射频消融术治疗主动脉无冠窦房性心动过速方法学特点

目的:探讨射频消融术治疗无冠窦房性心动过速(房速)的方法学特点.方法:分析14例无冠窦房速患者发作时体表心电图P波特点,展示发作时无冠窦、左房前间隔和希氏束最早激动的时间差异,5例患者采用三维(EnSite 3000 NavX)建模标测.结果:房速发作时P波时限(83±4)ms明显短于窦性心律时P波时限(106±9)ms,P＜0.05;右房最早激动点位于希氏束或其附近;无冠窦内最早心房激动较希氏束提前(10.8±7.2)ms,先于体表心电图P波提前(20.8±7.2)ms,5例患者通过房间隔穿刺术在左房前间隔测及的最早激动点较右房晚(4±2)ms.12例患者均在无冠窦内消融成功,2例患者在无冠窦内和希氏束后上方与无冠窦相对应处同时消融成功.随访4～30个月均无复发.结论:射频消融术是根治无冠窦房速的有效方法,对于房速消融不成功者,可选择在无冠窦内和希氏束后上方与无冠窦相对应处同时消融.     

主动脉无冠窦内射频消融前间隔房室旁路

目的 报道经主动脉无冠窦内射频消融前间隔房室旁路.方法 7例患者,男性4例,女性3例,平均年龄（38.4±14.7）岁.电生理检查证实存在房室旁路,并检查其前传逆传功能和诱发旁路参与的房室折返性心动过速.在心动过速时标测最早心房逆传激动点作为消融靶点.结果 7例心动过速时最早心房激动部位均位于前间隔区域,但经右心房途径反复消融均不能成功阻断旁路,而在无冠窦内可标测到最早逆传心房激动点并消融成功,无并发症出现.结论 主动脉无冠窦内消融可作为治疗前间隔房室旁路的一种新途径,特别适用于右心房前间隔区域消融失败的病例.     

经主动脉无冠窦内射频消融局灶性房性心动过速

目的探讨起源于主动脉无冠窦或其邻近组织的局灶性房性心动过速(简称房速)心脏电生理特点及经射频导管消融方法。方法 13例患者男3例,女10例,年龄52.7±9.8岁,阵发性房速病史4.2±4.5年。心房刺激诱发房速后,分析体表心电图P′波特点并于右房及主动脉无冠窦内进行激动标测。均于无冠窦内进行射频消融治疗。结果 13例心房刺激均能反复诱发或终止房速,平均周长340.9±46.0ms,房速时P′波时限77.8±14.4ms,明显短于窦性心律时P波时限111.2±10.3ms(P0.05)。常规激动标测,所有患者于His束处标测到相对提前的心房激动。经主动脉逆行方法 ,所有患者于无冠窦内标测到心房激动较His束处的心房激动提前9.3±6.1ms,放电1～2次于2～8s内终止房速。随访3～36个月,无复发病例及手术相关合并症。结论起源于主动脉无冠窦或其邻近组织的房速具有窄P′波及常规标测相对提前的心房激动位于His束处的特点。经主动脉无冠窦内标测消融是一种根治此类房速安全有效的方法 。     

无冠窦射频消融房速1例

患者女,63岁。因"阵发性心悸5年,加重10天"入院。患者5年前无明显诱因开始出现心悸,心率160bpm,伴有胸闷、气短,平均每月发作2次,每次持续2h左右,曾就诊于当地医院,给予维拉帕米治疗后好转。10天前,患者无明显诱因再次出现心悸,心率最快达180bpm,持续时间达6h,应用维拉帕米疗效不明显。发作频繁,平均每2天发作1次,每次持续     

无冠窦起源房速的电生理特征与射频消融

目的进一步分析起源于主动脉无冠窦房性心律失常的心电生理特征及射频消融治疗。方法11例患者经心内电生理检查和射频消融证实的起源于主动脉无冠窦局灶性房速,对其临床特征,心电生理特点及射频消融进行分析。结果无冠窦房速大多为女性,表现为阵发性,为心房或心室程序刺激诱发和终止。所有患者房速心电图P波窄而低幅,Ⅱ,Ⅲ,aVF和v,导联P波负正双向,Ⅰ,aVL导联直立,V2～V6导联P波负向。心内最早激动位于希氏束远端,并领先于体表P波起始（15±3）ms。无冠窦内标测最早激动等于或早于希氏束远端,局部电位特征为大A小V（或大V）,无希氏束电位,11例患者无冠窦内放电均在8秒内终止心动过速,均无并发症,无抗心律失常药物随访12±5月所有患者均无心动过速复发。结论主动脉无冠窦房速有独特的临床特征,心电图特征及心房内激动顺序,长期随访这类房速射频消融有良好的治疗效果。     

