应用Amplatzer封堵器治疗动脉导管未闭

目的 评价Ａｍｐｌａｔｚｅｒ封堵器治疗动脉导管未闭的初步疗效。方法 经导管置入Ａｍｐｌａｔｚｅｒ封堵器治疗ＰＤＡ共２６例。结果 全组２６例堵堵器均放置成功。造影示分流完全消失１６例（６１％）,微量残余分流８例（３１％）,少量残余分流２例（８％）。术后２４￣４８小时多普勒超声示分流完全消失２４例（９２％）,微量残余分流２例（８％）。１便封堵术后１７小时发生溶血,５４小时后行外科ＰＤＡ缝合术。结论应用     

Left vocal cord paralysis associated with long-standing patent ductus arteriosus

SUMMARY: Left vocal cord paralysis in association with patent ductus arteriosus is unusual. We report a patient with long-standing patent ductus arteriosus (PDA) in whom CT studies obtained before and after paralysis developed showed an interval increase in size of the pulmonary trunk. The pathogenesis of left vocal cord paralysis in association with long-standing PDA is discussed.     

儿童动脉导管未闭介入治疗术后早期左心形态及其功能的变化

目的 旨在探讨儿童动脉导管未闭（PDA）介入治疗前后左心形态、功能及血流动力学的变化。方法 应用经胸超声心动图对21例单纯性儿童PDA患者在介入治疗前后测量并记录左房、左室的前后径、横径、上下径及左室射血分数、短轴缩短率,同时测量二尖瓣、三尖瓣、主动脉瓣、肺动脉瓣峰值血流速度并记录。结果 21例儿童PDA患者介入治疗后早期左房收缩末期前后径、横径及左室前后径、横径均有明显变化,二者差异有显著性意义（P〈0．05）。结论 PDA介入治疗后减轻了左室容量负荷,早期左心形态及功能均有不同程度的改变。     

彩色多普勒超声心动图在老年动脉导管未闭封堵术中的价值

目的探讨彩色多普勒超声心动图(CDE)在老年动脉导管未闭(PDA)封堵术中的价值。方法封堵术前应用CDE筛选25例老年PDA适应证,彩色多普勒血流显像(CDFI)分流束血流信号估测PDA肺动脉端直径,与心血管造影对照,经统计学相关处理判断其正确性;连续波多普勒(CW)测量三尖瓣最大反流速度峰值,根据简化伯努利方程ΔP=4V2估算跨三尖瓣压力阶差,再加上右心房固有压力估测肺动脉压力,与心导管对照,经统计学相关处理判断其正确性;所有患者均行封堵术介入治疗,封堵术后再应用CDE判断封堵术疗效。结果根据CDE特征筛选25例老年PDA实施封堵术全部获得成功,封堵术后CDE判断疗效满意。CDFI测量分流束血流信号估测PDA肺动脉端直径与心血管造影对照,呈正相关(r=0.71,P<0.001);CW估测肺动脉压力与心导管对照,呈正相关(r=0.63,P<0.001)。结论CDE在老年PDA封堵术中具有重要价值,封堵术前筛选适应证应用CDFI估测PDA肺动脉端直径和应用CW估测肺动脉压力是关键,封堵术后判断疗效应用CDFI观察有无过PDA残余分流很重要。     

