房间隔穿刺定位法

介绍用右房造影定位和左房高定位两种房间隔穿刺定位法,各行二尖瓣狭窄球囊扩张术(BPMV)15例,结果是:前法全部成功;后法成功14例,失败1例。术中各具利弊。同时找到一种右房高定位法,比前二法定点更为简易、实用。此外提示,掌握芷确的进针方向对穿刺的成败极为重要。     

房间隔穿刺点食管左心房压迹定位法--房间隔穿刺定位的新方法

目的探索房间隔穿刺点定位的新方法.方法84例风湿性心脏病(风心病)二尖瓣狭窄患者,按入院先后顺序单纯随机分成研究组和对照组各42例,两组年龄、心脏大小等无显著差异,有可比性.研究组42例采用食管左心房压迹定位法,对照组42例采用Ross改良定位法,房间隔穿刺成功后均行直接左心房造影.结果研究组食管左心房压迹清楚,房间隔穿刺点容易确定,行房间隔穿刺成功率100%.对照组15例左心房轮廓不清,按定位点行房间隔穿刺成功率仅64.29%(27/42).两组有非常显著性差异(x2=18.26,P＜0.001).15例改行食管左心房压迹定位后,均穿刺成功.直接左心房造影显示,左心房大小与食管左心房压迹长度相关性好,成功房间隔穿刺点均在左心房影中下1/3水平线与脊柱中右1/3垂线之交点上.结论食管左心房压迹定房间隔穿刺点,方法准确安全,简单易行.     

下腔静脉造影——一种定位房间隔穿刺相关结构的有效方法

目的描述一种用于定位房间隔穿刺关键解剖结构的简单可靠方法。方法在2012年3~11月心房颤动(简称房颤)消融术中,连续3次穿间隔失败的23例患者中应用下腔静脉(IVC)造影指导房间隔穿刺术(TP)。在右前斜45°透视下,将造影管远端置于IVC口下1 cm处注射5~10 ml造影剂。IVC、右房(RA)、右室流入道(RVIT)和右室流出道(RVOT)依次显影。RA,RVIT和RVOT之间围绕的无造影剂充盈的区域是主动脉根部及相邻组织。冠状窦(CS)电极经股静脉置入,其转弯处标志CS口上缘。右前斜45°投照下,合适的房间隔穿刺点(TPS)应在RA的中间、无冠窦的后下方、CS口的后上方。结果 23例均成功完成IVC造影指导下的房间隔穿刺(20例1次穿刺成功,3例2次成功),并达到房颤消融的所有终点。91%(21/23)的患者所有结构清楚显示,能清楚看到所有患者RA下缘、后缘和无冠窦,在2例中RA上缘不能清楚显示。由IVC造影提示的最佳TPS在22例患者中是合适的。在IVC造影图像中,沿无冠窦后缘最头侧与CS口上缘之间连线的中点画一水平线(AE),AE线平分为4段。在87%(20/23)的患者,最佳TPS是在AE线上的左半段。结论 IVC造影能提供关于TPS定位及其周围解剖结构的重要信息,IVC造影确定的TP很适合应用于房颤导管消融术。     

房间隔穿刺28例分析

28例风湿性二尖瓣狡窄患者PBMV中行房间隔穿刺,右房造影法定位1例,左房高与右房高定位法结合定位27例,进针角度平均40～60°。27例成功,1例发生心包填塞,3例发生阵发性房颤。同时我们认为,有动脉栓塞史患者并非是房间隔穿刺顺血流左心导管术的绝对禁忌证,但术前应充分抗凝。     

改进的三维心腔内超声指引下零射线房间隔定位穿刺法

目的 评估改进的三维心腔内超声(IC E)指引下无射线房间隔定位穿刺法的安全性和有效性.方法 在IC E指引下在卵圆窝上预设穿刺部位并于上腔静脉根部间隔面设定穿刺针鞘起点,观察两点距离以及角度关系,房间隔穿刺针鞘从此起点按上述角度下拉至卵圆窝,IC E直视下穿刺.观察此改进后IC E指引房间隔方法的成功率、卵圆窝上通过...     

