先天性心脏病介入治疗的主要并发症

我国是世界上先天性心脏病（简称先心病）发病率较高的国家之一，发病率约占全部活产婴儿的0．7％加．8％，每年有15万-17万先心病新生儿患者，其中约10万患儿需要手术治疗。常见的先心病，如室间隔缺损（ventricular septal defect，VSD）、动脉导管未闭（patent ductus arteriosus，PDA）、     

我国风湿性心脏病的流行现状

目的 掌握我国风湿性心脏病的近期流行状况。方法 １９９３￣１９９５年对我国东、南、西、北、中六个省、市协作区的５￣１８岁学生样本人群进行风湿性心脏病调查。结果 据１９９４年调查资料，在２６９５４６人中共发现风湿性心脏病５９例，总患病率为０．２２％。各地患病率从０．０３‰至０．４０‰；农村患病率高于城市；患病率随年龄而增长，而男、女间无明显差异。病例中单纯二尖瓣病变占７３．７％，其中单纯二尖瓣狭窄占     

老年人心理失控与心脏病猝死关系分析

心理异常变化对疾病的相关性日益被临床重视 ,特别是老年心脏病患者 ,其情志的突变 ,对原发病影响尤为突出。本文收集了我院 80年代以来发生猝死的心脏病患者 46例 ,发现与强烈的情感刺激有显著关系。本文仅就其心理失控与老年心脏病猝死及情志对预防老年心脏病猝死的因果关系。1　临床资料本组病例均符合WHO对猝死的诊断标准。其中男 2 6例 ,女 2 0例 ,年龄 6 0～ 79岁 ,平均 (6 4 8± 6 7)岁。工人 9例 ,农民 5例 ,干部 2 0例 ,知识分子 12例。原发病为高心病合并冠心病者 2 6例 ,单纯冠心病10例 ,高心病 2例 ,风心病 2例 ,肺心病 1例 …     

长治市城乡92593名中小学生先天性心脏病调查

从１９８５年至１９９２年间，对长治市城乡３０２所学校９５６９３名５～１８岁中小学进行了先天性心脏病普查。实查人数９２５９３名，普查率９６．７６％，检出先天性心脏病３１２例，患病率３．３７‰。调查中发现，先天性心脏病患者发病串在男女性别间、市区和县区间、矿区和郊区农村间、年龄组之间均无明显差异（Ｐ＞０．０５）。     

静脉注射卡托普利对心脏病心衰患者甲状腺激素的影响

我们通过观察40例心力衰竭患者及11例正常对照组,用静脉推注卡托普利（captopril,CP）对甲状腺激素影响的即刻效应,试为治疗甲状腺功能亢进寻找一条新途径。 一、对象与方法 1.观察对象:心脏病心衰组40例,（男27例,女13例）,年龄14～71岁,平均45±16.55岁;其中肺心病15例,先心病10例,其他心脏病心衰15例。正常对照组11例（男7例,女4例〕,年龄22～50岁,均为无心血管、内分泌及其他重要脏器疾患的健康人。     

术后心脏病患者的心电图改变

心脏病患者施行手术(非心脏手术)时,由于麻醉和手术的影响,使得原已功能减弱的循环系统不足以维持心脏电生理及血流动力学的稳定性,加重循环功能障碍。而诱发或加重心肌缺血、缺氧及心律失常,甚至发生急性心肌梗死、心脏骤停。本文通过42例施行非心脏手术的心脏病患者术前、术后心电图(ECG)对比,分析影响ECG改变的因素。 1 资料与方法 本组42例系我院ICU施行非心脏手术的心脏病患者。男22例,女20例,年龄为27～78岁,平均57.32岁。各种心脏病均符合WHO诊断标准。冠心病26例,高心病14例,其中高心病合并冠心病5例,糖尿病合并冠心病2例,糖尿病合并高心病1例。风心病3例,甲亢性心脏病2例,先心病1例,糖尿病性心     