中老年动脉导管未闭彩色多普勒超声心动图特征和规律性研究

目的:探讨中老年动脉导管未闭(PDA)彩色多普勒超声心动图(CDE)特征和规律性。方法:应用CDE检查155例中老年PDA,寻找CDE特征和规律性,所有病例均经心血管造影对照,并行经皮穿刺PDA封堵术介入治疗。用彩色多普勒血流显像(CDFI)估测PDA肺动脉端直径与心血管造影测量PDA肺动脉端直径进行统计学相关检验,观察CDFI估测中老年PDA直径的准确性。结果:根据CDE特征对所有中老年PDA患者全部做出正确诊断,中老年PDA的CDE特征和规律性明显:①M型超声和二维超声心动图显示左心房(93.5%)、左心室(51.6%)内径不同程度增大,室间隔与左室后壁运动幅度增大;②所有患者CDFI均显示过动脉导管左向右五彩镶嵌分流束血流信号;③根据CDFI测量PDA肺动脉端分流束血流信号宽度判断PDA肺动脉端直径与心血管造影对照,二者呈显著正相关(r=0.73,P<0.001);④中老年PDA合并心脏瓣膜关闭不全明显增多,其中二尖瓣关闭不全(78.7%)、主动脉瓣关闭不全(61.3%)、三尖瓣关闭不全(34.8%)、肺动脉瓣关闭不全(30.3%);⑤中老年PDA合并肺动脉高压明显增多(46.5%);⑥中老年PDA患者女性(83.9%)明显多于男性(16.1%)。结论:中老年PDA的CDE特征和规律性明显,CDE对中老年PDA有特异性诊断价值。     

Mirror-image right aortic arch: A proposed mechanism in symptomatic vascular ring

We describe a rare case of right aortic arch with mirror-image branching and a left ductus arteriosus that form an anomalous vascular ring. The unusual feature of this symptomatic vascular ring is presence of a left (posterior) circumflex descending aorta in lieu of an aortic diverticulum which usually represents the posterior element of the vascular ring associated with right aortic arch and mirror-image branching. This we believe is the seventh reported case of Type 1 right aortic arch and only the third such case with a left circumflex descending aorta. Accurate diagnosis was made by barium esophagogram and angiocardiogram and was confirmed surgically. We propose a new theory as to why some vascular rings formed by the right aortic arch are symptomatic while others are not.     

高原地区动脉导管未闭37例X线分析

ＰＤＡ是高原地区常见的先天性心脏病之一，居首位。本文通过对３７例儿童ＰＤＡＸ线分析，认为高原地区与平原地区ＰＤＡＸ线征象基本一致，不同的是因高原缺氧易早出现肺动脉高压，因而肺动脉的凸出，右下肺动脉的增宽及右心房的增大较平原明显，肺血管纹理增多增粗县较紊乱，易与房或和室间隔缺缺损其它心内系统的复合畸形相混淆，给诊断和鉴别诊断带来困难，因此早期正确诊断和及是手术治疗实属重要。     

Respiratory distress syndrome treated with human surfactant: radiographic findings

Chest radiographs of 18 newborns treated with endotracheal instillation of human surfactant for respiratory distress syndrome (RDS) were compared with those of 18 similar but untreated infants. In the treated infants, severity of RDS significantly improved after surfactant administration. Most treated infants (16/18) exhibited a left-to-right shunt, presumably through a patent ductus arteriosus; similar findings were noted in untreated infants (17/18). Complications of respiratory assistance in the treated infants included transient pulmonary interstitial emphysema (n = 1), pneumothorax (n = 1), and mild (n = 4) to moderate (n = 2) bronchopulmonary dysplasia; the incidences of these complications did not exceed those in untreated infants. In three treated infants, a transient interstitial lung disease developed 3-4 days after surfactant administration.     

动脉导管未闭手术前后左室功能的对比

应用超声心动图测量儿童和成人各３６例动脉导管未闭患者．（ＰＤＡ）在手术前后左室舒张末期内径和收缩末期内径。应用Ｃｕｂｅ公式自动计算出左室舒张末期容积,收缩末期容积、每搏搏出量、射血分数、和短轴缩短率。将手术前后两组测量数据分别用统计学配对ｔ检验,再对两组手术前后ＬＶＥＤＶ指数进行对比。结果表明,两组手术后ＬＶＥＤＤ、ＬＶＥＤＶ、ＬＶＥＳＶ、ＬＶＳＶ、ＬＶＥＦ和ＬＶＦＳ均有不同程度变化,两者差异显著     