应用改制的房间隔穿刺管消融右侧游离壁旁道

应用改制的房间隔穿刺管消融右侧游离壁旁道张浩（新疆乌苏县解放军第十五中心医院心肾科乌苏８３３０００）许力舒杨敏全李国庆（新疆自治区人民医院心脏起搏介入中心）目前射频消融右侧游离壁旁道尚有一定难度，主要是因为普通大头导管与心脏组织接触不紧及固定不牢。为...     

房间隔穿刺法对儿童及青少年患者左侧房室旁路的导管射频消融

众多的研究已显示了导管射频消融是室上性心动过速的根治性方法。对左侧房室旁路而言,大多数医师熟悉并习贯采用主动脉逆行法,在二尖瓣环的心室侧进行标测和消融,尽管这一方法有许多优点,但操作过程中需反复跨越主动脉瓣,有造成主动脉瓣损伤的可能。我们对儿童及青少...     

一种特殊的房间隔穿刺方法

房间隔穿刺是目前心房颤动射频导管消融（下称消融）的必要步骤。大多情况下，只要正确掌握操作要领，训练有素的术者成功穿刺房间隔是不难的。但是有些情况下，例如患者已经接受过一次或多次房间隔穿刺术，房间隔卵圆窝疤痕形成，即使经验丰富的术者怎样调整穿刺点位置、重塑穿刺针头端的角度和增加穿刺力量，房间隔穿刺最终也难以成功。随着心房颤动消融的广泛开展，因房间隔穿刺失败而不能手术的病例并不少见。     

房间隔穿刺行射频消融及二尖瓣球囊扩张对房间隔完整性的影响

对房间隔穿例行射频消融（ＲＦ）的３９例预激综合征及二尖瓣球囊扩张（ＰＢＭＶ）的６５例风湿性心脏病二尖瓣狭窄（风心二狭）患者分别于治疗前、后进行经胸和经食管超声心动图检查，以观察上述方法对房间隔完整性的影响。结果：预激综合征患者术后未发现有房间隔缺损；风心二狭患者术后检出房间隔缺损（房缺）１２例，发生率为１８．５％，缺口的直径为２．６～５．１ｍｍ。认为：①房间隔穿刺行ＲＦ对房间隔的完整性无影响，安全可靠；②ＰＢＭＶ可导致一定比例的房缺，但缺口直径小，分流量少，不引起明显的血流动力学改变。     

冠状动脉导丝辅助房间隔穿刺与常规穿刺技术的随机对照研究

目的：冠状动脉导丝辅助房间隔穿刺（transseptal puncture, TSP）与常规穿刺技术的安全有效的研究。方法：共入选TSP患者240例（其中228例心房颤动，12例左侧旁道），进行描述分析。将患者分为导丝组（Wire-TSP,n=120）,TSP使用SWARZ鞘和Brockenbrough房间隔穿刺针，并且穿刺针内芯插入0.36mm冠状动脉导丝，穿刺针一旦穿过房间隔后可将冠状动脉导丝软端推入左心房（left atrium, LA），并送入左上肺静脉（left superior pulmonary vein,LSPV），证实针尖已进入LA。然后将扩张鞘和外鞘淹没针尖进入LA，将穿刺针和冠状动脉导丝交换为0.81mm的导丝，导丝送入LSPV。扩张鞘和外鞘通过0.81mm的导丝进入左心房。常规方法组（Con-TSP,n=120），使用标准TSP方法通过TSP在左心房注射造影剂确认针尖位置。结果：两组患者LAD无明显差异，均能够成功进行TSP建立了LA通道，且没有出现严重并发症。导丝组房间隔一次性穿刺成功率显著高于造影剂组（82.1%vs. 75%,P<0.001）,Wir...     

