ANEURYSM OF SINUS OF VALSALVA DISSECTING INTO THE INTERVENTRICULAR SEPTUM – ECHOCARDIOGRAPHIC DIAGNOSIS (A Case Report)

Aneurysm of sinus of Valsalva dissecting into interventricular septum is a rare entity. We report one such case who was incidentally diagnosed by echocardiography to have this abnormality during evaluation of a clinically suspected isolated aortic regurgitation.KEY WORDS: Aneurysm – dissecting – sinus of Valsalva, Echocardiography     

Total cavopulmonary anastomosis using atrial septal flap: technique and early results

Introduction The Fontan procedure has undergone many modifications to avoid atrial arrhythmias and thrombus formation. We used patient’s interatrial septum as a flap to direct the inferior venacaval blood to the superior venacava. Methods Seventeen patients, aged 1 to 17 years, underwent modified total cavopulmonary anastomosis. Interatrial septum was used to create the inner half of the atrial tunnel, outer half being formed by right atrial free wall. Post-operatively, all patients underwent echocardiography. Seven patients underwent 24 hour ambulatory Holter monitoring and 6 patients underwent cardiac catheterization and cineangiography. Results There was one early death due to low cardiac output. One patient had transient supraventricular arrhythmia. Two patients had singnificant pleural effusion. Holter Monitoring reveled sinus rhythm in all 7 patients studied. Follow up ranged from 18 to 60 months and patients were evaluated as they came for follow up. Long term follow up is currently being compiled. There was one late death from a non-cardiac cause. The remaining patients were in New York Heart Association (NYHA) Class I or II. All patients were in sinus rhythm. Echocardiography and cineangiography revealed absence of obstruction or leak. Conclusions Total cavopulmonary anastomosis using autogenous atrial septum is a useful modification for classical cavopulmonary anastomosis and provides good early results.     

温血或冷晶体心脏停搏液对体外循环术后房性心律失常发生的影响

目的　了解不同的心肌保护方法是否对体外循环 (ECC)术后房性心律失常有影响。　方法　将 12只成年杂交犬随机分为两组 ,A组 :6只犬 ,用持续温血心脏停搏液灌注 ;B组 :6只犬 ,用冷晶体心脏停搏液灌注和局部低温。两组动物主动脉阻断时间均为 30分钟。记录术前及术后 1～ 5天 2 4小时动态心电图 ,计算标准化房性心律失常 ,标准化室性心律失常和 2 4小时平均心率。　结果　 ECC后两组动物均未出现心房颤动。尽管术后 A组标准化房性心律失常率高于 B组 (P<0 .0 5 ) ,但两组动物术前、术后标准化房性心律失常率无明显变化 ,标准化室性心律失常率亦无明显变化。此外 ,两组动物术后 2 4小时平均心率亦升高 ,且 B组高于 A组 (P<0 .0 5 )。　结论　不同的心肌保护方法对 ECC术后房性心律失常的发生无明显影响。     

Staged single-ventricle palliation in an infant with hemoglobin SC disease

Staged single-ventricle palliation is used to treat many cyanotic congenital heart diseases. Hemoglobin sickle cell disease is associated with anemia and significant vascular sickling sequelae, which increase the risk associated with single-ventricle palliation. To our knowledge, there are no reports in the English-language medical literature of single-ventricle palliation having been performed on a patient who had either sickle cell anemia or sickle cell-hemoglobin C disease. Herein, we discuss our clinical and surgical management of an infant with tricuspid atresia type IA and hemoglobin sickle cell disease who survived single-ventricle palliative procedures through the 2nd stage of a bidirectional Glenn anastomosis.     

早产儿三元整合式教育方案的构建与实施

目的 建立早产儿三元整合式教育方案,并探讨其培训效果。方法 组建三元整合教育团队,按照早产儿的发育发展特点构建教育课程,搭建教育平台,包括开办家长学校、开展家长微课堂、视频引导、家长床旁照护操作培训等。采用NICU家长满意度调查表调查并比较培训前后家长满意度。结果 培训后早产儿家长的满意度总分为（191.90±0.20）分,培训前满意度总分为（176.00±4.40）分,差异有统计学意义（t=-41.68,P<0.001）;培训前后家长的知识和信息维度、家长参与照护维度、医护人员专业态度维度得分的比较,差异有统计学意义（t₁=-20.83,P₁<0.001;t₂=-27.30,P₂<0.001;t₃=-27.10,P₃<0.001）。结论 早产儿三元整合式教育方案能提升家长的照护知识和参与照护能力,提高家长对医护人员专业态度的满意度。     

亚太地区炎症性肠病处理共识意见(一)

虽然目前亚太地区尚无炎症性肠病（IBD）的大规模流行病学资料，但一系列研究显示其发病率和患病率呈上升趋势。与西方国家相比仍呈滞后现象。溃疡性结肠炎（UC）的发病率仍较克罗恩病（CD）高。除地域差异外。在一些多民族国家中，IBD尚可见种族差异。亚太地区IBD的遗传背景有异于西方国家。如据报道该地区CD患者未检出NOD2／CARDI5变异。一般而言，该地区IBD患者的临床过程似不如西方国家严重。 亚太地区IBD的诊断存在一些特殊问题。如缺乏IBD诊断金标准。存在多种小肠结肠炎，与IBD临床表现相似，使鉴别诊断特别困难。迄今为止，亚太地区IBD的诊断标准多采用西方国家的诊断标准。诊断必须逐步排除非IBD的小肠结肠炎。确诊应有典型的组织学表现。某些患者需借助随访和诊断性治疗才能确诊。进一步研究IBD发病机制将有助于开发更好的诊断标记物。 亚太地区IBD的治疗亦存在特殊问题。由于诊断困难。IBD患者常未能及时接受适当的药物治疗，但该地区仍广泛采用药物治疗方案。结合西方指南和本地经验可制定类似的处理原则。以利诱导缓解和维持缓解。提倡逐级使用基于病变范围、活动性和严重度的阶梯式治疗方案。对不同病例采用综合性、个体化的方法。随着对IBD发病机制和亚太地区IBD独特性的深入理解。合理、实用的药物治疗指南和应用生物制剂治疗将改善该地区IBD的治疗前景。