Structure function interface with sequential shortening of basal and apical components of the myocardial band

Objective: To mechanically test the intact cardiac structure to determine the sequence of contraction within the myocardial mass to try to explain ejection and suction. Methods: In 24 pigs (30–85 kg), segment shortening at the site of sonomicrometer crystals was continuously recorded. The ECG evaluated rhythm, and Millar pressure transducers measured intraventricular pressure and dP/dt. Results: Study of segment shortening defined a sequence of contraction within the myocardial mass, starting at the free wall of the right ventricle and on the endocardial side of the antero-septal wall of the left. Crystal location defined underlying contractile trajectory; transverse in right ventricle followed by basal posterior left ventricle, and from the endocardial anterior wall to the posterior apical segment and finally to the epicardial side of the anterior wall. Mean shortening fraction averaged 18±3%, with endocardial exceeding epicardial shortening by 5±1%. Epicardial segment crystal displacement followed endocardial shortening by 82±23 ms in the anterior wall, and finished 92±33 ms after endocardial shortening stopped, time frame that matches the interval of fast drop of ventricular pressure and the start of suction. Conclusions: Crystal shortening fraction sequence followed the rope-like myocardial band model to contradict traditional thinking, with two starting points of excitation–contraction, the right anterior free wall of the right ventricle, and the endocardial side of the anterior wall. Active suction may be due to active shortening of the epicardial fibers of the anterior wall, because relaxation was not detected when both mitral and aortic valves were closed during the interval previously termed ‘isovolumetric relaxation’.     

Laparoscopic cholecystectomy in a patient with a biventricular cardiac assist device.

Evaluation and management of abdominal pathology in patients with ventricular assist devices is likely to become increasingly important as the utilization of these devices expands. Ventricular assist devices represent a class of intracorporeal or paracorporeal mechanical devices that augment cardiac output in patients with congestive heart failure. Patients with ventricular assist devices supporting both right and left ventricles (biventricular assist devices) are uniquely challenging to the general surgeon because these devices restrict direct access to the abdominal cavity and because of the perioperative implications of biventricular heart failure. We describe herein the first reported successful laparoscopic cholecystectomy in a patient with a paracorporeal biventricular assist device. Cholecystectomy was performed in this patient for acute cholecystitis that occurred while the patient was awaiting heart transplantation. Our results add weight to the small body of evidence that laparoscopy is well tolerated in ventricular assist devices patients. The unique aspects of the biventricular assist device patient make laparoscopic abdominal intervention particularly suitable in this patient population.     

主动脉窦瘤破裂的外科治疗：附16例报告

低温体外循环下手术治疗主动窦瘤破裂１６例，采用右房切口１例，右室流出道切口１１例，窦瘤破入腔和主动脉根部双切口４例。单纯窦瘤破口修补２例；双头垫片针窦瘤基部与空间隔踬同并列间断褥式缝合修补３例；     

营养不良的胃肠形态和功能

蛋白质－热能营养不良是儿科常见疾病之一，它与胃肠道形态和功能有密切联系。营养不良可引起胃肠形态异常和功能障碍，而胃肠道形态异常又可引起营养物质吸收障碍，从而进一步造成营养不良。我们认为了解营养不良的胃肠形态和功能有助于儿科医师对本病的治疗。     

室间隔缺损患者肺动脉压的多因素分析

本文对４３例经心导管证实的空间隔缺损患者进行了多因素逐步回归分析，发现在２３项临床参数中，对肺动脉压有显著影响的因素，依次为红细胞压积、周围血管征、空间隔缺损大小、心脏杂音强度、心胸比率（ｒ＝０．８０２８），并初步探讨了各因素对肺动脉压的影响机制，旨在能非创伤性地动态了解患者肺动脉压力，为临床工作提供参考依据。     

Symptomatic cystic dilatation of V ventricle: Case report and review of the literature

We report a case of V ventricular cystic dilatation, presenting with specific neurological symptoms including low back pain, bilateral sciatica, weakness of dorsiflexion, and urinary retention. MRI showed a large cystic dilatation of the ventriculus terminalis. Surgical fenestration of the cyst allowed complete relief from symptoms and remission of the neurological deficit.     

Experimental Assessment of Right Ventricular Function in Normal Pigs with a Left Ventricular Assist Device

Abstract: Right ventricular (RV) failure during the use of a left ventricular assist device (LVAD) is the leading cause of death in circulatory support patients. Previous work, both experimentally and clinically, has shown the difficulties in predicting the behavior of the right ventricle at the start of LVAD. An experimental study has been designed to evaluate RV functional changes during LVAD and its relation to preload changes. The model used adult mongrel pigs (n = 10). Right ventricular functional parameters were measured with a thermodilution RV ejection fraction catheter. The left ventricle was supported by a Nippon Zeon blood pump. Two groups were studied, the first one was the LVAD–off group (n = 5) and the other was the LVAD–on group (n = 5) which was supported by LVAD at maximum flow. Change of cardiac output, mean pulmonary artery pressure (PAP), RV stroke work, and RV ejection fraction in both groups were not significantly different. However, the relationship between right ventricular end–diastolic pressure (RV–EDP) and right ventricular stroke volume (RVSV) was significantly changed at a high level of RV–EDP. When RV–EDP was over 6. 5 mm Hg in the LVAD–off group, RVSV decreased to 52. 3 ± 11. 5 ml while in the LVAD–on group, RVSV increased to 97. 2 ± 22. 0 ml. The change in PAP in the LVAD–on group was lower than in the LVAD–off group. We conclude that, at the volume overload state, LVAD can reduce the afterload of the right ventricle and maintain Frank–Starling's effect, thus having a beneficial effect on right ventricular performance.     

二维多普勒超声对室性早搏的血流频谱分析

观察室性早搏４３例，多普勒频谱表现为峰值流速减慢，早搏使前一组Ａ峰消失，后一组峰值流速增快。１９例早发型，主动脉瓣口、肺动脉瓣口无频谱出现，早搏每搏量因发生时间不同，每搏量减少不同，晚发型平均减少３７．６％，早发型平均减少７９．６％。讨论了产生机理及对心排量的影响。     

高血压病左室肥厚与QTc离散度关系的研究

目的 探讨高血压病病左室肥厚（ＬＶＨ）与非在室肥厚（ＮＬＶＨ）患者ＱＴｃｄ的关系及临床意义。方法 用分层抽样法测定１０３例原发性高血压病患者住院首次１２导联心电图ＱＴｃ离散度（ＱＴｃｄ）其中合并ＬＶＨ患者５７例，合并ＮＬＶＨ患者４６例，并与２０例健康人作对照，结果 ＱＴｃｄＬＶＨ组分别与ＮＬＶＨ组，对照组比较均有非常显著性差异（Ｐ〈０．０１）ＮＬＶＨ组与对照组比较无显著性差异（Ｐ〉０．０５）。结论