老年心房颤动病人华法林抗凝治疗的有效性安全性评价

目的　评价华法林用于老年心房颤动病人抗凝治疗的有效性、安全性。方法　选择符合本研究抗凝标准的132例老年心房颤动病人随机分为两组 ,华法林治疗组 (治疗组 ) 5 8例 ,给予华法林 3mg/ d开始 ,监测凝血酶原时间(PT)及国际标准化比值 (INR) ,7～ 15 d使 INR达到 1.8～ 2 .5范围内 ,以后每月查 1次 INR。若病人增加或减少药物有出血倾向时随时再测 INR。阿司匹林对照组 (对照组 ) 74例 ,给予阿司匹林 30 0 mg/ d,分 2次口服 ,密切随访。结果　治疗组 7～ 15 d,平均 (9.1± 2 .8) d,INR达 1.8～ 3.0 (平均 2 .1± 0 .13) ,其中 INR在 1.8～ 2 .5 (平均 1.92±0 .2 3)之间者占 92 .7% ,治疗组有 1例心瓣膜病人出现脑梗死 ,而对照组有 7例发生脑梗死 ,差异显著 ,其余不良反应率两组差异无显著性。结论　老年心房颤动病人选择华法林 2～ 3mg/ d时 ,加强服药后监测及各药物间的相互作用 ,使 INR保持在 1.8～ 2 .5之间是有效、安全的     

慢性心房颤动患者心室率变化意义的探讨

目的分析探讨慢性心房颤动患者心室率变化的意义，为临如何预防心房颤动患者出现脑栓塞、心功能降低等并发症提供理论依据。方法将入院或门诊就诊病程超过1年的慢性心房颤动患者分为脑栓塞组和非脑栓塞组，各30例，观察比较两组患者临床特征，动态心电图计数比较两组患者最大心室率、平均心室率及最小心室率变化，超声心动图测定两组患者左房内径大小、左室射血分数变化，血浆凝血酶原时间凝固法测定两组患者血浆凝血酶原时间国际标准化比值（INR）变化。结果两组患者一般临床特征、左房内径大小、INR值比较。差异无统计学意义。脑栓塞组最大心室率、平均心室率及最小心室率均明显快于非脑栓塞组，左室射血分数明显低于非脑栓塞组。结论慢性心房颤动患者降低心室率对预防脑栓塞、左心功能降低有重要意义。     

不同压力下人脐带静脉的形态变化

运用扫描电镜和光镜观察了人脐带静脉的形态结构及其在0～8.0kPa 压力下的变化.脐静脉结构类似中等动脉.内皮细胞和内弹力膜的形态随实验压力增大而改变.6.7～7.3kPa是脐静脉内膜的临界破坏压,5.3～6.7kPa 是制备脐静脉作为管道移植材料的最佳压力.     

Effect of atrial pacing therapy with selective pacing algorithms on paroxysmal atrial fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia among the elderly. Its incidence increases dramatically with increasing age and decreasing left ventrieular function, peaking in subjects with overt congestive heart failure, Because of the unsatisfactory efficacy and possible serious side effects of clinically available anti-AF drugs for AF patients with sick sinus syndrome, pacing techniques have recently been applied in the treatment of AF. The cardiac pacemaker Vitatron     

Interatrial septum rupture during balloon measurement of a patent foramen ovale in a young patient presenting cryptogenic stroke.

We report the case of a 36-year-old woman admitted for cryptogenic stroke, in whom the Patent Foramen Ovale (PFO) diameter measurement, with a purpose built sizing balloon, performed before the closure procedure, was complicated with the rupture of the inter-atrial septum generating an Atrial Septal Defect (ASD) with a significant left-to-right shunt. This kind of complication may not be easy to handle, changing the initial procedural strategy from PFO to ASD closure technique requiring specific material and operator's technical skill.     

The vanishing vast ventricular thrombus.

A 54-year old man presented with multiple pulmonary emboli and an incidental finding of a huge left ventricular thrombus. Transthoracic echo images demonstrated a globally dilated heart with very poor left ventricular function. It was elected to manage the patient medically, and he was commenced on warfarin therapy, resulting in completed resolution of the thrombus over 10 weeks. No underlying cause was found and he did not experience any further embolic events. This illustrates a rare case of a large ventricular thrombus in a patient with no underlying risk factors.     

Recurrence of left atrium-pulmonary vein conduction following successful disconnection in asymptomatic patients.