老年心脏病348例临床分析

我院1984～1988年间收住院的老年人心脏病348例,男260例,女88例。年龄60～88岁,平均71.2岁。根据有关标准分类,其中肺心病79例(22.7%),冠心病54例(15.5%),高心病47例(13.5%),肺心病合并冠心病45例(12.9%)。冠心病合并高心病32例(9.2%),糖心病性心脏病(糖心病)22例(6.3%),心肌病16例(4.6%),肺心病合并高心病15例(4.3%),风心病12例(3.5%),糖心病合并高心病7例(2.0%),糖心病合并肺心病5例(1.4%),风心病合并高心病4例(1.1%),甲状腺机能亢进性心脏病3例(0.9%),风心病合并冠心病、贫血性心脏病各2例(各     

磁共振在复杂先天性心脏病诊断中的价值

先天性心脏病（先心病）,国外发病率为3．2‰～8‰,我国每年大约有15～20万新生儿患病,新生儿发病率约占1．51‰～13．7‰。大多数先心病为简单畸形如房间隔缺损、室间隔缺损、动脉导管未闭等,超声心动图可满足诊断需要。先心病复杂或复合畸形大约占先心病15％。近年来,随着医学技术的迅速发展,很多复杂先心病亦能够通过外科手术实施根治或姑息性治疗。但是,诊断是治疗的基础,术前准确的诊断在先心病治疗及预后均起着至关重要的作用。     

风湿性心脏病15年调查报告

目的：研究风心病的易患因素、发病率及死亡原因。方法：分类统计1985－1999年在我科住院的风湿性心脏病病人的易患因素、发病率及死亡原因等。结果：该病占心内科平均年总住院率的6．9％（582／8412）；以青壮年居多，占71．1％；农民发病率最高为44％（256／582）。风心病15年间总死亡率为7．9％，死亡原因以泵衰竭为主，其次为猝死。结论：重视风湿热的预防和早期诊治，是降低风心病发病率的关键，防治重点在农村。心瓣膜病一旦发生，应积极动员作手术或介入性治疗，延长寿命，提高生存质量。     

我国风湿性心脏病的流行现状——国家“八、五”风湿热课题风湿性心脏病调查报告

目的掌握我国风湿性心脏病的近期流行状况。方法１９９３～１９９５年对我国东、南、西、北、中六个省、市协作区的５～１８岁学生样本人群进行风湿性心脏病调查。结果据１９９４年调查资料，在２６９５４６人中共发现风湿性心脏病５９例，总患病率为０２２‰，各地患病率从００３‰至０４０‰；农村患病率高于城市；患病率随年龄而增长，而男、女间无明显差异。病例中单纯二尖瓣病变占７３７％，其中单纯二尖瓣狭窄占９２％；诊断时合并风湿活动者占２３７％。结论调查结果显示，我国青少年儿童患病率近１０余年有明显下降，但有些地区仍较高。今后仍有必要对人群风湿性心脏病的流行趋势进行长期监测，并适当进行一些成人风湿性心脏病调查，继续做好防治工作。     

Prevalence of rheumatic fever and rheumatic heart disease in Bangladeshi children

Background

Recent prevalence data on rheumatic fever (RF) and rheumatic heart disease (RHD) are lacking in Bangladeshi population.

Aim

We have done this national level cross-sectional survey to determine the prevalence of RF and RHD in Bangladeshi children.

Methods

Samples were drawn from three out of seven divisions of Bangladesh from both urban and rural areas. Trained and experienced enumerators visited households to suspect cases of RF or RHD in 5–19 years children by asking structured questions on symptoms and signs of RF and RHD (n = 56,827). Then trained doctors again took history and examined them for RF/RHD. RF was defined according to the Modified Jones Criteria 1992. Doppler echocardiography was done to confirm the diagnosis in all suspected cases of RF/RHD.

Results

A total of 36 RF cases (new and old) and 16 Doppler echocardiography confirmed RHD cases were identified. Prevalence of RF and RHD was 0.9 per 1000 (95% confidence interval: 0.7–1.2) while prevalence of RF was 0.6 per 1000 (95% CI: 0.4–0.9) and RHD 0.3 per 1000 (95% CI: 0.2–0.5).

Conclusion

Observed prevalence of RF and RHD indicates that RF/RHD is disappearing from Bangladesh. However, studies using new technology of portable echocardiographic screening are needed.     

Echocardiographic screening in a resource poor setting: Borderline rheumatic heart disease could be a normal variant

Objective

To estimate the echocardiography confirmed prevalence of rheumatic heart disease (RHD) in school children in Fiji.

