巨大左房黏液瘤伴二尖瓣口狭窄及关闭不全1例

患者女,49岁。劳力性心悸、气促2年,加重1周。查体:血压128/80mmHg,心率86次/分,期前收缩4次/min,心尖区闻及3/6级收缩期吹风样杂音及舒张期隆隆样杂音。心电图:窦性心律,左房大,左室心肌劳损。超声心动图:左房、左室增大;左房内巨大团块状回声(约80mm×45mm),其蒂附着于房间隔     

超声诊断右房巨大黏液瘤1例

患者男 ,2 1岁 ,自幼体弱易“感冒” ,两年前感长时间活动后胸闷、气短 ,近期此症状明显加重入院。查体 :心率 92次 /min ,呼吸 18次 /min ,血压 6 / 10kPa ,口唇无紫绀 ,颈静脉怒张。胸骨左缘第 3,4肋间可闻及三级收缩期及舒张期杂音。超声所见 (图 ) :右心房增大 ,其内可探及 7.0cm× 4 .9cm巨大实性中等回声团 ,边界清晰 ,边缘不规整回声欠均匀 ,并可见一蒂连于房间隔右房面 ,收缩期占据整个右房 ,舒张期部分落入右室。超声诊断 :右房巨大黏液瘤。术中所见 :瘤体占据整个右房 ,蒂长约 1cm ,位于房间隔距卵圆孔边缘 ,将瘤体完整摘除。病…     

超声诊断儿童房室复合黏液瘤1例

患儿,男,10岁,因突发性晕厥3次入院.查体:叩诊心界无明显扩大,心率70次/分,律齐,二尖瓣听诊区闻及3/6级SM.心电图示:V1～V4导联T波倒置,V5～V6 T波双向.     

彩超拟诊左房黏液瘤1例

患女．63岁：汉族，慢性咳嗽咳痰两个月，加重伴胸闷、憋气7d来院就诊。查体：神志清，双肺可闻及少量湿性罗音，血压120/80mmHg，心电图：窦性心动过速。     

多普勒超声评价胎儿房间隔瘤与房音隔缺损的相关性

目的 应用多普勒超声诊断胎儿房间隔瘤（ＡＳＡ）并评价与房间隔缺损（ＡＳＤ）的相关性。方法 对１０２０例胎儿进行多普勒超声心动图检测。结果 被检出的８例ＡＳＡ中３例合并中央型ＡＳＤ,其中２例伴严重的房性心律失常和三尖瓣反流;１例出生后复查示ＡＳＡ伴裂隙样小ＡＳＤ;２例出生后示卵圆孔（ＦＯ）未闭;２例瘤体缩小及１例消失。结论 ①胎儿ＡＳＡ的发生可能与妊娠早期ＦＯ处帘膜形成或继发隔的发育异常有关,因此与ＡＳＤ密切相关;②ＡＳＡ合并ＡＳＤ时更易诱发房性心律失常;③单纯的ＡＳＡ出生后常见ＦＯ未闭或小的房内分流而可能导致局部血栓物质的形成造成栓塞。     

心房黏液瘤的超声诊断与临床价值

目的：总结46例心房黏液瘤超声诊断与临床价值。方法：回顾性分析46例心房黏液瘤病例术前超声诊断，术后资料对比，左房黏液瘤36例，右心房黏液瘤10例。结果：超声诊断心房黏液瘤具有简便、无创、准确、费用低等优点。外科临床医生往往是以超声检查为主要诊断依据直接手术。结论：超声是目前诊断心房黏液瘤最有临床价值的非创伤性检查方法，它不仅可以避免心导管和心血管造影检查所致栓塞的危险，而且可为临床上早期诊断及指导手术提供可靠依据。     

Completed atrioventricular block induced by atrial septal defect occluder unfolding: A case report

