Percutaneous balloon aortic valvuloplasty in the treatment of congenital valvu lar aortic stenosis in children

Objective To assess the effect of the balloon valvuloplasty for congenital valvular aortic stenosis (AS) in children.Methods A total of 27 (mean age 6.09 years) children with AS accepted the treatment of percutaneous balloon aortic valvuloplasty (PBAV).The ratios of balloon/valve were 0.95±0.08 for 19 cases of typical AS and 1.00±0.11 for 8 cases of hyp oplastic AS.The patients were evaluated by the gradients across aotic valves i n pre- and post-PBAV and by echocardiogram during the follow-up period.Results Fifteen of 19 （78.9%）cases of typical AS had a better outcome and the gradien t of the remaining 4 cases (26.7%) had increased after follow-up (ΔP>50 mm Hg).Four of 8 (50.0%) cases of hypoplastic AS had satisfactory responses and the gradient of the remaining 3 cases (75.0%) rose.There was no moderate to s evere aortic insufficiency (AI). Conclusion The balloon aortic valvuloplasty provides safe and significant hemodynamic and c linical improvement in pediatric patients.The outcome of PBAV for typical AS is better than for hypoplastic AS.     

顺行和逆行取栓对静脉瓣膜及血管壁的影响

目的：比较顺行取栓与逆行取栓在猪腋静脉急性血栓形成对于其瓣膜功能和静脉壁形态的影响。方法：分别结扎猪的腋静脉的近远端,于结扎段内注入凝血酶原,放置６ｈ使形成血栓。随机分配为顺行取栓和逆行取栓组,对血栓段进行取栓。取栓后２４ｈ行取栓静脉插管逆行造影以评估瓣膜功能;切取此段静脉作ＣＤ８＾＋细胞免疫组化和苏木精－伊红（ＨＥ）染色以对比血管内膜及平滑肌的损伤程度。结果：逆行与顺行取栓在所有的例数中都成功地     

THE VALUE OF 99mTc-MIBI MYOCARDIAL PERFUSION SPECT IMAGING IN DETECTING CORONARY ARTERY DISEASE IN PATIENTS WITH VALVULAR DISEASE BEFORE OPERATION

Objective. The aim of this study was to detect coronary artery disease using ^99mTc-MIBI myocardial perfusion imaging in patients with valvular disease. Methods. Thirty patients with valvular disease confirmed by echocardiography underwent ^99mTc-MIBI myocardial perfusion imaging using multiSPECT lh after stress test (exercise, dipyridamole or dobutamine test) and were performed coronary angiography within 1 month before valvular operation. Results. For 29 out of the 30 patients, the results of ^99mTc-MIBI myocardial perfusion imaging were similar with those of coronary angiography, the concordance rate was 96.7 % and the negative predictabili-ty was 100%. Conclusion. ^99mTc-MIBI myocardial perfusion imaging is a reliable non-invasive method for detecting coronary artery disease in patients with valvular disease and so as to draw up suitable operation programs for them.     

Velocity distributions in the left ventricular outflow tract in patients with valvular aortic stenosis: Effect on the measurement of aortic valve area by using the continuity equation

