Transesophageal Echocardiographic Analysis of the Systolic Pattern of the Anterior Mitral Leaflet in Patients with Flat Chest

Transesophageal echocardiography was conducted to determine the systolic pattern of the anterior mitral leaflet in patients with flat chest, and to differentiate it from that associated with mitral valve prolapse. The fronto-sagittal index (an index of chest flattening) was determined in 50 subjects using chest radiographs, and was used to classify them into a flat chest group (index < 0.38, n = 28) and a normal chest group (index ≥ 0.38, n = 22). We then used transesophageal echocardiography to examine the anterior leaflet in these subjects. A significant positive correlation was observed between the fronto-sagittal index and the short-to long-axis diameter ratio of the left ventricle in all patients. These parameters, and the left atrial dimension were lower in the flat than the normal chest group. The clear zone area of the anterior leaflet during mid-to late-systole was significantly larger in the flat chest group. However, no intergroup differences existed in the rough zone area of the anterior leaflet or in the middle scallop area of the posterior leaflet. Mitral regurgitation was observed in 20 and 12 subjects in the flat and normal chest groups, respectively. The maximum mitral regurgitant area did not differ between the two groups. The clear zone area of the anterior leaflet increased significantly following inhalation of amyl nitrite in 22 subjects of both groups, but the other areas did not increase. The mitral regurgitant area decreased or disappeared after amyl nitrite at a similar rate in each group. Thus, the decrease in the antero-posterior dimension of the thorax in subjects with flat chest affects the systolic pattern of the clear zone of the anterior leaflet more than that of the rough zone of the anterior leaflet or the posterior leaflet. This systolic pattern in such patients differs from that associated with mitral valve prolapse.     

改良的额肌瓣辅以缝线悬吊减张治疗上睑下垂

目的　为了减少额肌损伤 ,保证额肌瓣转移 ,治疗中、重度上睑下垂 ,术后吻合口无张力愈合 ,加快血运建立的效果。方法　用 3 - 0可吸收缝线横向贯穿睑板上缘提上睑肌腱膜组织 2针 ,经额肌瓣隧道缝至眶上缘骨膜上 ,转移不等边额肌瓣使之无张力缝合。结果　减张手术组 2 5例 ,总优良率 92 % ,常规手术组 34例 ,总优良率 61 .1 8%。结论　本手术方法减少了额肌瓣外侧血管神经损伤 ,增强了额肌的收缩力 ,利用缝线悬吊减张辅助吻合口愈合 ,是治疗中、重度上睑下垂的有效辅助方法     

吻合腓肠浅动脉的游离小腿后侧皮瓣修复手掌软组织及神经缺损

目的 探讨修复手掌软组织及神经同时缺损的新方法。方法 利用吻合腓肠浅动脉的游离小腿后侧皮瓣修复手掌软组织及神经缺损6例。结果 临床应用6例，全部成活，术后10～13个月随访，皮瓣外形近似正常手掌，两点辨别觉为5mm，感觉为S4；患指感觉恢复为S3两例，S4四例。结论 利用吻合腓肠浅动脉皮瓣修复手掌软组织及神经缺损是理想的方法。     

Accessory atrioventricular pathway, supra-, and infrahisian conduction impaired due to mitral annulus calcification

Disorders of conduction occurring simultaneously in both normal and accessory pathways of patients with Wolff-Parkinson-White (WPW) syndrome have only rarely been observed. To our knowledge this is the first report of impaired conduction in both pathways in WPW syndrome due to mitral annulus calcification (MAC). This case of WPW syndrome type A presented the following conduction abnormalities: (1) right bundle-branch block; (2) transient second-degree AV block with prolonged PR interval of the conducted beats; (3) during electrophysiological study, induction of tachycardia, dependent (phase 3) second-degree AV block, and occasionally conduction of two consecutive beats, the second showing an increased H-V interval (from 25 to 60 ms) and left bundle-branch block (LBBB) pattern, due to (4) infrahisian conduction abnormality.     

心脏瓣膜替换术121例报告

目的：总结体外循环下心脏瓣摸替换术的经验，对风心病的治疗提供依据。方法：我院施行心脏瓣膜替换术１２１例，共１４９枚瓣膜，年龄２７～６２岁，术前心功能ＮＹＨＡ分级：Ⅱ级１９例，Ⅲ级７５例，Ⅳ级２７例，心胸比例（Ｃ／Ｔ）０６～０９４。结果：全组术后早期死亡８例，死亡率７％，死亡原因为心律失常３例，低心排３例，呼衰１例，急性心包填塞１例。结论：（１）术前强调强心、利尿、扩血管及纠正水电平衡，术中重视心肌保护及手术操作的准确性，术后继续强心及呼吸机辅助呼吸，维持酸碱及水电平衡，积极补充血容量和纠正心律失常。（２）室性心律失常的防治应加强术前准备，预防低血钾和心肌保护及常规安放心外膜起搏导线等，对低心排者，主张在血容量补足基础上给予正性肌力药物和血管扩张剂，呼衰处理适当延长呼吸支持时间，必要时预防性气管切开。（３）右房、房间隔径路可兼顾二尖瓣、三尖瓣病变处理及连续缝合法行二尖瓣替换术，缩短主动脉阻断时间，缝线与瓣环周围组织张力均匀，可防止瓣周漏的发生，同时线结少，对于防止血栓形成也有一定好处。     

