A case of a persistent left vena cava superior with atresia of the right atrial ostium of the coronary sinus

A persistent left vena cava superior with an atretic ostium of the coronary sinus was found during the routine dissecting course in the embalmed cadaver of an 83-year-old woman who had died from cardiac infarction. The left vena cava superior was very narrow in diameter (4 mm), originated at the lateral part of the left vena brachiocephalica and ran down between the venae pulmonales sinistrae and the auricula sinistra. The vena cava opened into the sinus coronarius of the heart, which terminated as a blind sac due to an atretic ostium. The vena coronaria sinistra as well as the vena interventricularis posterior drained into the sinus coronarius. Congenital atresia of the coronary opening is a rare malformation and is usually associated with other anomalies. The congenital ostial atresia could be the cause of a persistent left vena cava superior, which then takes over the drainage of the cardiac veins.     

Aneurysms of the sinus of Valsalva: Morphology and long term surgical results

Objective One hundred and forty seven patients with aneurysm of sinus of Valsalva (ASV) underwent surgery between January 1977 and June 2000. The morphological features and the surgical outcome in these patients were analyzed. Patients and Methods The age ranged from 5 to 62 years (mean 27.0<11.5 years), and all were congenital in aetiology. The aneurysm originated from the right coronary sinus in 116 (78.9%), from the non-coronary sinus in 25 (17%) from the left coronary sinus in 1 (0.6%) and from more than one sinus in 5 patients. In 14 patients (9.5%) the ASV remained unruptured. It ruptured into the right ventricle in 87, into the right atrium in 40 and into the left ventricle in 3 patients. In 11 instances, the ASV dissected into the interventricular septum. A ventricular septal defect was present in 63 (43%) patients and in the majority (n=56) it was subarterial. Moderate to severe aortic regurgitation was present in 43 patients. Surgical correction was through a bicameral approach (n=111) or through the aorta (n=28) or the chamber of rupture (n=8). Results There were 3 operative deaths and 5 late deaths over a follow up of 2 months to 23 years (mean 100.7<64.7 months). Acturial and event free survival at 23 years were 94.0%<3.0% and 82.0%<6.0% respectively. Presence of moderate or severe aortic regurgitation was significantly associated with reduced event free survival. A comparison of the Indian patients with patients collected from the literature, revealed that the Indian patients represent a separate subset of patients and can be placed in middle of the spectrum between the Oriental and the Western patients. Conclusion Indian patients represent a different set of patients. Adequate surgery yields gratifying early and late results.     

高血压病人昼夜血压变化与靶器官损害的关系

目的 研究高血压病人昼夜血压变化与靶器官损害的关系及其临床意义。方法 将６８例原发性高血压Ⅰ期和Ⅱ期病人,按照血压昼夜变化分为杓型组。比较两组病人２４小时动态血压及尿微量蛋白、空间隔厚度、左心室舒张末直径、左心室后壁厚度、左心室重量。结果：非杓型组左心室重量和平均２４小时动态血压、夜间收缩压、睡眠时最低舒张压,与杓型组比较有显性差异。结论 非杓型组原发性高血压病人靶器官损害程度较杓型组病人更为明     

高血压患者动态血压监测的临床意义

目的 :借助动态血压监测 ( ABPM)和心脏超声探讨轻中度高血压患者其左室肥厚与血压昼夜节律的关系。方法 :91例轻中度高血压左室肥厚患者进行 ABPM监测 ,根据监测结果将其分为 2组 :血压节律正常者 3 5例 ( A组 ) ,异常者5 6例 ( B组 ) ,将这两组患者 ABPM和左室肥厚的参数进行比较。结果 :B组比 A组有较高的 2 4h SBP,n SBP,n DBP、收缩压负荷以及明显的 L VMI。结论 :轻中度高血压患者其异常血压昼夜节律与左室肥厚密切相关 ,ABPM监测能够为判断高血压患者的病情严重程度与预后提供依据。     

Giant extracardiac unruptured aneurysm of the sinus of Valsalva: a case report

Extracardiac unruptured aneurysm of the sinus of Valsalva (ASV) is rare and difficult to diagnose accurately by echocardiography or cardiac catheterization preoperatively. A 63-year-old woman, with dyspnea and palpitations, diagnosed with aortic regurgitation (AR) with congestive heart failure and extracardiac unruptured ASV, was referred to our hospital for surgical repair. The unruptured ASV was well visualized by magnetic resonance imaging (MRI), and diagnosed as an extracardiac type. Surgical repair was performed by aortic valve replacement and aneurysmectomy. It was concluded that early surgical repair of extracardiac ASV should be considered to prevent sudden death, and MRI is an accurate and useful method for preoperative diagnosis. Received: February 15, 2001 / Accepted: May 22, 2001     