BACKGROUNDAn atrial septal defect is a common condition and accounts for 25% of adult congenital heart diseases. Transcatheter occlusion is a widely used technique for the treatment of secondary aperture-type atrial septal defects (ASDs).CASE SUMMARYA 30-year-old female patient was diagnosed with ASD by transthoracic echocardiography (TTE) 1 year ago. The electrocardiogram showed a heart rate of 88 beats per minute, normal sinus rhythm, and no change in the ST-T wave. After admission, TTE showed an atrial septal defect with a left-to-right shunt, aortic root short-axis section with an ASD diameter of 8 mm, a parasternal four-chamber section with an ASD diameter of 9 mm, and subxiphoid biatrial section with a diameter of 13 mm. Percutaneous occlusion was proposed. The intraoperative TTE scan showed that the atrial septal defect was oval in shape, was located near the root of the aorta, and had a maximum diameter of 13 mm. A 10-F sheath was placed in the right femoral vein, and a 0.035° hard guidewire was used to establish the transport track between the left pulmonary vein and the inferior vena cava. A shape-memory alloy atrial septal occluder with a waist diameter of 20 mm was placed successfully and located correctly. TTE showed that the double disk unfolded well and that the clamping of the atrial septum was smooth. Immediately after the disc was revealed, electrocardiograph monitoring showed that the ST interval of the inferior leads was prolonged, the P waves and QRS waves were separated, a junctional escape rhythm maintained the heart rate, and the blood pressure began to decrease. After removing the occluder, the elevation in the ST segment returned to normal immediately, and the sinus rhythm returned to average approximately 10 min later. After consulting the patient’s family, we finally decided to withdraw from the operation.CONCLUSIONCompression of the small coronary artery, which provides an alternative blood supply to the atrioventricular nodule during the operation, leads to the emergence of a complete atrioventricular block.     

Perioperative anesthesia management in pediatric liver transplant recipient with atrial septal defect: A case report

BACKGROUNDPreoperative conditions in pediatric liver transplant recipients are understandably complex. Compared with adults, children have lesser compensatory abilities and demand greater precision during procedural executions. In the setting of end-stage liver disease, the heightened perioperative risk of coexistent cardiovascular pathology may impact graft survival as well. Requirements for anesthesia and perioperative management are thus more rigorous, calling for individualized treatments that reflect specific cardiovascular constraints and proposed surgical plans.CASE SUMMARYReports of perioperative anesthesia management and liver transplant prognostication in pediatric patients with concurrent atrial septal defects are scarce. Herein, we detail the course of liver transplantation in a child with dual afflictions, focusing on perioperative anesthesia management and the important contributions of the anesthesiologist (pre- and perioperatively) to a positive therapeutic outcome, despite the clinical hurdles imposed.CONCLUSIONChildren with atrial septal defects bear substantially more than customary perioperative risk during orthotopic liver transplants, given their compromised cardiopulmonary reserves and functional states. Comprehensive preoperative cardiovascular assessments, including use of agitated-saline contrast echocardiography (to characterize intracardiac shunting) and multidisciplinary deliberation, may offer insights into structural cardiac pathophysiologic effects and transplant-related hemodynamic changes that impact new grafts. At the same time, active and effective monitoring and other measures should be taken to maintain hemodynamic stability in the perioperative period, avoid entry of bubbles into the circulation, and ease congestion in newly grafted livers. Such efforts are crucial for transplantation success and graft survival.     

实时三维超声心动图在Ⅱ孔型房间隔缺损介入治疗中的应用

目的前瞻性观察实时三维经胸超声心动图(RT 3-D TTE)在Ⅱ孔型房间隔缺损(Ⅱ ASD)介入治疗中的应用价值.方法对13例Ⅱ ASD患者在介入治疗术中,同时行RT 3-D TTE和经食管超声心动图(TEE)全程监控导管走行、测量ASD直径、观察封堵伞位置,并对测量结果进行比较分析.结果 RT 3-D TTE和TEE对13例患者均可达到同样的影像辅助监测作用,在对ASD直径的测量中,球囊测量均值为(20.08±3.84)mm、TEE为(19.0±3.87)mm、RT 3-D TTE为(19.38±3.01)mm,三者间相比无显著性差异(P>0.05),但回归方程中发现RT 3-D TTE的估计标准误(SEE=1.65)较TEE的估计标准误(SEE=1.95)小.结论 RT 3-D TTE检查无创、无痛苦、图像直观,显示了较强的临床实用性,但其无法使用多普勒对残余分流情况进行评价.     