The cross-sectional velocity distribution in the left ventricularoutflow tract was studied in 40 patients with valvular aorticstenosis. Doppler colour flow mapping and a time-interpolationmethod were used to construct the cross-sectional velocity andtime-velocity integral (TVI) profiles at different levels. Byusing pulsed Doppler, the subaorticflow velocity was sampledfrom the anterior, middle and posterior regions along the diameterof the left ventricular outflow tract (at 0.5 to 1.0 cm proximalto the aortic anulus) in the apical long axis view. Thus, foreach patient, three aortic valve areas were calculated by usingthe continuity equation. Each patient was assigned to one oft/treesubgroups according to the left ventricular ejection fraction(EF): subgroup I with EF25% (n=10), subgroup II with 25%<EF50%(n=17) and subgroup III with EF>50% (n = 13). Velocity distributionsin the three subgroups were compared to each other. Results:(1) The velocity distribution in the left ventricular outflowtract was skewed with the highest velocities and TVIs alongthe anterior wall and septum. The skewness of the velocity distributionwas more pronounced in the apical long axis view than in thefour chamber view (P<0.05). The extent of skewness of theTVI profile was positively correlated to the left ventricularEF both in the long axis view (r=0.63; P<0.001) and in thefour chamber view (r=0–57; P<0.001). (2) Pulsed Dopplersampling from different regions along the diameter produceddifferent TVIs, and therefore yielded significantly differentcalculated aortic valve areas, especially in subgroup III. Due to the skewness of the velocity distribution in the leftventricular outflow tract, location of the pulsed Doppler samplevolume significantly affects the accuracy of aortic valve areacalculation by using the continuity equation, especially inpatients with relatively high left ventricular EF. In patientswith low EF, selection of pulsed Doppler sampling site is lessimportant.     

多平面经食管超声心动图对心瓣膜病合并心内血栓的诊断价值

目的：探讨多平面经食管超声心动图对心瓣膜病合并心内血栓的诊断价值。方法：分别５３例心瓣膜病合并心内血栓的多平面经食管超声心动图（ＭＴＥＥ）和经胸超声心动图（ＴＴＥ）技术的声像图表现。结果：ＭＴＥＥ及ＴＴＥ对心内血栓检出率分别１００％及６９．８％;ＭＴＥＥ能检出云雾状、血液淤滞和絮状新鲜血栓,而ＴＴＥ则无法显示这些声像图。结论：ＭＴＥＥ对心内血栓的检出率高,临床应用ＭＴＥＥ检查心瓣膜病,对选择治疗措     

Measuring health-related quality of life in patients with venous leg ulcers

Introduction: The effect on quality of life by healing leg ulcers is not known and no validated disease-specific tool is available for measuring health-related quality of life (HRQoL) for people with venous leg ulcers. The objective of this paper was to compare four generic instruments [MOS 36-Item Short-Form Health Survey (SF-36); EuroQol (EQ); McGill Short Form Pain Questionnaire (SF-MPQ) and the Frenchay Activities Index (FAI)] used for measuring HRQoL in people with venous leg ulcers, and to offer guidance on the most appropriate tool for researchers. Methods: Two hundred and thirty-three patients with venous leg ulcers were recruited as part of a randomised controlled trial of the cost-effectiveness of community leg ulcer clinics. Subjects completed questionnaires containing the four instruments on three occasions (initial assessment, 3 and 12 months). The discriminative and evaluative properties of the four instruments were compared. Results: All four instruments were acceptable to patients, taking a mean of 19.3 (SD 6.3) min to complete. At initial assessment, the SF-MPQ had poorer discriminative properties than the other three instruments and was not able to distinguish between the different patient groups in relation to age and ulcer duration. The FAI was good at discriminating between the different patient groups (at initial assessment) in relation to age, mobility and ulcer size. At the three-month follow-up, the SF-MPQ was more responsive than the other measures and detected changes in HRQoL, whereas the EQ and SF-36 did not. At 12 months, the SF-MPQ still identified differences and the SF-36 and EQ also did at this stage. Conclusion: In the absence of a validated condition-specific tool for measuring changes in general health status for patients with venous leg ulcers, we make the following recommendations. For evaluating the outcome of interventions with a short-term follow-up (three months) in a clinical study we recommend the SF-MPQ and for 12-month follow-up in a clinical study the SF-36, with or without the SF-MPQ.     