一期动静脉转流与并加压破坏深静脉瓣对比的实验研究

目的:改进一期动静脉转流术的疗效。方法:10只狗双后肢,随机选择一侧后肢行一期动静脉转流,另一侧行一期动静脉转流加水压破坏深静脉瓣。术后30天通过动脉造影进行对比研究。结果:后者能更有效地加速远段深静脉瓣的破坏,使动脉血逆行更远,同时形成更为丰富的侧枝循环,而不会增加肢体肿胀和深静脉血栓的机会。结论:一期动静脉转流加水压破坏深静脉瓣可能是治疗严重肢体缺血更为有效的方法。     

主动脉瓣机械瓣置换术后交替脉

报道４例因主动脉瓣关闭不全行主动脉瓣置换术后的患者在术后早期出现脉搏交替现象，此时心电图为整齐的窦性心律，所记录的脉搏图形高低交替，如扪诊桡动脉时则会发现桡动脉搏数为心电图示心率的一半。患者术后均顺利恢复，显示这一现象为一过性的、良性的过程。推测这一现象出现的原因可能是术后早期主动脉瓣不再有回流，因而巨大的左室腔充盈不足，加之左室收缩力尚低，不能在每次收缩时都能射出同等量的血流所致     

中指近节背侧岛状皮瓣

介绍中指近节背侧岛状皮瓣的应用解剖,该皮瓣的营养动脉为第2掌背动脉,位置表浅,解剖容易,安全可靠。自1990年11月以来,应用该皮瓣修复手部软组织缺损共6例,均获成功。     

Anaesthetic experience with paediatric interventional cardiology

Anaesthetic and sedation techniques, complications and outcomes were reviewed in 176 children undergoing 184 interventional cardiologic procedures. Techniques included sedation only, and ketamine, inhalational or narcotic anaesthesia. Ketamine infusion was the technique most frequently used. Ketamine was associated with a higher incidence of respiratory complications (P < 0.05) than the other techniques. The higher incidence of hypercarbia (15.6 per cent), which did not affect outcome, may be attributable to the use of supplemental sedatives. The incidence of upper airway obstruction (7.8 per cent) was similar to that of previous studies. Vascular compromise resulted from the procedure in 33 patients, necessitating surgical correction in 16. Cardiac perforation occurred in four cases, causing one death. Pulmonary valve stenosis was most amenable to balloon dilatation and aortic valve stenosis least amenable. Ketamine was the anaesthetic agent preferred by cardiologists for use in the catheterisation suite when general anaesthesia was required. Vigilant monitoring by anaesthetic staff is necessary during the procedure, and avoidance of concomitant narcotics is recommended if a ketamine technique with spontaneous ventilation is used. Les techniques anesthésiques et de sédation ainsi que les complications et les issues ont été revues chez 176 enfants subissant 184 procedures cardiaques. Les techniques ont inctu soil la sédation seulement, soit l’anesthésie à la kétamine, aux agents d’inhalation ou aux narcotiques. La perfusion de kétamine était la technique la plus fréquemment utilisée. La ketamine était associée à une plus grande incidence de complication respiratoire (P < 0.05) comparativement aux autres techniques. La plus grande incidence d’hypercarbie (15.6 pour cent), n’ayant pas affecté l’issue, pourrait être attribuée à l’utilisation additionnelle de sédatifs. L’incidence d’obstruction des voies aériennes supérieures (7.8 pour cent) était similaire aux études préalables. Un problème vasculaire suite à la procédure fut observé chez 33 patients dont 16 ont requis une correction chirurgicale. Une perforation cardiaque est survenue dans quatre cas provoquant le décès d’un seul patient. La sténose de la valve pulmonaire était la procédure la plus susceptible d’être dilatée et la sténose de la valve aortique la moins susceptible. La kétamine était l’agent anesthésique préféré par les cardiologistes lors des cathétérisations quand une anesthésie générate était requise. Une surveillance vigilante par une équipe anesthésique fut nécessaire durant la procedure. Il faut aussi éviter l’administration de narcotiques si la kétamine est administrée en respiration spontanée.

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Presented in part at the Canadian Anaesthetists’ Society annual meeting in Halifax, June 1988.