婴幼儿心内直视手术中的护理问题及对策

随着先天性心脏病诊断及外科治疗和灌注技术的不断进步,术前、术后管理的完善,先天性心脏病患儿得以早期进行手术矫治.     

Free‐wall perforation of the left ventricle after acute myocardial infarction complicated with pericardial tamponade that mimicked ascending aortic dissection: A case report

Life‐threatening cardiac events may be misdiagnosed as acute aortic dissection because of notable symptom mimicry. We report the case of a 72‐year‐old male patient with presentations presumed to be of aortic origin. However, surgery revealed posterior free‐wall perforation in the left ventricle caused by the occlusion of an obtuse marginal branch.     

经导管Amplatzer封堵器和外科手术治疗动脉导管未闭对照试验的Meta分析

目的评估经导管Amplatzer封堵器治疗动脉导管未闭(PDA)的疗效,为临床应用提供指导。方法采用Meta分析方法,对国内外有关经导管Amplatzer封堵器和外科手术治疗PDA的对比临床研究进行综合定量分析,采用RevMan4.2.2软件进行数据处理,计算各组技术失败率、并发症及严重并发症发生率、残余分流率等的相对危险度(RR)及其95%可信区间(CI)。结果符合纳入标准共5篇文献,总样本量349例。经导管Amplatzer封堵器组技术失败率高于外科手术组[5组对照试验(CT),349例,3.0%vs0,RR=4.29,95%CI(0.77,23.95)],但无显著性差异(P=0.10);并发症发生率低于外科手术[5组CT,343例,3.1%vs38.0%,RR=0.11,95%CI(0.05,0.23)](P<0.00001);严重并发症发生率显著低于手术组[5组CT,343例,0.5%vs6.0%,RR=0.23,95%CI(0.06,0.90)](P=0.03);Amplatzer封堵器组治疗后即时残余分流率高于手术组[4组CT,304例,16.3%vs0,RR=16.06,95%CI(3.0,86.12)](P=0.001);出院时残余分流率虽高于手术组,但无显著性差异(2.5%vs0,P=0.33)。结论经导管Amplatzer封堵器治疗PDA尽管成功率低于外科手术,但其创伤小、并发症发生率低、疗效与手术相仿,随着封堵器及其输送系统的不断改进和完善,在适应证范围内经导管Amplatzer封堵器治疗可作为PDA外科手术治疗的替代方法。     

Left Ventricular Abnormality and Covert Atrial Fibrillation in Embolic Stroke of Undetermined Source

Aims: The relationship between left ventricular (LV) function and AF detection in embolic stroke of undetermined source (ESUS) patients with insertable cardiac monitors (ICMs) remains unclear. We investigated the association between LV function and AF detection in patients with ESUS after ICMs implantation. Methods: We enrolled patients with ESUS who underwent ICMs implantation from September 2016 to September 2020 using a single-center, prospective registry. LV systolic and diastolic functions were assessed on precordial echocardiography by LV fractional shortening (LVFS) and average E/e’, respectively. Associations between characteristics of LV function and detection of AF by ICMs were analyzed. Results: Participants comprised 101 patients (median age, 74 years; male, 62%). During a median follow-up period of 442 days (interquartile range (IQR), 202–770 days), AF was detected in 24 patients (24%). Median duration from ICMs implantation to AF detection was 71 days (IQR, 13–150 days). When LVFS and E/e’ were dichotomized by cutoff value, each of low LVFS (＜35.5%; adjusted hazard ratio (HR), 4.77; 95% confidence interval (CI), 1.77–12.9) and high E/e’ (≥ 8.65; adjusted HR, 4.56; 95%CI, 1.17–17.7) were independently associated with AF detection after adjusting for age and sex. When patients were divided into four groups according to dichotomized LVFS and E/e’, the combination of low LVFS and high E/e’ was independently associated with AF. Conclusions: In patients with ESUS after ICMs implantation, the LV characteristics of low LVFS and high E/e’ were associated with AF detection.     

Evaluation of pulmonary blood flow in bilateral bidirectional Glenn shunts: value of 4‐D flow cardiac magnetic resonance in the evaluation of pulmonary artery confluence stenosis

Bilateral bidirectional Glenn shunts are associated with the risk of developing pulmonary artery bifurcation stenosis, resulting in variable pulmonary blood flow to either lung. This could negatively impact the subsequent stages of the single ventricle palliation pathway. This report highlights the value of 4D flow sequence from the cardiac magnetic resonance imaging in demonstrating the pulmonary blood flow characteristics following a bilateral bidirectional Glenn procedure. Mapping the blood flow pattern and its quantification to each lung provide objective insights into the possible predisposing factors for the development of pulmonary bifurcation stenosis.     

