多平面经食道超声心动图估测左心耳功能及血栓的评价

目的 评价应用经食道超声心动图(TEE)估测左心耳功能及诊断左房血栓的价值。方法 采用TEE对33例伴有或不伴有房颤患者检测左心耳容量及收缩功能，探测左房和左心耳内有无明确血栓征象。并与经胸多普勒二维超声心动图(TTE)比较。结果 33例患者中左房血栓6例，左心耳血栓6例，排除左房血栓3例。根据左心耳面积测定计算出左心耳射血分数(Efv)与左心耳峰值血流排空速度(Per)相关性良好(r=0．84)。结论 TEE不仅可定性诊断左房血栓，还可测量左心耳射血分数，房颤患者左心耳面积扩大，左心耳射血分数减低，评价左心耳功能较二维超声心动图更为准确。     

Acute Tubular Necrosis Associated with Angiotensin Receptor-neprilysin Inhibitor

Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), significantly reduces mortality and morbidity in patients with chronic heart failure with a reduced ejection fraction (HFrEF). However, a considerable number of patients treated with sacubitril/valsartan experience hypotension, oliguria, progressive azotemia, and renal failure as adverse events. These issues have been linked to significant gaps in the usage and dosing of guideline-directed medical therapy with ARNI in patients with HFrEF. We herein report a relevant case of pathologically proven acute tubular necrosis after the first dose of sacubitril/valsartan, highlighting the importance of optimizing the medical therapy in an outpatient with HFrEF.     

常温下半肝血流阻断在肝内胆管结石术中的应用分析

目的：探讨左肝内胆管结石的治疗方法,提高手术切除率,降低手术风险系数。方法：回顾性总结63例左肝内胆管结石患者在常温下阻断左半肝血流,行左肝叶切除、肝内含石胆管直视下切开取石和肝胆管Roux-en-Y胆肠吻合等手术后,患者术后并发症、肝内胆管结石的复发率、再手术率以及术后患者的肝功能恢复情况等。结果：本组无手术死亡,治愈率82.4%,好转率17.6%,残石率8.3%。并发症23例,胆漏2例,膈下感染4例,切口感染9例,术后转氨酶升高6例,消化道出血2例,全部并发症经非手术治疗全愈。经1～8年随访,复查B超、CT、肝功等检查,随访率87.7%;复发6例,复发率9.52%。结论：该方法可以控制肝切除术中的失血,保留了健侧肝脏的血运,术中及术后对肝功能损伤较轻。是一种比较简单、可行、合理的肝血流阻断方法。     

胸痛特征诊断冠心病的准确性

目的 探讨胸痛特征诊断冠心病的准确性.方法 连续入组2012年6月至2016年6月经过冠状动脉造影(CAG)和冠状动脉血流储备分数(FFR)检查的住院患者240例,根据临床病史的描述将患者分成无胸痛组(55例),不典型胸痛组(79例),典型劳力心绞痛组(64例)和支架植入组(42例).将不同胸痛性质与CAG和FFR进行...     

Evolution of thrombolytic therapy in patients with HeartWare ventricular assist device thrombosis: a single-institutional experience

Open in a separate window OBJECTIVESPump thrombosis remains a major challenge in heart failure patients with left ventricular HeartWare assist device. Current International Society for Heart and Lung Transplantation recommendations favour surgical pump exchange over lysis because safety and efficacy of lysis has been controversially reported. This study summarizes our experience on our HeartWare thrombosis prevention strategy as well as thrombolysis through implementation of our institutional standardized HeartWare assist device protocol.METHODSOutcomes of all HeartWare thrombosis patients admitted between 2010 and 2020 were analysed. Thrombolysis therapy using tissue plasminogen activator was used as the first-line therapy in this study and thrombolysis therapy efficacy was defined as freedom from stroke, bleeding, recurrent HeartWare assist device thrombosis or surgical device exchange within 30 days after lysis application.RESULTSA total of 507 patients have been included in this study and 66 patients (13%) collectively developed a first HeartWare-thrombosis after a median of 12 months (8–22 months) after HeartWare implantation. Forty patients were treated with unstandardized lysis, of whom 7 patients had thrombolysis associated complications, such as incomplete thrombus resolution requiring surgical pump exchange in 4 patients, but also intracranial haemorrhage occurring in 3 patients. Three patients died in the non-protocol group. Eight device thrombosis patients were treated according to our protocol, showing no lysis-associated complication.CONCLUSIONSDespite current recommendations, preferring surgical HeartWare pump exchange in thrombosis, thrombolysis therapy for first HeartWare thrombosis can be safe and effective in a standardized protocol setting, including anticoagulation adjustment and intensified blood pressure control management.     

