Septal Myectomy in Hypertrophic Cardiomyopathy: National Outcomes of Concomitant Mitral Surgery

Objectives

To assess the frequency and implications of mitral valve (MV) surgery at the time of septal myectomy (SM) for hypertrophic cardiomyopathy (HCM) in a national cohort.

A classification of lesions around interventricular foramen and its clinical value

Objectives: Lesions around interventricular foramen are difficult to remove for their important adjacent structures. We classify these tumors according their location on Magnetic Resonance Image (MRI) to help us resect these lesions. Methods: Thirty-two tumors around the interventricular foramen were studied according their location and anatomic relations in MRI. Results: Tumors around interventricular foramen were classified into three types. The first one mainly locates in lateral ventricle and the second one growth both in lateral ventricle, interventricular foramen and third ventricle, while the third one mainly in third ventricle. Different surgical approaches were adopted according their classification and the patients recovered well. Conclusion: This classification can help us to chose the surgical approach for these tumors.     

Age is not a predictor of patent foramen ovale with right-to-left shunt in patients with cerebral ischemic events

BACKGROUND: Patent foramen ovale (PFO) with or without atrial septal aneurysm (ASA) is highly associated with cerebral ischemic events in young patients. The prevalence of PFO and ASA in elderly patients with cerebral ischemic events is not well described. OBJECTIVE: Our study is to evaluate the frequencies of PFO with right-to-left shunt (RLS) and ASA in elderly patients and to determine whether age is a predictor of flow-reversed PFO with RLS in cerebral ischemic events. METHODS: A prospective registry for all consecutive patients with cerebral ischemic events who were evaluated by transesophageal echocardiography (TEE) for the detection of possible cardiac source of embolization was established and maintained in a university hospital. Patients' demographics including age, gender, ethnic origin, cerebrovascular risk factors, and all positive TEE data were collected from July 2000 to August 2001 for statistical analysis. A univariate and multivariate stepwise logistic regression analysis was performed. RESULTS: In older patients the prevalence of PFO with RLS, PFO, and ASA was 25/118 (20%), 28/118 (24%), and 38/118 (32%), respectively, as opposed to younger patients, in whom it was 35/119 (30%), 39/119 (33%), and 38/119 (32%), respectively. Older patients had higher frequencies of hypertension (59; 69%), CAD (25; 21%), and prior history of stroke (23; 20%) as opposed to younger patients. Younger age (<60 years), gender, smoking history, hypertension, hyperlipidemia, CAD, and prior history of stroke were not associated with higher prevalence of PFO with RLS. Patent foramen ovale was associated with ASA (P < 0.001) and LVH (P < 0.019) in patients with TIA and stroke. In multivariate analysis only ASA (P < 0.001) remained significant with PFO, with RLS controlling for age, gender, and LVH. CONCLUSIONS: PFO with RLS and ASA are frequently present in elderly stroke and/or TIA patients and age is not a predictor for PFO. Transesophageal echocardiography should be considered for all stroke and/or TIA patients irrespective of their age.     

Late free atrial wall rupture after percutaneous atrial septal defect closure and transvenous pacemaker implantation

We report a remarkable case of right atrial rupture, 3 years after transcatheter closure of a secundum atrial septal defect, and 7 months after permanent transvenous two‐chamber pacemaker implantation. The etiology of the rupture remains unclear, but the presence of the two intracardiac devices is probably not coincidental. © 2008 Wiley‐Liss, Inc.     

颈静脉孔的放射解剖学

对200侧正常颈静脉孔的X线影像和20侧尸头颈静脉孔进行了观测。颈静脉孔有单、双孔之分,左侧的单、双孔分别占86%和14%,右侧的分别占80%和20%。单孔的形态可分四种,双孔的间隔为骨桥。左、右侧颈静脉孔的面积分别为46mm~2和62mm~2。颈内静脉位于孔的后外侧部,舌咽神经位于前内侧部,迷走神经和副神经可位于前内侧部、后外侧部或二部交界处。     

颈静脉孔区肿瘤临床表现及影像学分析

目的探讨颈静脉孔区肿瘤的临床特点、影像学特征。方法回顾性分析2006年5月-2009年12月32例颈静脉孔区肿瘤的临床及影像学资料,术前32例患者均行颞骨薄层CT和头颅MRI平扫加增强扫描,22例怀疑颈静脉球瘤患者于术前24dx时内行血管造影和肿瘤供血血管栓塞。32例颈静脉孔区肿瘤有31例行肿瘤全切手术,1例怀疑颈静脉球瘤患者因乙状窦血栓性静脉炎导致患者反复发热未行手术治疗。术后病理诊断颈静脉球瘤21例,神经鞘瘤10例。结果32例颈静脉孔区肿瘤主要临床表现为耳鸣、听力下降和周围性面神经麻痹。颈静脉球瘤的特征性表现为侵蚀性骨质破坏及“盐和胡椒”征：神经鞘瘤表现为压迫性骨质改变、多发囊变并中度强化。结论CT与MRI的合理结合应用,有助于病变的临床诊断和鉴别,有利于下一步手术方案的选择。     

椎基静脉孔及椎体静脉解剖在椎体成形术中的意义

目的　为胸腰椎（T8～L5）椎体成形术减少骨水泥渗漏等并发症提供解剖学依据。 方法　对40例健康成人胸腰椎螺旋CT薄层扫描和重建,观察每节段正中矢状位和横断位图像上椎基静脉孔（basivertebral foramen, BF）和椎体静脉孔道(vertebral vein, VV)出现的频率;测量椎体正中矢状径（VD）和BF宽（BFW）、深（BFD）高（BFH）;测量BF距椎体左右缘距离（VW1和VW2）和距上下终板的距离（VH1和VH2）,应用Stata7.0统计学软件包对上述数据进行统计学分析。 结果 BF及VV出现的频率从T8到L5逐渐增大,BF和VV观察到的频率在性别间差异无统计学意义（P＞0.05）。BFW、BFH、BFD从T8至L5随椎体增大相应增大。在不同椎体上BFD约为VD的1/3。VW1和VW2之间差异无统计学意义（P＞0.05）;VH1和VH2之间差异有统计学差异(P＜0.05)。BF更接近椎体上终板。 结论 熟悉BF和VV在椎体内的分布有助于减少椎体成形术中骨水泥渗漏等并发症的发生。