三维电解剖标测指导射频导管消融治疗起源于主动脉无冠窦房性心动过速

目的探讨起源于主动脉无冠窦房性心动过速（房速）的电生理特征及三维激动标测指导射频导管消融治疗无冠窦房速的安全性和有效性。方法43例局灶性房速经普通电生理检查及三维电解剖激动标测明确起源于无冠窦者7例。结果7例患者均于心动过速发作时消融10s内心动过速终止。所有患者于消融即刻心动过速终止或出现心动过速加速。在（20±6）个月的随访中心动过速未复发。结论三维激动标测指导射频导管消融治疗起源于主动脉无冠窦房速是安全有效的。     

主动脉无冠窦内和二尖瓣环-主动脉连接处射频导管消融局灶性房性心动过速

目的报道13例主动脉无冠窦内和1例二尖瓣环一主动脉连接（MAAJ）处成功消融局灶性房性心动过速（房速）,探讨该类房速的电生理特点及标测和消融方法。方法14例患者,男性3例女性11例,平均年龄（54．4±10．4）岁,均有阵发性房速病史。心房刺激诱发房速后,分析体表心电图P’波特点并于右心房进行激动标测,如果最早心房激动邻近希氏束附近,少数患者在此处消融,其他患者和上述消融不成功患者,经主动脉逆行途径,在无冠窦内标测和消融。如果消融不能成功,则经房间隔穿刺途径至左心房标测最早激动部位处消融。结果房速发作时体表心电图P’波明显变窄（77．8±14．4）ms。右心房激动标测均在希氏束附近标测到相对提前的心房激动,3例于此处消融失败。14例经主动脉逆行途径于无冠窦内标测到最早心房激动提前希氏柬处心房激动0～20．0（10．1±6．3）ms,13例于无冠窦内消融成功,包括1例改用盐水灌注导管后消融成功。1例经无冠窦消融失败后,经穿刺房间隔于MAAJ处标测到最早心房激动处消融成功。随访3～38个月,均无复发。结论对于具有窄P’波及标测右心房最早激动位于希氏束附近的局灶性房速,经主动脉逆行途径在无冠窦内标测和消融具有很高的成功率,经穿刺房间隔在左侧MAAJ处消融或应用盐水灌注导管无冠窦内消融可能进一步提高消融成功率。     

无冠窦起源的室性心律失常消融一例

患者男性,12岁,因频发室性早博、短阵室性心动过速入院行射频消融术,体表心电图提示为右侧His束旁起源室性早博、室性心动过速.右侧His束区域最早激动点提前QRS波约45 ms,单极图呈"QS"型,窦性心律下可记录到His电位,低功率消融出现交界性反应且消融无效.于左室流出道标测显示无冠窦激动最早,局部可记录到尖峰双电...     

经导管封堵无冠窦瘤破裂至右心房一例

1一般资料 主要病史:患者,男,31岁.1个月前从事家务劳动时突感胸闷,稍作活动时即感呼吸困难,无意识丧失及一过性黑朦.查体:心率104次/分,律齐,血压120/50 mmHg(1 mmHg=0.133 kPa),心前区无隆起,可触及震颤,叩诊心浊音界不大.三尖瓣及主动脉听诊区可闻及5/6级双期杂音.超声心动图:主动脉无冠窦轻度扩张,直径约43 mm,可见破口位于三尖瓣根部右心房侧,大小为7 mm.X线胸片:两肺血多,主动脉不宽,肺动脉段轻度凸出,右心房室大.     

主动脉右冠窦瘤破入右心房介入治疗二例

病例1：患者女性,41岁,因＂发现心脏杂音6年余,阵发性心悸4年余＂入院。心悸发作时心电图提示室上性心动过速。入院后查体：血压120/80mmHg。心尖搏动位于第五肋间左锁骨中线内1cm,心率80次/分,心律齐,胸骨左缘3、4肋间可闻及连续性杂音,未向颈部、腋下传导。     

急性血吸虫病合并流行性出血热1例

本文报道了1例急性血吸虫病合并流行性出血热患者的诊断与治疗。     

Splenic rupture in dengue hemorrhagic fever: report of a case and review

Dengue is currently the most important arboviral disease in the world, particularly in tropical countries in which the environmental conditions favor the development and proliferation of the mosquito vector. Dengue hemorrhagic fever presents in two phases: an initial phase, which is characterized by sudden onset of fever and a variety of nonspecific signs and symptoms, and a critical phase, which is characterized by the recovery from fever and development of hemorrhagic symptoms and circulatory insufficiency. This report documents a case of splenic rupture in a patient with dengue hemorrhagic fever who developed hypovolemic shock and subsequently died. Although splenic rupture is a known complication of other acute infections, it is a rare complication of dengue; therefore, it may be misdiagnosed. In the case described here, the poor outcome mainly resulted from the sudden onset of complications; the patient died of splenic rupture less than 24 h after admission, and the cause of death was confirmed at necropsy.     