Congenital Right Pulmonary Artery Agenesis with Atrial Septal Defect and Pulmonary Hypertension

Unilateral pulmonary artery agenesis is a rare congenital anomaly caused by a backward displacement of the conical artery of the truncus arteriosus. It is commonly associated with additional cardiovascular abnormalities. A 7‐year‐old girl was admitted to our clinic with the complaint of shortness of breath upon exertion. Chest radiography revealed a hypoplastic right lung. Absence of the right pulmonary artery with atrial septal defect and pulmonary hypertension was demonstrated by echocardiography, computed tomography, and cardiac catheterization. Bosentan is effectively used to treat pulmonary arterial hypertension.     

Cardiac Troponin Levels after Percutaneous Atrial Septal Defect Closure: A Qualitative Systematic Review and Meta-Analysis

Introduction: We conducted a systematic review and meta-analysis of published studies to determine the prevalence of troponin elevation after percutaneous atrial septal defect closure (pASDc) as well as to describe the association between troponin elevation and different anatomical risk factors for erosion. Methods: A qualitative systematic review and meta-analysis was undertaken. The selected studies included patients of any age receiving a pASDc; performed under transesophageal echocardiography monitoring; reporting troponin level measurement after the intervention; and indicating prevalence of troponin elevation and/or the association with risk factors for erosion. Results: Six studies were found which included 391 patients in total. The age of the patients ranged from 1 to 80 years and were mainly female (between 59 and 81%). The success rate of pASDc varied from 92–100%. The prevalence of myocardial injury varied between 16% and 100%. In the meta-analysis cohort including 347 patients with available data, the fixed effect model showed a prevalence of 41.8% CI (95%) 36.6% to 47.2%. Five studies found a relationship between the size of the implanted device and the presence of myocardial injury. The size of the defect, multiple defects within the interatrial septum, deficient posterior rim, lack of use of sizing balloon and longest duration of the procedure were also related to myocardial injury. Conclusion: The usefulness of troponin levels measurements after pASDc has been insufficiently studied. The routinely use in a standardized protocol would be useful to determine which patients need a closer follow-up.     

Transseptal Puncture for Transcatheter Closure of an Eccentric Atrial Septal Defect

The feasibility of transcatheter closure of atrial septal defects depends mainly on their morphology. A case is presented illustrating successful closure of a defect with inadequate anterior rim using transseptal puncture of the abundant residual septum. The Atrial Septal Defect Occlusion System (ASDOS) umbrellas could be placed at the center of the septum occluding the defect completely.     

Echocardiographic Hypertrabeculated/Non-compacted Right Ventricle Accompanied by Atrial Septal Defect and Anomalous Pulmonary Vein Connection

Myocardial noncompaction (NC) is a disorder of the embryonic endomyocardial morphogenesis frequently associated with congenital cardiac abnormalities. NC predominantly affects the left ventricle (LV). Right ventricle (RV) NC may occur in association with LV involvement or in isolation. A 47-year-old woman was admitted for atrial septal defect closure. Transthoracic echocardiography revealed hypertrabeculation of the RV apex, consisting of multiple deep recesses with the entrance of blood flow in color Doppler imaging, suggestive of isolated RV hypertrabeculation/NC. The RV and right atrium (RA) were enlarged, and systolic pulmonary arterial pressure was slightly increased. Our patient''s associated abnormalities were atrial septal defect (superior sinus venosus type), anomalous connection of the right upper pulmonary vein to the junction of the superior vena cava and the RA, and large patent foramen ovale. Association between atrial septal defect and partial anomalous pulmonary vein connection and isolated hypertrabeculated/noncompacted RV should be considered by cardiologists.     

Isolated Ruptured Inter‐Atrial Septal Cystic Echinococcosis during Pregnancy

Herein, we present a case of asymptomatic isolated cardiac cystic echinococcosis localized entirely to the inter‐atrial septum in a pregnant woman. The patient underwent successful surgery. Cardiac cystic echinococcosis is rarely seen in pregnancy. A high index of suspicion is necessary for the diagnosis of a cardiac cyst hydatid. The treatment of cardiac cyst hydatid is surgical and should not be delayed during pregnancy. Early surgery might prevent septic embolization and cardiac life‐threatening complications and save the lives of both mother and baby as in the present case.