Design

Cross-sectional observational study.

Setting

Ten primary schools in Fiji.

Patients

School children aged 5–14 years.

Interventions

Each child had an echocardiogram performed by an echocardiographic technician subsequently read by a paediatric cardiologist not involved with field screening, and auscultation performed by a paediatrician.

Main outcome measures

Echocardiographic criteria for RHD diagnosis were based on those previously published by the National Institutes of Health (NIH) and World Health Organization (WHO), and data were also analyzed using the new World Heart Federation (WHF) criteria. Prevalence figures were calculated with binomial 95% confidence intervals.

Results

Using the modified NIH/WHO criteria the prevalence of definite RHD prevalence was 7.2 cases per 1000 (95% CI 3.7–12.5), and the prevalence of probable RHD 28.2 cases per 1000 (95% CI 20.8–37.3). By applying the WHF criteria the prevalence of definite and borderline RHD was 8.4 cases per 1000 (95% CI 4.6–14.1) and 10.8 cases per 1000 (95% CI 6.4–17.0) respectively. Definite RHD was more common in females (OR 5.1, 95% CI 1.1–48.3) and in children who attended school in a rural location (OR 2.3, 95% CI 0.6–13.50). Auscultation was poorly sensitive compared to echocardiography (30%).

Conclusion

There is a high burden of undiagnosed RHD in Fiji. Auscultation is poorly sensitive when compared to echocardiography in the detection of asymptomatic RHD. The results of this study highlight the importance of the use of highly sensitive and specific diagnostic criteria for echocardiography diagnosis of RHD.     

Prevalence of rheumatic fever and rheumatic heart disease in rural Bangladesh

A community-based study was done on 5923 rural Bangladeshi children aged 5-15 years to determine the prevalence of rheumatic fever (RF) and rheumatic heart disease (RHD). The prevalence was found to be 1.2 (95% confidence interval 0.3-2.1) per 1000 for RF defined by revised Jones criteria and 1.3 (0.4-2.2) per 1000 for Doppler echocardiography-confirmed RHD.     

Rheumatic heart disease: a school survey in a rural area of Rajasthan.

Thirty four of 10168 school going children were found to have rheumatic heart disease (RHD) in a school survey conducted in the rural areas of Churu district in Rajasthan. The prevalence rate was 3.34/1000. A high prevalence of RHD was found in 11 to 15 year age group. Maximum prevalence of RHD was in low socioeconomic group. Out of these thirty four cases of RHD, isolated mitral stenosis was present in sixteen, isolated mitral regurgitation in four, combined mitral stenosis and mitral regurgitation in ten patients.     

1410例慢性心力衰竭合并心房颤动住院病例回顾性分析

目的分析慢性心力衰竭合并心房颤动住院病例的特点。方法采用2中心、回顾性、对照研究。对病例在年代(Ⅰ、Ⅱ、Ⅲ组)、性别、年龄分期等方面的特点进行分析。结果入选1 410例,年龄呈现老龄化(P<0.01)。心功能以NYHAⅢ、Ⅳ级为主,占87.9%。Ⅰ和Ⅱ组的首位病因是风湿性心脏病,Ⅲ组则是冠心病。随着年龄的增加,女性患者心房颤动比例减少。老年前期首位病因是风湿性心脏病,老年期和高龄老年期则为冠心病。总的好转率82.9%,总的病死率12.6%,后者以Ⅲ组最低(P<0.01)。死亡病例的首位病因逐渐由风湿性心脏病演变为冠心病,死因以非心脏性原因死亡居多,其次为心功能恶化。结论慢性心力衰竭合并心房颤动住院病例的首位病因从风湿性心脏病演变为冠心病;高龄、冠心病合并心房颤动可能逐渐成为慢性心力衰竭的主要流行趋势。     

Prevalence of rheumatic fever and rheumatic heart disease in school children in a rural community of the hill region of Nepal

A survey of school children aged 5 to 16 years living in a rural community of the hill region of Nepal, situated about 15-22 km outside Kathmandu city, was conducted to determine the prevalence of rheumatic fever (RF) and rheumatic heart disease (RHD). Of the 4,816 eligible children enrolled in the selected schools, 4,452 (92.4%) were examined. WHO expert committee criteria (1966) was used for the diagnosis and classification of rheumatic fever. Chest x-ray, electro-cardiography, echocardiography and Doppler study were done in all suspected cases of rheumatic heart disease. Six cases of RHD (1 pure mitral stenosis, 3 mitral regurgitation and 2 combined mitral stenosis and regurgitation) were identified giving overall prevalence rate of 1.35 per thousand. No case with active rheumatic fever could be identified. This is the first study on prevalence of RF/RHD in Nepal. The prevalence rate is lower than that reported from neighbouring countries.     