动脉窦瘤破裂介入治疗成功1例

患者,男,28岁。于3d前提重物时突然感到心悸、胸闷,休息后未见缓解,后喘憋症状逐渐加重,不能平卧,双下肢及下腹部明显水肿,收入山东滕州市中心人民医院急诊科胸痛中心病房。体检:急性病容,T37·0℃,P100次/min,R25次/min,BP105/50mmHg(1mmHg=0·133kPa),心尖搏动明显,约在第6肋间锁骨中线外3cm处,并可扪到明显震颤。听诊双肺呼吸音粗,在胸骨左缘第2、4肋间听到粗糙连续性杂音。肝脏肋下约3cm。心脏多普勒超声示右冠状窦瘤样扩张,大小约2·4cm×3·3cm,可见宽约0·7cm的开口与右室相通,全心扩大,左室64mm、左房49mm、右房67mm×58mm、右…     

Spontaneous unscarred uterine rupture in a twin pregnancy complicated by adenomyosis: A case report

Introduction:Uterine rupture during pregnancy is a serious obstetric complication accompanied by a high incidence of maternal morbidity and mortality, and the presence of uterine scars is the main risk factor. In the present case, uterine rupture occurred in an unscarred uterus in a nonlaboring primigravida woman with adenomyosis and twin pregnancy in the third trimester.Patient concerns:In this case, the patient suspected to have a history of endometriosis have got twin pregnancies following intracytoplasmic sperm injection, and complained of recurrent lower abdominal pain from 16 weeks to 29 weeks of gestation.Diagnosis:After exploratory laparotomy, the patient was diagnosed with uterine rupture and adenomyosis.Interventions:The patient was first administered expectant treatment such as antibiotics, tocolytics, and fluid replacement therapy. Symptoms then appeared repeatedly and worsened, followed by eventual peritoneal irritation, and exploratory laparotomy was performed.Outcomes:Two live female fetuses were extracted by cesarean section, and the uterine laceration was repaired. The mother recovered without any postoperative complications, and the babies were discharged after receiving one month of prematurity care without any postnatal complications.Conclusion:Adenomyosis and the conception of twins may lead to uterine rupture. For pregnant women with a history of adenomyosis with multiple gestations, close monitoring for signs of uterine rupture is necessary. Single-embryo transfer and multifetal pregnancy reduction should be recommended for infertile patients with adenomyosis.     

Dermatomyositis complicated with Kaposi sarcoma: a case report

We describe the case of a 75-year-old Italian woman affected by dermatomyositis (DM) treated with steroid, high-dose intravenous immunoglobulins (IVIgs) and cyclophosphamide (CPX), taken orally. After a few months, the patient presented multiple red vascular skin lesions diagnosed as Kaposi sarcoma (KS). Steroid was furtherly reduced, and CPX was stopped. We put the patient on chemotherapy with intravenous infusion of vinblastine and vincristine on alternate weeks obtaining the remission of KS. DM is well controlled by a low-dosage steroid and high-dose IVIgs.     

主动脉窦瘤破裂形成室间隔夹层一例

患者男性,46岁,因突发胸痛、胸闷60 min于2010年7月入院.患者无明显诱因突发心前区疼痛,伴胸闷、心悸、大汗及左上肢麻木,含服速效救心丸后症状稍缓解.患者有反复发作胸痛、气促病史1年余,多在情绪激动及劳累下发作,伴晕厥2次.2009年4月在当地医院查心电图示三度房室传导阻滞,查超声心动图示左心房增大,室壁增厚,主动脉瓣轻度反流.     

急性心肌梗死合并室间隔穿孔术后改良体外膜肺辅助治疗1例

<正>1临床资料患者,男,56岁,2019年12月23日无明显诱因下出现心前区钝痛,持续约(1～2) d;1周后出现胸闷心悸,呼吸困难,无法平卧。外院心脏超声示：室间隔缺损。外院予以对症治疗无好转。随即转入我院,查体闻胸骨左缘第三四肋间3/6级粗糙全收缩期杂音。心电图示Ⅲ、AVF异常Q波、ST-T改变。心脏超声示全心增大、左室壁节段性异常伴室壁瘤形成、室间隔穿孔,肺动脉高压（中度）,