Therapeutic alternatives in the treatment of intrahepatic biliary obstruction

Intrahepatic biliary obstruction was treated in 60 patients (49 with cholangiocarcinoma and 11 with sclerosing cholangitis) who were classified according to the upper limit of their obstruction (Group I, proximal common hepatic duct; Group 2, right and left main hepatic ducts; Group 3, intrahepatic bile ducts). Thirty-six patients underwent percutaneous transhepatic biliary drainage, and 14 underwent catheterization through a T-tube track, Five of this latter group had the T-tube placed to establish a route of access for later interventional radiologic manipulations. Since most diseases that produce intrahepatic biliary obstruction are progressive, the use of any single approach is limited. The advantages of a surgically created route of access combined with the flexibility of interventional radiologic techniques help to maximize the therapy and extend the palliation that many of these patients receive.     

Imaging of a supernumerary kidney

A 33-year-old female patient was investigated for a right lower quadrant pain. The investigation, which included an excretory urography and a computed tomography examination, revealed a normal kidney on the right side and another two normal sized, complete kidneys on the left side, which appeared to have a small parenchymal bridge. The patient was treated surgically for a cyst of the right ovary. Received: 12 October 1999; Revised: 28 January 2000; Accepted: 16 March 2000     

Bilateral Achilles tendon rupture: a report on two cases

Two cases of traumatic bilateral Achilles tendon rupture are reported. One of the patients was a healthy middle-aged man, who had been an active nationallevel gymnast 20 years earlier. He had not suffered any complaints of Achilles tendons before. The ruptures occurred when, after a sauna, he showed his guests a vault forwards, which he had been able to perform easily. This time the landing took place on the toes, causing a high peak stretch to the calf muscles and Achilles tendons. The total rupture of both Achilles tendons was treated surgically, with an excellent result 2 days after the trauma. End-to-end suturation and a fascial flap plasty were made on both sides. No macroscopic degeneration could be detected on the rupture sites. He was allowed to walk freely 6 weeks after the surgery. The second case was a 54-year-old woman, who had suffered from Achilles tendinitis and peritendinitis for 2 years. Both tendons had been surgically treated, and severe adhesions and local degenerative changes had been found. The tendon rupture occurred when she injured her left ankle while getting out of the car. Two days later she fell at home, because of the weakness of the left side, and consequently the right Achilles tendon was injured. She was treated conservatively for 10 days, before the surgery was performed. Both tendons were ruptured and an extensive degeneration of the area was observed. The right side suffered from a rerupture, which was again treated surgically. After surgery the recovery was slow, but the final result 3 years later was moderate. Neither of the patients had any systemic diseases.     

高压氧对大鼠早期脓毒症膈肌p38促分裂素原活化蛋白激酶信号通路的影响

目的 观察高压氧对大鼠脓毒症膈肌p38促分裂素原活化蛋白激酶(mitogen-activated protein kinases,MAPK)信号通路的影响,以探讨其对脓毒症膈肌损伤的保护作用。方法 SPF级成年雄性SD大鼠30只,采用数字表法随机分为A组（假手术组,n=10）、B组(脓毒症组,n=10)及C组（高压氧治疗组,n=10）。其中A组在给予水合氯醛麻醉成功后,从正中线剪开大鼠腹部,然后缝合伤口。B组和C组在麻醉成功后,使用盲肠结扎穿刺(cecal ligation and puncture,CLP)模型将大鼠制成脓毒症动物模型,并且C组在术后立即行高压氧治疗。所有大鼠在术后16 h处死,取左侧膈肌检测肌条收缩力,右侧膈肌检测膈肌肌细胞凋亡率及p38 MAPK蛋白表达。结果 B组与A组比较,膈肌肌细胞凋亡率及p38 MAPK蛋白表达明显上升,肌条收缩力明显下降,2组比较差异有统计学意义(P＜0.01)。给予高压氧治疗后,膈肌细胞凋亡率、p38 MAPK蛋白表达及肌条收缩力较脓毒症组明显恢复,2组比较差异有统计学意义(P＜0.01)。结论 高压氧能够有效抑制脓毒症时p38 MAPK蛋白的表达,减少膈肌肌细胞凋亡率,从而减轻脓毒症膈肌损伤。     