Diagnosis of heart failure in elderly patients in primary care

BACKGROUND: Heart failure is difficult to diagnose in a primary care setting with a reported false positive diagnosis in up to 70% of cases. Aims: To use echocardiography in a large rural practice to evaluate the accuracy of diagnosis of heart failure in patients over 65 years of age. METHODS: Sixty patients with a previous diagnosis of heart failure were selected at random from the practice records and were invited to attend for an echocardiogram at the practice premises. RESULTS: Fifty-eight patients attended, the age was 81+/-7 years, 29% had impaired left ventricular (LV) systolic function of whom 65% were in atrial fibrillation. A further 7% had isolated diastolic LV dysfunction. The prevalence of heart failure by clinical assessment was 29 per 1000 in this patient group and 9 per 1000 when echocardiography was used to confirm the diagnosis. CONCLUSION: True heart failure in this population is less prevalent than has been estimated from practice records.     

冠心病与风湿性心脏病引起的慢性收缩性心力衰竭患者预后差异性比较

目的通过分析冠心病与风湿性心脏病引起慢性收缩性心力衰竭患者预后的差异,探讨病因对心力衰竭患者预后的影响。方法回顾性分析我院2005年至2010年因冠心病或风湿性心脏病住院的心力哀竭患者临床资料,对所有人选患者电话随访。根据病因将患者分为冠心病组和风湿性心脏病组;根据患者预后分为存活组和死亡组。以单因素和多因素Cox风险比例模型分析冠心病和风湿性心脏病心力衰竭患者预后差异;以单因素和多因素Cox生存分析确认心力衰竭患者预后危险因素。结果共1552例患者纳入本次研究,平均随访3年。冠心病组和风湿性心脏病组分别为1096例（70.62%）和456例（29.38%）,存活组和死亡组分别为1113例（71.71%）和439例（28.29%）。平均随访3年,冠心病组和风湿性心脏病组总死亡率分别为33.85%和14.91%。多因素Cox比例风险模型分析发现,冠心病总死亡率为风湿性心脏病的1.53倍（95%CI 1.33～1.86;P〈0.01）,结论与风湿性心脏病相比,冠心病引起心力衰竭患者预后差,病因是影响慢性收缩性心力衰竭患者预后的独立危险因素,病因应纳入影响心力衰竭患者的预后评价中。     

Echocardiographic screening for rheumatic heart disease: Age matters

Background

Echocardiography is emerging as a screening tool for rheumatic heart disease (RHD) in endemic regions. The vast majority of surveys have been limited to children. We ought to appreciate the interest of including adolescents in their late teens in such school screening programmes.

Methods

School-based echocardiography cross-sectional survey conducted in Dakar, Senegal (March 2010). A total of 2004 school attendees were randomly selected and enrolled in the study, among which 1116 were aged 5–15 years old (group 1), and 888 were 16–18 years old (group 2). Case detection rates and phenotype of RHD were compared according to age groups.

Results

A total of 22 youngsters were suspected by on-site echocardiography, 12 in group 1 and 10 in group 2. Among the 12 RHD cases suspected on-site in group 1, 6 (50%) were eventually considered as confirmed RHD, compared to 9 out of 10 (90%) in group 2, giving prevalence rates of 5.4 (CI 95% 2.0–11.7) and 10.1 (CI 95% 4.6–19.2) per 1000 in group 1 and group 2, respectively. The proportion of marked/advanced lesions was 33% in group 1, and 89% in group 2 (p = 0.08). Mean concordance rates between the 3 reviewers were 40% for group 1, compared to 93% in group 2 (p = 0.05).

Conclusions

Extension of screening to adolescents in their late teens should be considered with interest in the light of the higher prevalence of the disease and relative clarity of subclinical cardiac lesions that could be more easily detected in the field.