Maternal and perinatal outcome in rheumatic heart disease.

OBJECTIVES: To study the maternal and perinatal outcome of pregnancies complicated by rheumatic heart disease. METHODS: A retrospective study was carried out in the cardio-obstetric clinic of the Postgraduate Institute of Medical Education and Research, Chandigarh (India) over a period of 13 years (1987-1999) involving 486 pregnant patients with rheumatic heart disease. Maternal and perinatal outcome was reviewed. RESULTS: Three hundred and four patients (63.3%) had single valve involvement and mitral stenosis was the most predominant lesion (89.2%). One hundred and seventy one (38.6%) patients had undergone surgical correction prior to the onset of pregnancy. One hundred and thirteen patients (22.6%) were identified as NYHA class III-IV. Mitral valvotomy was performed during pregnancy in 48 patients. The incidence of preterm birth and small for gestational age newborns was 12% and 18.2%, respectively. There were 10 maternal deaths, of which eight patients were NYHA III and IV. CONCLUSIONS: Rheumatic heart disease in pregnancy is associated with significant maternal and perinatal morbidity in NYHA class III-IV patients.     

气囊扩张对74例良性溃疡伴幽门梗阻的长期疗效再探讨

目的　再次评价气囊扩张对良性消化性溃疡伴幽门梗阻的长期疗效。方法　患者先行内科保守治疗 ,保守治疗不成功再行内镜下气囊扩张术。幽门螺杆菌阳性均给予根除治疗 ,抗溃疡病药物治疗至少一个月。结果　 74例幽门梗阻中有 4 3例内科保守治疗成功 ,另 31例行气囊扩张术 (最大直径 1 2～ 1 4 mm) ,平均扩张次数为 1 .6 8±0 .83次。在随访 2 1 .0 6± 1 3.1 3个月中 ,梗阻的复发率分别为 4 .6 5 %和 1 6 .1 3% (P>0 .0 5 ) ,两组均未见并发症。结论　幽门梗阻气囊扩张术是一种安全、有效的方法 ,最终用多大直径的球囊扩张以梗阻症状解除为准 ,对良性溃疡伴幽门梗阻 ,即使是瘢痕型梗阻首选球囊扩张 ,如扩张不满意者才考虑手术治疗。     

Balloon Dilatation of the Pulmonary Valve in a Patient with Pulmonary Atresia and Intact Ventricular Septum Using a Commercially Available Radiofrequency Catheter

Using a commercially available 5F deflectable radiofrequency catheter, we have succeeded in percutaneous valvotomy of an imperforate pulmonary valve and consecutive balloon dilatation in a baby with pulmonary atresia and intact ventricular septum. After the procedure, right ventricular systolic pressure fell from 125 mmHg to 65 mmHg, and right ventriculography demonstrated anterograde blood flow into the pulmonary arteries. There were no major complications. Doppler echocardiography at 1 year after the procedure demonstrated a pressure gradient across the pulmonary valve of 20 mmHg with mild pulmonary and tricuspid regurgitations.     

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     

Intravascular ultrasound in interventional radiology

Intravascular ultrasound (IVUS) imaging provides useful additional information to X-ray angiography in selected cases of balloon angioplasty and stent placement with complex vascular anatomy and unclear findings at angiography. It facilitates accurate measurements of the vessel dimensions and reveals the extent of the disease for the selection of proper angioplasty balloon size, as well as confirms full expansion and attachment of the stent or stent graft to the arterial wall. Intravascular US imaging contributes useful information for the basis of planning surgical or endovascular therapy of aortic dissection and is valuable for guiding percutaneous fenestration of the dissection flap. This imaging modality facilitates placement of vena cava filter without cavography and/or fluoroscopy in patients with contraindication for iodine contrast media and/or X-ray fluoroscopy. Technical development may further increase utility of IVUS imaging in interventional radiology. Received: 22 May 2000; Accepted: 7 June 2000     