BACKGROUND: The clinical significance of conduction recurrences in isolated pulmonary veins of patients with atrial fibrillation is not established. METHODS: Twenty-two patients with paoxysmal atrial fibrillation underwent successful pulmonary vein isolation. Six months after the procedure, 14 patients were free of atrial fibrillation. Two of these patients were subjected to repeat mapping of the left superior pulmonary vein. RESULTS: There was recurrence of pulmonary vein to left atrium conduction despite complete lack of symptoms or evidence of recurrent atrial fibrillation. CONCLUSION: Successful pulmonary vein isolation with abolition of paroxysmal atrial fibrillation does not confer permanent disconnection of the pulmonary vein musculature from the left atrium.     

Epicardial radiofrequency ablation for chronic atrial fibrillation undergoing simultaneous on-pump beating coronary artery bypass grafting

Off-pump coronary artery bypass grafting has become an attractive surgical alternative for myocar-dial revascularization because of the advantage of myocardial protection and other benefits of patients. However, it is still regarded as a controversial treatment for the coronary artery disease accompanied by atrial fibrillation (AF). A significant number of patients in need of coronary revascularization have chronic AF. Although the Cox-Maze III procedure is the gold standard for the surgical treatment of AF, few of these patients undergo AF operations at the time of their coronary bypass grafting. We report herein a case of the pulmonary vein isolation to eliminate the AF by means of epicardial radiofrequency ablation combined with 2 vessels coronary artery bypass grafting on the beating heart with the aid of cardiopulmonary bypass.     

多普勒超声心动图对儿童急性肾炎早期左室舒张功能的研究

目的　采用多普勒超声心动图评价儿童急性肾炎 (AGN)早期左室舒张功能 (LVDF)损害的严重程度及疗效观察。方法　将 76例急性肾炎患儿按病情程度分为轻度、重度两组与 5 4例健康对照组进行对照。应用HP - 10 0 0型超声诊断仪 ,分别于治疗前和治疗后 2周测定二尖瓣舒张早期峰值流速 (EV)、二尖瓣舒张晚期峰值流速 (AV)、EV AV比值、舒张早期充盈分数(EI)、舒张晚期充盈分数 (AI)、EI AI比值、E峰加速时间 (AT)、E峰减速时间 (DT)、DT AT比值、肺静脉收缩期最大前向血流速度(S)、舒张期最大前向血流速度 (D)、D S比值、左房内径 (LA)、主动脉内径 (AO)、LA AO比值等 11项指标。结果　EV AV、EI AI、LA AO、D S是判断LVDF损害的重要指标 ;LVDF损害与病情严重程度有关 ,其中 ,EV、EV AV、EI、EI AI、AT、D S随病情加重而降低 ,AV、AI、DT、DT AT、LA AO随病情加重而增高 ;EI、AI、AT、DT、DT AT是评价其疗效的重要指标 ;治疗后 ,LVDF恢复时间晚于临床症状恢复时间。结论　上述指标可动态检测LVDF ,对指导临床诊治具有重要意义。同时该检测方法操作简便易行、重复性强、无痛苦 ,结果较为精确。     

Regional left atrial voltage in patients with atrial fibrillation

BACKGROUND: Regional differences in fibrosis, particularly related to the posterior wall and septum, may be important in atrial fibrillation (AF). Using electroanatomic mapping, voltage can be used as a measure of fibrosis. OBJECTIVES: The purpose of this study was to determine if patients with AF have disproportionately lower voltage in the septal and posterior walls of the left atrium. METHODS: Sinus rhythm left atrial electroanatomic maps were used in serial patients presenting for left atrial ablation of AF (8-mm tip). Patients undergoing left atrial mapping for focal atrial tachycardia (AT) were used as a comparison group (4-mm tip). Animal experiments were performed to assess the influence of ablation catheter tip size on voltage amplitude. RESULTS: The posterior and septal walls exhibited the lowest voltages in both groups. Compared with the anterior wall, there was a 3.78-fold greater odds of finding a low-voltage point (<0.5 mV) in the septum (P <.001) and a 3.37-fold greater odds of finding a low-voltage point in the posterior wall (P <.001) in the AF patients; the proportion of low-voltage points by region were not significantly different in the AT group. In the animal model, the mean voltage obtained from an 8-mm ablation catheter was significantly higher (0.30 +/- 0.17 mV) than that obtained from the same points using a 4-mm catheter (0.22 +/- 0.17, P = .05). CONCLUSION: Regional differences in voltage are present in patients with atrial arrhythmias, with AF patients exhibiting significantly more low-voltage areas in the septum and posterior walls.