Increased oxytocinergic system activity in the cardiac muscle in spontaneously hypertensive SHR rats

IntroductionThe present study aimed to determine whether the presence of cardiac hypertrophy due to arterial hypertension is associated with a change in the activity of the oxytocinergic system in cardiomyocytes.Material and methodsThe experiments were performed on male, spontaneously hypertensive rats (SHR, n = 10) and normotensive Wistar-Kyoto rats (WKY, n = 12). Blood samples were collected from both SHR and WKY animals to asses plasma oxytocin (OT) concentration; the rats were sacrificed by decapitation. Samples of the left and right ventricles were harvested for the analysis of the OT and oxytocin receptor (OTR) protein by ELISA, and OT and OTR mRNA expression by RT-PCR. Immunohistopathological studies were performed to confirm the presence of OTR receptors in the cardiac muscle of the ventricles.ResultsPlasma OT concentration did not differ between SHR and WKY rats. In the SHR rats, the expression of OT mRNA and the OT protein level was higher in the left and the right ventricle, while OTR mRNA expression was significantly lower in both the left and the right ventricle. However, the level of OTR protein was higher only in the left ventricle of the SHR rats. The presence of OTR receptors was confirmed by immunohistochemical analysis in the muscle of the right and left ventricle.ConclusionsThe presence of arterial hypertension is associated with increased activity of the oxytocinergic system in the heart, especially in the area of the left ventricle. These findings support the important role of this system in the maintenance of cardiovascular homeostasis.     

Acute Embolic Occlusion of Renal Artery after the Bentall Procedure: the Role of Primary Renal Angioplasty

Acute renal occlusion is an uncommon emergency problem in daily practice. The diagnosis is often missed or delayed not only because of its rarity but also nonspecific of clinical presentation. Sudden and complete termination of arterial blood supply to the kidney may lead to renal infarction and a complete loss of renal function. Although the need of early revascularization is uniformly recommended, but the methods has not been established. We presented a case of acute thromboembolic renal artery occlusion in patient who had a history of Bentall''s surgery. Renal infarction and artery occlusion were clearly visualized by computed tomography angiogram (CTA). The patient was successfully treated with angioplasty and stenting of main renal artery with complete disappearance of symptoms and recovery of his renal function.     

Effects of cluster nursing on cardiac function and quality of life in coronary heart disease patients with chronic heart failure: A protocol of randomized controlled trial

Background:Coronary heart disease (CHD) chronic heart failure has high morbidity and mortality, which poses a serious threat to patients’ quality of life and life safety. For the treatment of chronic heart failure of CHD, in addition to drugs, high quality nursing measures are also very important. Cluster nursing is a high-quality nursing model based on evidence-based evidence. There is no clinical study to evaluate the effect of cluster nursing on cardiac function and quality of life of CHD patients with chronic heart failure.Methods:This is a prospective randomized controlled trial to investigate the effects of cluster nursing on cardiac function and quality of life in patients with CHD chronic heart failure. Approved by the Clinical Research Ethics Committee of our hospital, patients will be randomly assigned to either routine nursing or cluster nursing. They will be followed up for 3 months after 4 weeks of treatment. Observation indicators include: The total effective rate of cardiac function improvement, Minnesota Living with Heart Failure Questionnaire, left ventricular ejection fraction, N-terminal pro-brain natriuretic peptide, 6-minute walk test, adverse reaction, etc. Data were analyzed using the statistical software package SPSS version 25.0.Discussion:This study will evaluate the effects of cluster nursing on cardiac function and quality of life of CHD patients with chronic heart failure. The results of this study will provide clinical basis for establishing reasonable and effective nursing programs for CHD patients with chronic heart failure.     

特发性室性心动过速的导管射频消融治疗效果

目的 评价导管射频消融(radiofrequency catheter ablation,RFCA)对特发性室速(idiopathic ventricular tachy-cardia,IVT)的治疗效果以及心电图对消融靶点的定位价值.方法 对126例特发性室速患者的电生理资料及RFCA治疗效果进行回顾性分析.多数患者采用激动顺序标测,射频能量采用温控法(60～65℃).结果 126例患者中右室流出道(right ventricular outflow tract,RVOT)IVT 62例、左后间隔IVT 43例,其他部位IVT 21例.本组RFCA的总成功率为87.3%,RVOT-IVT和左后间隔IVT的成功率显著高于其他部位IVT(96.8%和90.7% vs 52.4%,P<0.05).本组8例患者存在发作性晕厥(发作的R-R间期230～260 ms),其中4例合并房室结双径路、2例合并隐匿性房室旁道、2例合并多形性室速.随访6个月至10年,复发9例(复发率为8.2%),均再次RFCA成功.合并心动过速性心肌病者6例,术后3个月心脏大小与心功能均恢复正常.结论 采用激动顺序标测法RFCA治疗IVT成功率高;室速发作时体表心电图对绝大多数室速起源具有定位价值;部分室速可能合并房室旁道或房室结双径路.     

卡托普利治疗急性冠脉综合征合并心房颤动的临床疗效

目的:探讨转换酶抑制剂(ACEI)卡托普利在急性冠脉综合征(ACS)合并心房颤动(房颤)治疗中的作用。方法:选择我院1998年1月至2004年1月期间收住的急性冠脉综合征合并心房颤动患者126例,分为ACEI治疗组(82例)和对照组(44例),随访2年,评价两组的治疗效果。结果:ACEI治疗组房颤再发率、转为永久性房颤的发生率及缺血相关事件均明显低于对照组,P(0.05。结论:ACEI类药物早期、长期应用于ACS,对治疗ACS合并房颤是有效的。