胃粘膜瓣成型预防食管胃吻合术后反流的观察

目的:介绍胃粘膜瓣成型预防食管胃吻合术后反流的临床应用.方法:食管、贲门癌50例,行部分食管部分胃切除,用吻合器作食管胃吻合后行胃粘膜瓣成型.结果:成型组术后无反流症状,上消化道造影及放射性核素显像表明该手术方法抗反流作用明显.食管镜检查示胃粘膜瓣成型组吻合口粘膜充血、水肿、糜烂、溃疡较常规手术组明显减轻.结论:胃粘膜瓣成型术可有效预防食管胃吻合术后胃食管反流.     

Stepwise interventional approach in a neonate with pulmonary valve atresia and intact ventricular septum

In neonates with pulmonary atresia and intact ventricular septum the aims of therapy are maintenance of pulmonary blood flow and right ventricular decompression in order to achieve right ventricular support of the pulmonary circulation. Recent developments in interventional heart catheterization with pulmonary radiofrequency-assisted balloon valvuloplasty and ductal stent implantation offer an alternative to the classical surgical approach. We report on a neonate with membranous pulmonary atresia and intact ventricular septum, in whom a large interatrial right-to-left shunt via the foramen ovale persisted after radiofrequency-assisted pulmonary balloon valvuloplasty on the 2nd day of life. The interatrial shunt prevented adequate right ventricular filling and antegrade pulmonary perfusion leading to severe cyanosis (transcutaneous oxygen saturation 40%). In order to increase pulmonary blood flow and raise left atrial pressure, the arterial duct was stented. After ductal stenting, prostaglandin was discontinued and the transcutaneous oxygen saturation remained stable around 89%. At follow up after 7 weeks the foramen ovale had decreased in size and only a small left-to-right shunt was present, documenting the effectiveness of this approach. Conclusion Based on the present case we propose a stepwise interventional approach for the neonate with pulmonary atresia and intact ventricular septum. If cyanosis persists after isolated pulmonary valvuloplasty despite adequate right ventricular function, ductal stent implantation can reduce interatrial shunting and thus improve oxygen saturation. Received: 12 January 1998 / Accepted: 15 February 1998     

Management of Rheumatic Mitral Stenosis With Annular Calcification During HeartMate 3 Implantation

There is a lack of data-driven consensus on the treatment of mitral stenosis at the time of left ventricular assist device implantation. The presence of severe mitral annular calcification further complicates mitral valve intervention. This case report presents a 72-year-old woman with severe mitral stenosis and severe annular calcification with end-stage ischemic cardiomyopathy who underwent HeartMate 3 (Abbott Cardiovascular) implantation. The mitral valve pathology was successfully managed with concomitant open balloon valvuloplasty and surgical commissurotomy on a fibrillating heart without aortic cross-clamp. This approach avoided the need for mitral valve replacement and the potential risks associated with annular decalcification and reconstruction. Longer follow-up is needed to determine its effectiveness over time.     

Studies on percutaneous transvenous mitral commissurotomy using a modified transseptal approach

Summary A modified version of Brockenbrough's trans-septal catheterization technique was carried out in 11 patients indicated for percutaneous transvenous mitral commissurotomy (PTMC). In 8/11 (72.7%), a coiled guide-wire was successfully inserted through theforamen ovale without atrial septal puncture. The Brockenbrough needle was used merely to maintain stiffness and the orientation of the dilator. PTMC was performed with an Inoue single balloon without incident.Patent foramen ovale was found by transesophageal echocardiography prior to the operation in only 1/11 patients (9.0%); nonetheless, it proved not to be a critical factor for the success of the procedure. This procedure seems to have much potential to enable the treatment of mitral stenosis with a lowered risk to the patient, as long as it is performed with precision and caution.     

Catheter balloon valvuloplasty of stenotic aortic valves. Part I: Anatomic basis and mechanisms of balloon dilation

Catheter balloon valvuloplasty of stenotic aortic valves has met with generally poor short- and long-term clinical results. Part of this problem resides with the lack of recognition of various etiologies of aortic stenosis. Part I of this review discusses the various etiologies of aortic stenosis and provides an anatomic basis for successful valve dilation. Results of an in vitro study indicate stenotic aortic valves are dilated by various mechanisms (cracking, stretching) based in part upon the etiology of the aortic valve stenosis.     

二尖瓣狭窄伴房颤球囊扩张术术前抗凝及术后复律探讨

对 2 6例二尖瓣狭窄 (MS)合并心房颤动 (Af)患者 ,在行经皮球囊二尖瓣扩张术 (PBMV)前给大剂量肝素短程抗凝 ,并对其中 1 9例在术后即给予同步直流电复律。结果　二尖瓣口面积 (MVA)由 0 92± 0 2cm2 扩大至 1 95± 0 3 7cm2 ,左房平均压 (LAP)由 3 1 2± 1 2 7kPa降至 1 4 2± 0 85kPa,而左房内径 (LAD)由 52 7± 8 1mm缩小至 4 2 5± 5 9mm。 2 6例均无血栓栓塞并发症及出血并发症 ;1 9例术后即刻行同步电复律者 1 5例 ( 78 9% )复律成功。     

肺动脉瓣球囊扩张术前后应用多普勒超声估测跨瓣压差的临床价值研究

目的 通过与心导管测量对比来评价经皮肺动脉瓣球囊成形术（PBPV）前后应用Doppler超声心动图估测跨瓣压差的临床价值。方法 对178例患者在行PBPV术前利用Doppler测量肺动脉瓣跨瓣压差（△P’）,与相应的心导管测量值（△P）作相关性分析;并利用Doppler对PBPV术后48例患者进行了4～102个月（平均19.5个月）的随访。结果Doppler测量的△P’值与导管测量的△P值之间有着良好的直线相关性,r值为0.80,P<0.05;随访中Doppler测量的△P’值与PBPV术后即刻导管测量的△P值之间差异无显著性（P=0.05）。结论Doppler超声作为一种准确、无创、简便而有效的检查方法,对估计PBPV术前肺动脉瓣狭窄程度,评价术后疗效有较高的临床应用价值。