Haemodynamic Results of Aortic Valve Replacement with the Kay-Shiley Disc Valve

Thirty-nine patients, operated on 8 to 14 months previously with replacement of the aortic valve by a disc valve (Kay-Shiley), were subjected to a postoperative follow-up investigation including right and left heart catheterization. Pre-operatively, aortic stenosis was present in 14 cases, aortic insufficiency in 8, combined stenosis and insufficiency in 15 and an associated mitral stenosis in 2 cases.

Physical working capacity (W₁₅₀) was unchanged, while exercise tolerance (W_max) was significantly increased after operation (from 460 to 670 kpm/min). Cardiac output in relation to oxygen uptake was lower than normal pre-operatively and was unchanged postoperatively. Left ventricular pressures diminished significantly; the peak systolic pressure decreased from 210 to 157 mmHg at rest and from 241 to 172 mmHg during exercise, and the end-diastolic pressure from 23 to 13 mmHg at rest and from 32 to 19 mmHg during exercise. Left atrial (or PCV) mean pressure decreased from 17 to 10 mmHg at rest and from 31 to 16 mmHg during exercise.

Systolic pressure differences across the prosthesis were observed in all patients. The peak pressure difference at rest was in average 28 mmHg and increased to 37 mmHg during exercise. The mean pressure difference averaged 24 mmHg at rest and 31 mmHg during exercise.

The calculated orifice area of the prosthesis, according to the Gorlin formula, averaged 1.36 (±0.3) cm² at rest and 1.54 (± 0.4) cm² during exercise, and was in average 64% of the actual orifice area.

The improvement of cardiac function observed postoperatively is explained by a reduction of cardiac work in combination with a higher distensibility of the left ventricle, leading to decreased pressures in the left atrium and pulmonary circulation.     

憩室切除术治疗十二指肠乳头旁憩室的疗效

十二指肠憩室是一种常见疾病,好发于十二指肠降部.60％ ～ 70％的十二指肠憩室发生于十二指肠降部乳头周围2～3 cm处,称为十二指肠乳头旁憩室.本研究回顾性分析2006年5月至2010年10月我中心采用憩室切除术治疗3例十二指肠乳头旁憩室患者的临床资料,探讨该手术方式的适应证和疗效.     

胃底疾病误诊为左肾上腺疾病的二例报告并文献复习

目的分析我科近年来误将胃底疾病诊断为左肾上腺疾病的2例患者的临床资料和影像学资料,结合文献报道分析误诊原因,降低误诊率,提高诊断准确性。 方法通过分析我科将1例胃底憩室误诊为左肾上腺囊肿和1例胃间质瘤误诊为左肾上腺肿瘤患者的临床资料特别是影像学资料进行回顾性分析,并结合文献报道分析疾病的特点。 结果误诊为左肾上腺囊肿和肿瘤的胃底憩室和胃间质瘤患者临床表现无特异性,特别是实体肿瘤的患者合并高血压病,易引起误诊;术前应特别重视患者的影像学资料,影像学资料可提供重要参考信息。 结论胃底疾病如胃憩室、胃间质瘤等虽发病率较低,临床表现不典型,诊断左侧肾上腺占位病变时当影像学读片发现肿瘤位置偏高,与胃壁粘连等,应高度怀疑胃底疾病,应该进一步行胃镜和上消化道造影等检查,对术前怀疑为胃底疾病的肾上腺区占位,经腹腔行腹腔镜手术能够从容处理胃底疾病,避免后腹膜途径术中需改变手术体位和路径。     

经阴道超声联合宫腔镜检查在子宫瘢痕憩室诊断中的应用价值

目的:探讨经阴道超声检查联合宫腔镜检查在剖宫产术后子宫瘢痕憩室诊断中的价值。方法:回顾性分析2015年10月至2016年12月在上海国际和平妇幼保健院住院治疗的50例剖宫产术后子宫瘢痕憩室患者的经阴道超声声像图、宫腔镜检查及磁共振检查结果。结果:经阴道超声联合宫腔镜检查诊断剖宫产术后子宫瘢痕憩室的准确率为100%(50/50),经阴道超声检查为76%(38/50)的比较,差异有统计学意义(P0.05)。结论:经阴道超声联合宫腔镜检查技术能提高剖宫产术后子宫瘢痕憩室的诊断率。     

