Echocardiographic predictors of left ventricular outflow tract obstruction and systolic anterior motion of the mitral valve after mitral valve reconstruction for myxomatous valve disease

OBJECTIVE

To determine predictors of systolic anterior motion and left ventricular outflow tract obstruction (SAM/LVOTO) after mitral valve repair (MVRep) in patients with myxomatous mitral valve disease.

BACKGROUND

Mechanisms for the development of SAM/LVOTO after MVRep have been described; however, predictors of this complication have not been explored. We hypothesize that pre-MVRep transesophageal echocardiography (TEE) can predict postrepair SAM/LVOTO.

METHODS

Using TEE, the lengths of the coapted anterior (AL) and posterior (PL) leaflets and the distance from the coaptation point to the septum (C-Sept) were measured before and after MVRep in 33 patients, including 11 who developed SAM/LVOTO (Group 1) and 22 who did not (Group 2).

RESULTS

Group 1 patients had smaller AL/PL ratios (0.99 vs. 1.95, p < 0.0001) and C-Sept distances (2.53 vs. 3.01 cm, p = 0.012) prior to MVRep than those in Group 2. Resolution of SAM/LVOTO was associated with increases in AL/PL ratio and C-Sept distance. This reflects a more anterior position of the coaptation point in those who developed SAM/LVOTO.

CONCLUSIONS

These data suggest that TEE analysis of the mitral apparatus can identify patients likely to develop SAM/LVOTO after MVRep for myxomatous valve disease. The findings are consistent with the concept that SAM of mitral leaflets is due to anterior malposition of slack mitral leaflet portions into the LVOT. The position of the coaptation point of the mitral leaflets is dynamic and a potential target and end point for surgical designs to prevent SAM/LVOTO post MVRep.     

非洛地平治疗单纯收缩期高血压临床观察

目的 研究非洛地平对单纯收缩期高血压（ISH）的治疗效果。方法 从我科113名高血压网络成员中筛选73名入选，给予非洛地平5mg/d-10mg/d,po。观察12周后的治疗效果和不良反应。结果 70名最终治疗的患不良反应少，降压总有效率达到91.4%。结论 非洛地平是一种安全、有效的治疗ISH药物，能降低心胸血管病的发生率和死亡率。     

彩色多普勒检测妊高征患者胎儿脐动脉血流的应用价值

目的：评价脐动脉多普勒血流参数在妊高征（PIN）孕妇中的检测价值及对围产期胎儿预后的价值。方法：应用彩色多普勒检测126例妊高征孕妇脐动脉血流动力学参数,并随机抽取50例正常孕妇为对照组,进行分析和总结,研究其脐动脉血流收缩末速率和舒张末速率峰值的比值（S/D）、搏动指数（PI）与围产儿之间的关系。结果：妊高征组的S/D值和PI值均高于对照组（P〈0.01）;妊高征组伴有胎儿宫内发育迟缓（IUGR）者的S/D值和PI值均高于妊高征组不伴有胎儿IUGR者;在妊高征组内S/D≥3者围产儿预后不良发生率明显高于S/D〈3者（P〈0.05）。结论：妊高征组S/D值和PI值均高于正常妊娠者,S/D值和PI值异常者围产儿预后不良明显增高,因此脐动脉血流分析是了解妊高征胎盘功能、预测围产儿预后敏感而实用的监护手段。     

Area Under the Real‐Time Contact Force Curve (Force–Time Integral) Predicts Radiofrequency Lesion Size in an In Vitro Contractile Model

FTI Predicts RF Lesion Size in Contractile Model. Introduction: Electrode tissue contact, radiofrequency (RF) power and duration are major determinants of RF lesion size. Since contact forces (CF) vary in the beating heart, we evaluated contact force–time integral (FTI) as a predictor of lesion size at constant RF power in a contractile bench model simulating the beating heart. Methods and Results: An open‐tip irrigated catheter was attached to a movable mount incorporating a dynamic force sensor allowing closed loop control to achieve desired force variations between the catheter tip and bovine skeletal muscle placed on a ground plate. RF energy (20 and 40 W for 60 seconds, 17 cc/min irrigation) was delivered during (1) constant contact (C) at 20 g, (2) variable contact (V) with a 20 g peak and 10 g nadir, and (3) intermittent contact (I) with a 20 g peak and 0 g nadir with loss of contact. V and I protocols were performed at 50 and 100 catheter movements/min and 2 systole:diastole time ratios (50:50 and 30:70). The area under the CF curve was calculated as the FTI. Measured FTI was highest in C, intermediate during V and lowest during I and correlated linearly with lesion volume (P < 0.0001 for 20 and 40 W). Lesion volume was highest in group C, intermediate in V and lowest in group I (P < 0.05 for C vs V, V vs I, and C vs I). Conclusions: Lesion size correlates linearly with measured contact FTI. Constant contact produces the largest and intermittent contact the smallest lesions despite constant RF power and identical peak contact forces. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1038‐1043, September 2010)     

超声心动图对左室节段性室壁运动定量分析方法的对比研究

目的：比较左室节段性室壁运动超声心动图定量分析方法在冠心病诊断中的准确性。方法165例研究对象,分成3组：正常对照组60例,心肌梗死组45例,冠状动脉狭窄组60例。采用彩色多普勒超声仪检查,观察指标包括：左室前间隔的内膜运动幅度（EndoD ）、室壁增厚率（ΔT H ）、收缩期径向应变（RS ）、收缩期组织速度（VS）。应用ROC曲线分析比较各指标诊断冠心病的准确性。结果（1）冠状动脉狭窄组及心肌梗死组的RS、ΔTH、EndoD、VS明显低于正常对照组（P＜0．01）。（2）RS、ΔTH、EndoD、VS检测心肌梗死及冠状动脉狭窄的准确率分别为：89．3％、89．3％、81．3％、80．7％及68．1％、70．0％、61．9％、60．0％。（3）RS、ΔTH、EndoD、VS诊断心肌梗死及冠状动脉狭窄的受试者工作特征（ROC ）曲线下面积分别为：0．868、0．863、0．833、0．859及0．724、0．705、0．689、0．663。结论室壁增厚率及径向应变诊断冠心病的准确性最高。     

护理干预减轻剖宫产后病人静脉滴注缩宫素致宫缩痛的效果观察

目的:探讨护理干预措施对剖宫产后病人静滴缩宫素致宫缩痛的影响。方法:将200例住院产妇随机分为观察组(100例)和对照组(100例),对照组在静滴缩宫素时仅进行常规的护理,观察组在此基础上对产妇的认知、行为、心理和环境因素等进行干预,比较两组宫缩痛的程度。结果:观察组在接受护理干预后疼痛程度明显减轻,与对照组比较P<0.05,差异有显著性意义。结论:本干预方法能减轻剖宫产后病人静滴缩宫素引起的宫缩痛。     

单纯收缩期高血压患者血清一氧化氮水平变化及相关性研究

目的　探讨单纯收缩期高血压患者外周血液一氧化氮 (NO)的浓度变化及其意义。方法　测定 78例原发性单纯收缩期高血压患者空腹外周血液NO浓度 ,并与同期 16例健康体检者相对照。结果　高血压患者的NO浓度是 (4 6.4± 7.8) μg ml。其中 1级高血压为 (5 6.2± 7.8) μg ml,2级高血压为(4 8.5± 11.4) μg ml,3级高血压为 (3 4.7± 13 .2 ) μg ml ;对照组为 (5 7.7± 8.7) μg ml。 结论　单纯收缩压升高也是引起血管内皮功能障碍的一个因素 ,且血压值越高 ,NO水平越低 ,二者呈负相关