经皮球囊扩张椎体后凸成形术治疗骨质疏松性椎体骨折68例疗效分析

目的:探讨经皮球囊扩张椎体后凸成形术在治疗骨质疏松性椎体骨折中的临床疗效。方法:2009年10月-2011年4月选择本科68例骨质疏松性椎体骨折患者,在C臂机或CT透视引导下,经单侧或双侧椎弓根入路行经皮球囊扩张椎体后凸成形术。在术前术后应用疼痛视觉模拟量表(VAS)对患者疼痛进行评分,术后随访。结果:治疗后症状得到改善,患者VAS下降(P<0.01),病椎椎体高度增加(P<0.01)。结论:经皮球囊扩张椎体后凸成形术治疗骨质疏松性椎体骨折,可以快速缓解疼痛,安全恢复椎体高度,明显提高生活质量,是一种安全、有效的微创操作技术,     

简易气囊扣带术治疗孔源性视网膜脱离

目的 介绍一种治疗视网膜脱离的简易气囊扣带术.方法 选择5例患者实施气囊扣带术.气囊经球结膜切口插入视网膜裂孔相应部位的球结膜下.扩张气囊,产生顶压效果,促使视网膜下液吸收.术后1～2d在视网膜裂孔周围行眼底激光光凝封闭裂孔.5～7d后取出气囊导管.结果 4例患者一次手术成功,1例因新发生的视网膜裂孔再次脱离,施行传统的巩膜扣带术成功复位.所有病例随访一年以上未发生视网膜的再次脱离.结论 对于特定的孔源性视网膜脱离,气囊扣带术相对于传统的巩膜扣带术而言是简易有效地治疗手段,值得尝试推广.     

SKY椎体后凸成形术与PVP对骨质疏松多椎体压缩骨折责任椎体选择性治疗的比较

目的探讨SKY椎体后凸成形术与PVP对骨质疏松多椎体压缩骨折责任椎体选择性治疗的疗效对比,评价治疗骨质疏松多椎体压缩骨折责任椎体的有效方法。方法分别于术前、术后2周、术后6月、18个月进行疼痛强度视觉类比评分,观察患者的疼痛症状及生活治疗改善程度。结果 52例手术均成功完成,每个椎体的骨水泥灌注量为3-6mL。两组手术方法术前、术后VAS评分P值分别<0.05,余比较不具统计学意义,两组手术方法术前、术后SF-36评分P值分别<0.05,余比较不具统计学意义。结论无论是SKY椎体后凸成形术或PVP对骨质疏松多椎体压缩骨折选择性治疗均可取得良好的效果,相比PVP,SKY椎体后凸成形术更具优势,但价格昂贵,限制了它的使用。     

经皮椎体后凸成形术治疗老年椎体后壁完整的重度骨质疏松性椎体压缩骨折的效果

目的 探讨经皮椎体后凸成形术(PKP)治疗老年椎体后壁完整的重度骨质疏松性椎体压缩骨折(OVCF)的临床效果.方法 回顾性分析2012年1月至2014年1月于本院诊治的47例(54个椎体)OVCF患者临床资料,所有患者均采用球囊扩张复位法进行PKP治疗,治疗后随访18～24个月.对比患者治疗前、后及末次随访时患椎高度、疼痛度评分(VAS)、局部Cobb角及健康调查评分(SF-36),观察临床治疗效果.结果 47例患者治疗前患椎平均高度为(8.4±1.3) mm、VAS评分为(7.9±1.8)分、局部Cobb角为(25.1±5.5)°、SF-36评分为(33.2±6.5)分;治疗后3d患椎平均高度为(12.8±1.9)mm、VAS评分为(2.3±1.1)分、局部Cobb角为(17.2±4.5)°、SF-36评分为(44.5±6.8)分;末次随访患椎平均高度为(12.3±2.1) mm、VAS评分为(2.4±1.3)分、局部Cobb角为(18.3±4.7)°、SF-36评分为(46.3±7.1)允治疗后3d及末次随访数据与治疗前比较差异均具有统计学意义(均P＜0.05),治疗后3d与末次随访数据比较差异无统计学意义(P＞0.05).结论 OVCF患者采用球囊扩张复位法行PKP治疗,安全性高,临床效果明显.