梅克尔憩室诱发儿童闭袢性肠梗阻的诊治体会

目的分析梅克尔憩室引起儿童急性闭袢性肠梗阻患儿的临床资料,为及时救治提供经验。方法回顾本院自2006年3月至2014年10月收治的儿童腹腔内闭袢性肠梗阻的临床资料,就梅克尔憩室引起急性肠扭转、压迫形成闭袢性肠梗阻病例的病因、发病时间、临床表现、手术方式、术中发现及预后等进行分析。结果 8年间,收治腹腔内闭袢性肠梗阻患儿共37例,其中梅克尔憩室引起者9例。在梅克尔憩室引起的闭袢性肠梗阻中,男性6例,女性3例;平均发病年龄6.5岁,开放手术6例,腹腔镜手术3例。术中证实梅克尔憩室与周围组织粘连形成闭袢7例;肠扭转2例,其中1例为梅克尔憩室引起并伴肠坏死;另1例为纤维索带引起。术中行肠管复位,肠切除肠吻合或纤维索带切除术,术后1例出现粘连性肠梗阻,保守治疗无好转行再手术。所有患儿术后恢复良好,痊愈出院,随访12个月至8年未见异常。结论梅克尔憩室是引起儿童急性闭袢性肠梗阻的主要病因之一,学龄前后期发病多见,病情进展迅速,术前确诊困难,需早期探查,挽救肠管。     

Congenital left ventricular diverticulum: A rare cause of cardiac arrhythmia

Congenital left ventricular diverticula are rare cardiac malformations that usually remain asymptomatic. However, life-threatening complications as ventricular arrhythmias, systemic embolism, spontaneous rupture and development of valvular regurgitation, are described. Diagnosis is based on excluding coronary artery disease, traumatic or inflammatory causes, and other underlying cardiomyopathies. Treatment is directed towards the potential complications, yielding mainly therapy of ventricular arrhythmia. Surgical resection is required for larger-sized congenital aneurysms with adverse hemodynamic effects. We present two cases of a left ventricular diverticulum causing cardiac arrhythmia which led to further surgical treatment.     

Electrophysiological characteristics of left atrial diverticulum in patients with atrial fibrillation: Electrograms,impedance and clinical implications

Background

Left atrial diverticulum (LAD) is not rare in patients with atrial fibrillation (AF). Recent reports focused on its morphology however data on its electrophysiological characteristics are lacking. Our study aims to investigate the electrogram and impedance features of LAD.

Methods

This study included 24 patients (mean age, 58.5 ± 10.7 years) with LAD undergoing catheter ablation for AF and 24 gender-and-age-matched individuals without LAD as controls. A bipolar LAD electroanatomic map was acquired in sinus rhythm from all study participants. Points were acquired for diverticulum in the LAD group and for corresponding areas in the control group. Electrogram deflections were counted, bipolar voltage and impedance were measured for each point, and average ?impedance and highest ?impedance were calculated.

Results

A total of 234 points were collected in the two groups. In the LAD vs. control group, median (Q1, Q3) of electrogram deflections was 6 (5, 7) and 4 (4, 5) (P < 0.0001), respectively, voltage was not significantly different (1.58 ± 0.68 mV vs. 1.28 ± 0.65 mV, P = 0.10), and average ?impedance was significantly higher in the LAD group (19.5 ± 9.0 Ω vs 3.9 ± 1.7 Ω, P < 0.0001). A cut-off value of 9.5 Ω for ?impedance predicted LAD with sensitivity, specificity, and positive and negative predictive values of 83.5%, 92.8%, 92.1% and 84.9%, respectively.

Conclusions

Electrogram was more fractionated and impedance was higher at LAD than in corresponding areas without LAD, which might help to differentiate LAD during catheter ablation for AF.