主肺动脉间隔缺损1例

患儿，女，43天，外院诊断为肺炎转入我院。超声心动图示：全心长大，以右心明显；心室壁增厚。右室流出道及肺动脉增宽；距肺动脉瓣环约5mm处，升主动脉左侧壁与主肺动脉右侧壁之间的间隔连续性中断约11mm（图1）；实时三维超声心动图采集全容积图像并进行旋转切割，显示主肺动脉间隔缺损（APSD）的主动脉面和肺动脉面均呈圆形（图2）。     

Evaluation of right ventricular and right atrial size in children with atrial septal defect using two-dimensional apex echocardiography

The ability of two-dimensional apex echocardiography to evaluate right ventricular and right atrial size was evaluated in 43 normal children and compared with 20 patients with a secundum atrial septal defect. From the apical four chamber view, the long axis length and short axis diameter of the right ventricle and right atrium were measured. The end-diastolic area of the right ventricle and end-systolic area of the right atrium were determined by planimetry. These data were indexed for body surface area. When compared with normal subjects, the area index of the right atrium and right ventricle were enlarged significantly in patients with a secundum atrial septal defect (p < 0.001 and p < 0.001, respectively). Mean values for the short axis dimension of the right ventricle and for the short axis and long axis diameter of the right atrium were greater in atrial septal defect patients than in normal subjects (p < 0.001 for all). However, when both groups were compared, considerable overlap existed between the dimension measurements. Right ventricular long axis length failed to separate the two groups. Thus, two-dimensional apex echocardiography provides a noninvasive means of assessing right ventricular and right atrial size in children with an atrial septal defect.     

中老年房间隔缺损患者的手术治疗

目的：总结中老年房间隔缺损患者手术治疗经验。方法：对36例〉45岁继发孔型房间隔缺损患者进行手术治疗，均伴有不同程度的心功能不全、心律失常、肺动脉高压或房室瓣功能障碍。房间隔缺损修补采用直接缝合或心包片修补，同期行三尖瓣戍形术10例，二尖瓣成形术3例。结果：36例患者术后恢复顺利，全组无死亡病例，术后随访3～48个月，同术前相比心功能明显改善。结论：对有手术适应证的中老年房间隔缺损患者进行手术治疗安全、有效。     

超声心动图在房缺介入治疗中的应用价值

目的 探讨经胸(TTE)及经食道(TEE)超声心动图在房缺(ASD)介入治疗中的应用价值。方法 TTE或TEE在36例ASD患者中进行选择并指导完成Amplatzer堵闭器的封堵及术后随访。结果 31例封堵术成功,5例(经TTE选择的病例)不适合行封堵或封堵失败;TTE(16.8±6.8)mm、TTE(20.0±4.41)mm所测ASD大小与球囊伸展直径(25.42±5.0)mm之间的关系分别显示为无相关(r=0.231,P>0.05)及有一定的相关性(r=0.357,P<0.05),而TTE在去除部分ASD残缘的软边后重新测量得到的缺损直径(22.8±4.9)mm与球囊伸展直径之间相关性良好(r=0.955,P=0.0000);5例ASD残缘较长而硬(18.0±2.0)mm的患者在TTE指导下完成封堵;在术后短、中期的随访中,TTE显示所有患者堵闭器位置固定,短期内残余分流(2例)消失及右室容量负荷降低(26例)。结论 ASD堵闭术前应常规行TEE检查以正确筛选病例并指导堵闭器型号的选择,对于残缘较长(最好>1cm)而硬质的ASD、可在TTE指导下完成手术,而TTE在术后随访期中能对封堵疗效作出全面的评价。     

Cryoballoon pulmonary vein isolation and left atrial appendage occlusion prior to atrial septal defect closure: A case report

BACKGROUNDIn patients who suffer from both atrial fibrillation (AF) and atrial septal defect (ASD), cryoballoon pulmonary vein isolation (PVI), sequential left atrial appendage (LAA) occlusion and ASD closure could be a strategy for effective prevention of stroke and right heart failure.CASE SUMMARYA 65-year-old man was admitted to our institution due to recurrent episodes of palpitations and shortness of breath for 2 years, which had been worsening over the last 48 h. He had a history of AF, ASD, coronary heart disease with stent implantation and diabetes. Physical and laboratory examinations showed no abnormalities. The score of CHA2DS2VASc was 3, and HAS-BLED was 1. Echocardiography revealed a 25-mm secundum ASD. Pulmonary vein (PV) and LAA anatomy were assessed by cardiac computed tomography. PV mapping with 10-pole Lasso catheter was performed following ablation of all four PVs with complete PVI. Following the cryoballoon PVI, the patient underwent LAA occlusion under transesophageal echocardiographic monitoring. Lastly, a 34-mm JIYI ASD occlude device was implanted. A follow-up transesophageal echocardiography at 3 mo showed proper position of both devices and neither thrombi nor leakage was found.CONCLUSIONSequential cryoballoon PVI and LAA occlusion prior to ASD closure can be performed safely in AF patients with ASD.