Coil occlusion of the paient ductus arteriosus: lessons learned

Purpose: To review the clinical outcomes of catheter-directed coil occlusion (coil occlusion) of persistently patent ductus arteriosus (PDA) at a pediatric tertiary care hospital. Methods: A retrospective review of all patients referred to the Cardiac Catheterization Laboratory for coil occlusion at our institution was performed. Twenty-one consecutive patients (12 female) underwent coil occlusion and follow-up between May 1995 and December 1997. We undertook PDA occlusion if: (a) the PDA narrowed to less than 4 mm on echocardiogram and (b) the minimum body weight was approximately 10 kg. Standard right and retrograde left heart catheterization was performed, followed by coil occlusion. Color-flow mapping (CFM) was used intra-procedurally to confirm occlusion of the PDA with a follow-up study several weeks later. Results: The median age and weight of the patients were 33 months and 13.2 kg, respectively. Fourteen patients received one coil, with six requiring a second coil and one requiring multiple coils. Initial follow-up was at a median of 2.4 months. At latest follow-up, 2 patients still have persistent flow at the ductal level. The coils were deployed without complication or embolization. Conclusions: A review of our first 21 cases demonstrated three important lessons: (1) the maximum diameter of the PDA suitable for coil occlusion is approximately 3 mm; (2) CFM must show complete obliteration of flow in the catheterization lab in order to ensure occlusion of the PDA at follow-up; and (3) the Jackson detachable system allows for precise placement of the coil, often within another coil.     

Airway obstruction by right aortic arch with right-sided patent ductus arteriosus: demonstration by MRI.

An unusual cause of airway obstruction was demonstrated by MRI in two infants with congenital heart disease. The two infants experienced airway obstruction caused by a right aortic arch with right-sided patent ductus arteriosus. The diagnosis was established by MRI prior to surgery; angiography did not demonstrate the critical relationship between the large ductus and the airway. Axial, sagittal, and coronal MRI displayed the right arch, dilated ductus, and the compression of the proximal right bronchus and distal trachea by the ductus. Surgical findings confirmed the MR diagnosis. Thus, MRI can be used to localize the site of airway obstruction and to demonstrate unusual types of vascular anomalies.     

Renal blood flow in neonates: quantification with color flow and pulsed Doppler US.

Color flow and pulsed Doppler ultrasound measurements of renal artery blood flow were compared with cardiac output in 22 preterm and 19 full-term healthy neonates. Renal arteries were insonated 3-5 mm from the abdominal aorta at an angle of less than 15 degrees. Vessel diameter was estimated from color flow diameter. Total renal blood flow increased significantly (P less than .001) with advancing birth weight and gestational age, because of increased vessel diameter, but flow velocity did not. The mean (+/- 1 standard deviation) value for both right and left renal artery blood flow was 21 mL/min/kg +/- 5, and the mean proportion of cardiac output to the kidneys was 16.1% +/- 3.7. Seven preterm infants with a symptomatic patent ductus arteriosus had increased cardiac output values (444 mL/min/kg +/- 45) and reduced right (15 mL/min/kg +/- 7) and left (16 mL/min/kg +/- 7) renal artery blood flow, with 6.6% +/- 2.0 of cardiac output directed to the kidneys. These values normalized after closure of the ductus. This study provides normative data for renal artery blood flow in neonates during the first week of life.     

Percutaneous transcatheter coil occlusion of the patent ductus arteriosus aided by the nitinol snare: Further observations

Purpose: To assess the safety and efficacy of the nitinol snare to aid in the delivery of a Gianturco coil in percutaneous occlusion of a patent ductus arteriosus (PDA). Methods: Seventeen patients (mean age 8.2 years) underwent catheterization and coil occlusion of a PDA (mean minimum diameter 1.9 mm). A nitinol snare was used to deliver and position the coil in the ductus. Results: A single Gianturco coil was placed successfully in all patients, resulting in complete ductal occlusion documented by aortic angiography. Color echocardiography documented a trivial residual shunt in one patient who had no audible cardiac murmurs following the procedure. There was no hemodynamic or echocardiographic evidence of left pulmonary artery obstruction. There were no complications and all patients were discharged within 24 hr following the procedure. Conclusions: Percutaneous coil occlusion of the PDA is safe and effective. Snare-controlled coil delivery eliminates the risk of coil dislodgement and optimizes coil position.     

