形10例、四叶瓣畸形3例,各种瓣膜畸形在瓣膜数目、交界数目及位置、瓣膜开放及关闭形状方面均有特点并均伴有不同程度的狭窄、关闭不全或二者并存;心内结构改变有升主动脉扩张、左室增大、左室肥厚;瓣膜畸形类型及钙化程度、心内结构及功能改变情况是选择手术方法时的重要参考信息。结论TEE是主动脉瓣畸形的可靠诊断方法,瓣膜矫治术前应用TEE可为临床提供有价值的参考信息,有助于手术方法的正确选择。