Cerebral venous angiomas: Surgery as a mode of treatment for selected cases

Summary Eleven patients with venous angiomas, 6 males and 5 females ranging in age from 4 to 58, are presented. Four patients presented with intracerebral haematoma and 3 patients had associated cavernous angioma, respectively. Patients with intracerebral haematoma had signs and symptoms due to the localication of the haematoma. The other patients presented with headache, seizures, vertigo, ataxia and mental disturbances. Pre-operative diagnosis was based on computerized tomography, magnetic resonance imaging and cerebral angiography. In 9 surgical cases it was confirmed by histopathological examination of operative specimens.After establishing the type, size and location of the lesion decision for operative treatment was made in nine cases, in four of them because of the presence of an intracerebral haematoma and in 5 of them due to severe disability. Eight of these 9 patients recovered completely and one improved. No severe cerebral oedema was encountered after converging medullary veins were excised and main draining veins partially coagulated.In this small series we encountered an unexpectedly large percentage of venous angiomas causing intracerebral haemorrhage which are commonly considered more benign than other vascular malformations. After reviewing previously reported cases of venous angiomas causing intracerebral haemorrhage and severe neurological deficit we think that the term benign is worth reconsidering. We propose a thorough examination of each case of venous angioma and the operative treatment when appropriate taking into account patients state and location of angioma.     

Incidence of Femoral Vein Occlusion After Catheter Ablation in Children: Evaluation with Magnetic Resonance Angiography

Catheter ablation in children requires placement of multiple large femoral venous sheaths and catheters. Magnetic resonance angiography (MRA) was used to evaluate the effect of indwelling lines on femoral venous blood flow. Between October 1993 and February 1994 a total of 17 patients scheduled for catheter ablation underwent venous MRA. Two-dimensional time-of-flight MRA was performed 12–70 hours after catheterization on all patients. All patients received intravenous heparin during the procedure and had aspirin therapy instituted after ablation. Eighteen catheter ablations and MRA studies were performed on the 17 patients (one patient underwent repeat ablation). There were 7 females and 10 males, with a mean age of 14.8 ± 4.2 years (range 8–21 years). Patients had three venous sheaths inserted in the left femoral vein (5F, 6F, and 7F with external diameters measuring 1.7, 2.0, and 2.3 mm, respectively) and one sheath in the right femoral vein (7F). Four patients (22%) had altered venous flow (two complete obstructions and two partial obstructions) following catheterization. None of these patients experienced symptoms or complications. It was concluded that there is an increased incidence (22%) of venous obstruction following catheter ablation, but there are no related complications. Venous MRA provides a rapid, noninvasive method for evaluating venous flow abnormalities and possibly detects patients at risk for complications.     

Assessment of adolescent varicocele

Varicocele is the most important male factor responsible for decreased fertility potential in married couples. From March through June 1994, 2,470 school boys aged 10–20 years were examined to establish the incidence of consecutive grades of varicocele and to develop a protocol for diagnosis and treatment of adolescents with varicocele. Grade 1 varicocele was found in 18%, grade 2 in 12%, and grade 3 in 5% of the population examined. An original protocol of ultrasonographic (US) examination (previously verified by angioscintigraphy) was introduced to assess boys with clinically diagnosed varicocele. The volume of each testis, testicular volume decrease (TVD), pampiniform vein diameter (PVD), and basal (BBF) and maximum blood flow (MBF) velocities were measured in 625 boys. In 74 cases a semen analysis was performed. The statistical analysis revealed that the presence of venous reflux and PVD correlated with the grade of varicocele. Decreases in testicular volume were highly dependent on the grade of varicocele, PVD, and BBF and MBF velocities. Analysis of the relationship between spermatic (boys over 17 years) and US findings revealed that the quality of spermatogenesis can be predicted by US examination in adolescents with varicocele. The authors recommend multiparametric US examination as a reliable, objective, and repeatable technique for establishing criteria for operative treatment in boys under 18 years of age with varicocele as well as for postoperative evaluation.     

Venous graft repair following brachial artery thrombosis in a neonate

A case of venous graft repair to recover blood flow of a newborn's upper extremity, is described. Eventhough this complication remains uncommon, we emphasize on to avoid brachial artery for vascular monitorization and to perform microsurgical revision as elective procedure if conservative therapy is unsuccessful. Accepted: 4 February 1997