鼻窦CT值对鼻窦手术的指导意义

目的 探讨鼻窦CT值对鼻窦手术的指导意义。方法 将106例鼻窦疾病患者的CT值与鼻窦手术结果进行对比分析。结果 鼻窦CT值与临床诊断符合率为90.5％。结论 鼻窦CT检查结合标记CT值对指导鼻窦手术有重要意义。     

A 5-HT1B receptor agonist inhibits light-induced suppression of pineal melatonin production

Serotonin (5-HT) modulates the phase adjusting effects of light on the mammalian circadian clock through the activation of presynaptic 5-HT_1B receptors located on retinal terminals in the suprachiasmatic nucleus (SCN). The current study was conducted to determine whether activation of 5-HT_1B receptors also alters photic regulation of nocturnal pineal melatonin production. Systemic administration of the 5-HT_1B receptor agonist TFMPP attenuated the inhibitory effect of light on pineal melatonin synthesis in a dose-related manner with an apparent ED₅₀ value of 0.9 mg/kg. The effect of TFMPP on light-induced melatonin suppression was blocked by the 5-HT₁ receptor antagonist, methiothepin, but not by the 5-HT_1A antagonist, WAY 100,635, consistent with the involvement of 5-HT_1B receptors. The results are consistent with the interpretation that activation of presynaptic 5-HT_1B receptors on retinal terminals in the SCN attenuates the effect of light on pineal melatonin production, as well as on circadian phase.     

Nonphotic phase-shifting in Clock mutant mice

Nonphotic phase-shifting was studied in mice bearing the Clock mutation. First, free-running mice heterozygous for Clock and wild-type mice were induced to become active through a 4-h confinement to a novel running over 3 days. Second, mice exposed to light–dark cycle received daily hypocaloric food during 2 weeks, before being transferred to constant darkness and fed ad libitum. Behavioral activation during the mid-subjective day induced 40-min phase advances in the locomotor activity rhythm of wild-type mice, whereas it produced 50-min phase delays in the circadian behavior of Clock/+ mice. Calorie restriction phase-advanced by 80 min the locomotor activity rhythm in wild-type mice, but not in Clock/+ mice. Therefore, the response of the Clock/+ mice to nonphotic phase shifting differs from that of wild-type mice.     

Ⅱ型糖尿病患者血压状况分析

目的 研究糖尿病患者的血压状况,为糖尿病患者靶器官损害的防治提供依据.方法 对1997年7月至1999年10月在我院诊断的、偶测血压不高的Ⅱ型糖尿病患者43例和46名健康对照者进行动态血压监测,取24 h平均收缩压(24 h MSP)、24 h收缩压负荷值(24 h SPL)、24 h平均舒张压(24 h MDP)、24 h舒张压负荷值(24 h DPL)、白天平均收缩压(dMSP)、白天收缩压负荷值(dSPL)、白天平均舒张压(dMDP)、向天舒张压负荷值(dDPL)、夜间平均收缩压(nMSP)、夜间收缩压负荷值(nSPL)、夜间平均舒张压(nMDP)和夜间舒张压负荷值(nDPL),对受检者的血压昼夜节律及血压波动情况进行统计学分析.结果 糖尿病组的24 h MSP、dMSP、nMSP、24 h SPL、dSPL及nSPL与对照组比较,差异均有显著性意义(P＜0.01);非杓型血压及血压波动检出率亦明显高于对照组(P＜0.01);而24 h MDP、dMDP、nMDP、24 h DPL、dDPL、nDPL与对照组比较差异无显著性意义(P＞0.05).结论 糖尿病患者在临床上出现高血压之前已经出现收缩压升高、血压昼夜节律异常及血压波动,故控制糖尿病的慢性并发症应首先控制高血压,调整其异常的血压节律.动态血压监测能早期发现血压节律的异常.     

经冠状静脉窦射频消融心外膜旁道

报道 13例左侧心外膜旁道的特点和经冠状静脉窦射频消融的结果。 13例左侧旁道患者先经心内膜标测和消融 ,如不成功改由经冠状静脉窦标测 ,记录到旁道电位或最早激动的V波或逆传A波即进行消融。结果 :13例患者全部成功 ,平均放电 1.5± 0 .6次 ,能量 2 1± 4W ,时间 2 1± 9s。成功消融靶点 :左侧游离壁 2例、左后间隔冠状静脉窦憩室 4例、心中静脉 7例。 11例有效靶点均标测到振幅较大的旁路电位 ,其振幅大于A波和V波 ,与二者之比均大于 1。结论 :冠状静脉窦标测到振幅较大的旁道电位是左侧心外膜旁道的重要标志 ;冠状静脉窦消融可以有效地阻断心外膜侧旁道