Adrenal venography and ultrasound in the investigation of the adrenal gland: an analysis of 58 cases.

Adrenal venography has been carried out in 58 patients with the left adrenal vein being successfully catheterized in 91 per cent and the right in 77 per cent. Of the 30 patients with primary hyperaldosteronism, 11 adenomas (12-35 mm diameter) have been demonstrated at venography and two of 15 mm suspected, all of which were confirmed surgically. Aldosterone levels in the adrenal vein plasma were raised on the affected side. In the group of proved micronodular hyperplasia, two patients had surgically confirmed macronodules and venography demonstrated one of 12 mm diameter. Two adenomas of 11 mm and one macronodule of 15 mm have been demonstrated at venography in the remainder who have not had an operation. Ultrasound was carried out in 12 patients with primary hyperaldosteronism, ten of which had tumours at venography. Two adenomas measuring 30 and 31 mm were outlined by ultrasound and confirmed surgically. Seven adenomas, including one macronodule (10-25 mm in diameter) were not defined. Three intra-adrenal phaeochromocytomas (45-90 mm) and one extra-adrenal (80-85 mm) were demonstrated at arteriography, identified by ultrasound and confirmed surgically. Of the ten patients with Cushing's syndrome three had enlarged glands at venography, this was confirmed surgically. Cumulative experience from this analysis and published reports indicate that venography will demonstrate tumours of 10 mm or more in diameter and outline enlarged glands; aldosterone assays will lateralize tumours as small as 3 mm; ultrasound will outline tumours of 30 mm and selective adrenal arteriography will demonstrate tumours of 10 mm. One patient developed acute adrenal cortical insufficiency with intra-adrenal extravasation on one side and thrombosis of the central vein on the opposite side. A second case developed temporary adreno-cortical insufficiency. Published reports indicate that the risk of complication is about 1 per cent. The report includes an anatomical study of the efferent adrenal veins in 50 patients paying particular attention to the diameter, number of accessory hepatic veins, and the angle of entry and position of the right adrenal vein.     

Clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot

OBJECTIVE: To explore the clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot. METHODS: Eighteen patients with diagnosed Tetralogy of Fallot underwent cardiac CT angiography with 64-slice CT (CTA). Two- and three-dimensional images were used for diagnosing in all cases by means of MPR (coronal, sagital and oblique), cMPR, MIP and VRT. RESULTS: All patients had ventricular septal defect, pulmonary stenosis and hypertrophy of right ventricle. The morphologic features of Tetralogy of Fallot were equal to echocardiography. Patent ductus arteriosus (PDA) were detected on eight patients. Main coronary artery branches and partial sub-branches were visualized in all patients. Abnormal coronary arteries were found in seven cases: both left and right main coronary artery arising from the right aortic sinus one case, right main coronary artery and circumflex (CX) arising from the right aortic sinus one case, left anterior descending (LAD) and CX arising from left aortic sinus directly one case, left and right coronary artery arising from back and front of the aortic sinus, respectively, three cases. Pulmonary artery branch stenosis was found in 12 cases and branch pulmonary artery dilation noticed in 1 case. Double superior vena cava was also found in one case. According to the surgery the diagnostic accuracy of CT and Echocardiography was 95.45 and 83.33%, respectively. CONCLUSION: Two- and three-dimensional 64-slice CTA not only show the overall anatomical structure of the heart, but also show coronary and pulmonary arteries. With these results, evaluation of coronary anomalies and pulmonary artery stenosis with 64-MSCT is extremely valuable for planning the operative procedure on the patients with Tetralogy of Fallot.