Atrial Fibrillation-triggered Ventricular Fibrillation in a Patient with Early Repolarization Syndrome

A 54-year-old man with early repolarization syndrome (ERS) implanted with an implantable cardioverter-defibrillator (ICD) developed persistent atrial fibrillation (AF) three years after the implantation. Similarly, the remote monitoring system begun frequently detecting ventricular fibrillation (VF) and polymorphic ventricular tachycardia (PVT). Longer RR intervals were repeatedly observed just before the initiation of PVT/VF. Catheter ablation for AF successfully diminished both the PVT and VF events.     

Phospholamban p.Arg14del Cardiomyopathy: A Japanese Case Series

Phospholamban p.Arg14del is reported to cause hereditary cardiomyopathy with malignant ventricular tachycardia (VT) and advanced heart failure. However, the clinical courses of Japanese cardiomyopathy patients with phospholamban p.Arg14del remain uncharacterized. We identified five patients with this variant. All patients were diagnosed with dilated cardiomyopathy (DCM), developed end-stage heart failure and experienced VT requiring implantable cardioverter defibrillator discharge. Four patients survived after implantation of a left ventricular assist device (LVAD), while one patient who refused LVAD implantation died of heart failure. Based on the severe course of the disease, we propose genetic screening for phospholamban p.Arg14del in DCM patients.     

持续非卧床腹膜透析患者左心室肥厚与血清N-末端脑钠素原水平的关系

目的探讨持续非卧床腹膜透析（CAPD）患者左心室肥厚（LVH）与血清N-末端脑钠素原（NT-proBNP）水平的关系。方法连续入选32例接受CAPD治疗1年以上患者,超声心动图检查测算左心室心肌质量指数（LVMI）;根据LVMI将入选者分为左心室肥厚组和左心室正常组,双抗体夹心酶标免疫法测定两组患者血清NT-proBNP水平。结果入选CAPD患者中,左心室肥厚组17例,左心室正常组15例,左心室肥厚组血清NT-proBNP（6234.21±854.43）pg/ml较左心室正常组血清NT-proBNP（2456.23±576.98）pg/ml水平明显升高（P〈0.01）,且NT-proBNP水平与LVMI呈正相关（r=0.625,P〈0.01）,NT-proBNP诊断LVH的ROC曲线下面积为0.912。结论 CAPD合并LVH患者血清NT-proBNP水平明显升高,与LVMI呈正相关且有诊断价值,NT-proBNP可能是预测CAPD患者合并LVH的一个新指标。     

用Amplatzer导管封堵器介入闭合先天性膜周部室间隔缺损

目的 研究Amplatzer导管封堵器(ADO)介入闭合先天性膜周部室间隔缺损(VSD)的可行性、安全性和有效性，确定其适应证和并发症。方法 2001年5月至2002年12月，经导管闭合先天性膜周部VSD4l例，VSD直径4～12．8(平均6．0)mm，其上缘距离主动脉右冠瓣4．5～12(平均6．6)mm。心导管资料示QP／QS 1．4～2，6(平均1．7)，肺动脉收缩压19～34(平均25)mmHg。4l例膜周部VSD中，18例伴有膜部膨出瘤。结果 4l例VSD均顺利闭合成功，选用的ADO尺寸为6／4～16／14mm。术后心脏杂音立即消失，选择性左心室造影及经胸超声心动图均无明显残余分流。胸片示肺血管影较术前减少。心电图有12例出现不完全性右束支传导阻滞，l例出现完全性左束支传导阻滞．均在l～2周内自行消失。随访2～21个月，临床及实验室资料进一步改善，未见ADO移位、主动脉瓣或三尖瓣返流及其他并发症。结论 用ADO介入闭合先天性膜周部VSD是完全可行的，而且具有操作简便、安全高效、并发症少和费用较低等优点。     

运动员心动时相及左室顺应性观察

作者认为,对运动员左室功能的全面评价,应包括收缩和舒张功能两个方面,而不应该只是前者。文章提出XJY-6型心脏机能诊断仪可一机多用,尤以对LVEdp和ΔV/ΔP的测试,能为医务监督提供有价值的参据。