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1.
Dynamic LVOT Obstruction and Aortic Stenosis in the Same Patient: A Case of Challenging Doppler Hemodynamics
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Matthew W. Parker M.D. Francis J. Kiernan M.D. 《Echocardiography (Mount Kisco, N.Y.)》2015,32(6):1030-1032
We present a patient with both dynamic left ventricular outflow tract obstruction and valvular aortic stenosis. The aortic valve was calcified, and velocities and gradients measured by continuous‐wave Doppler met standard criteria for severe aortic stenosis. The increased subvalvular velocities invalidated assumptions of the simplified Bernoulli equation; correction using the longer form of the Bernoulli equation suggested a lower but still significant gradient. The complex shape of the subvalvular spectral Doppler envelope indicated supranormal systolic function and dynamic left ventricular outflow obstruction. Left heart catheterization with an end‐hole catheter was required to determine the subvalvular and valvular components of the obstruction. 相似文献
2.
Walid K. Abu Saleh Phillip Mason Odeaa Al Jabbari Hany Samir Brian A. Bruckner 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》2015,42(6):569-571
The Impella 5.0, a percutaneously inserted left ventricular assist device, has been used to support patients who have severe heart failure or who are undergoing high-risk percutaneous coronary intervention. We report our surgical placement of the Impella 5.0, through a graft sewn to the aorta, to unload the left ventricle of a 59-year-old man who was undergoing venoarterial extracorporeal membrane oxygenation for postcardiotomy shock. The patient underwent successful placement of a long-term left ventricular assist device before his discharge from the hospital. The versatility of the Impella 5.0 is exemplified in this patient who was successfully bridged to long-term support. 相似文献
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Joshua Manghelli Lisa Brown Hany B. Tadros Nabil A. Munfakh 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》2015,42(5):491-494
The inflammatory response induced by cardiopulmonary bypass decreases vascular tone, which in turn can lead to vasoplegic syndrome. Indeed the hypotension consequent to on-pump cardiac surgery often necessitates vasopressor and intravenous fluid support. Methylene blue counteracts vasoplegic syndrome by inhibiting the formation of nitric oxide.We report the use of methylene blue in a 75-year-old man who developed vasoplegic syndrome after cardiac surgery. After the administration of methylene blue, his hypotension improved to the extent that he could be weaned from vasopressors. The use of methylene blue should be considered in patients who develop hypotension refractory to standard treatment after cardiac surgery. 相似文献
5.
目的:应用超声多普勒探讨动脉粥样硬化(AS)与局部血流动力学的相关性。方法:对420例发生AS患者升主动脉、颈总动脉、颈内动脉、髂总动脉、股动脉的斑块分布情况进行统计、分析、对照。结果:420例AS患者各部斑块发生率分别为颈动脉窦部85.12%,动脉分叉前(腹主动脉、股动脉下端)45%,动脉分叉后(颈内、髂总、股深动脉起始)内、外侧壁分别为51.98%、53.45%,动脉平直区(颈总、股动脉干)34.58%,升主动脉为1.4%(6/420);升主动脉内径增宽和运动幅度减低发生率为90.71%(381/420)。各观察区与动脉平直区比较AS发生率有显著差异(P<0.001)。结论:AS斑块分布有明显的倾向性,认为局部血流动力学异常是导致AS发生的重要因素。 相似文献
6.
乳酸林格氏液、高渗盐水和全血对失血性休克犬血液动力学的影响 总被引:2,自引:0,他引:2
以失血性休克犬为研究对象,比较乳酸林格氏液(LR)、高渗盐水(HS)和全血(WB)对其血液动力学的影响。经右颈外静脉插入Swan-Ganz飘浮导管,分别在全身氧供(DO2)恢复至休克前水平时,以及液体复苏后5、10、15、30、60和120min时测量动物的各项血液动力学指标。结果显示,HS仅需要11.83ml/kg的液体量,在4.97min时即可使休克犬的DO2恢复至休克前的水平,而LR组和WB组则分别需要52.08ml/kg和23.33ml/kg的液体量,在20.83min和9.33min时才能使休克犬的DO2恢复至休克前的水平。3组动物在DO2恢复至休克前水平时其血液动力学指标均能恢复至休克前的水平。提示高渗盐水比乳酸林格氏液和全血更适合失血性休克患者的早期紧急液体复苏治疗。 相似文献
7.
目的 :探讨CT引导下微创清除术治疗急性高血压脑出血的疗效。方法 :对 38例急性高血压脑出血患者微创清除术前后行CT扫描 ,在CT引导下行微创清除术 ,并动态观察其疗效。结果 :38例急性高血压脑出血患者首次血肿清除率达 2 8.0 %~ 4 0 .0 %,其中 1 2例首次清除率为 4 0 .0 %~ 5 6 .0 %。存活 32例 7d后复查头颅CT证实者血肿清除率达 80 %以上。治愈有效率为 84 .2 %,死亡率为 1 5 .8%。结论 :CT引导下的微创清除术能有效地降低急性高血压脑出血的死亡率和致残率。 相似文献
8.
糖尿病肾内动脉血流动力学改变的研究 总被引:1,自引:0,他引:1
目的:观察糖尿病肾病不同时期肾内分级动脉血流动力学的改变。方法:用脉冲多普勒方法分别测量正常对照组、糖尿病正常蛋白尿阶段,隐匿性肾病.临床糖尿病肾病肾功能代偿期及糖尿病肾病肾功失代偿期各组肾内分级动脉Vmax、Vmin、TAMX、PI、RI血流参数.并与对照组比较。结果:糖尿病不同时期Vmax均增高.与正常对照组有显著性差异;Vmin随着病程的发展.逐渐减低;PI、RI随病情的进展逐渐增高.尤以糖尿病肾病肾功能代偿期及肾病肾功失代偿期明显。结论:多普勒超声是一种简便、直观、快速非创伤性检查糖尿病血流动力学改变的方法.通过对肾内分级动脉血流参数的观察.尤其是PI、RI的变化,判断糖尿病肾损害的程度。 相似文献
9.
Shohei Takeda Yutaka Inada Yoshiki Ozawa Narue Nakamizo Teruaki Tomaru 《Journal of anesthesia》1995,9(2):176-181
The cardiovascular responses to an infusion of KRN2391, a potassium channel opener, was studied in halothane-anesthetized
dogs. Intravenous administration of KRN2391 at 1.0 and 5.0 μg·kg−1·min−1 for 60 min produced dose-dependent decreases in mean arterial pressure (MAP) and systemic vascular resistance (SVR) associated
with dose-dependent increases in the cardiac index (CI) and stroke volume index (SVI) but was not accompanied by an increase
in heart rate (HR). The maximum decrease in MAP during the infusion of KRN2391 at 1.0 and 5.0 μg·kg−1·min−1 was −13±7% (P<0.01) and −37±10% (P<0.01), respectively. The maximum reduction in SVR after 1.0 and 5.0 μg·kg−1·min−1 was −20±11% (P<0.01) and −60±16% (P<0.01), respectively. A KRN2391 infusion of 1.0 and 5.0 μg·kg−1·min−1 increased Cl a maximum of 11±13% (P<0.05) and 65±33% (P<0.01), respectively. KRN2391 1.0 μg·kg−1·min−1 showed a tendency to increase SVI but this change was not significant, KRN2391 5.0 μg·kg−1·min−1, however, produced a significant increase in SVI. The present results demonstrate that the decrease in MAP and the increases
in CI and SVI caused by KRN2391 are due to a reduction in the afterload. Therefore, we conclude that these cardiovascular
profiles of KRN2391 may be benificial in perioperative uses including the control of systemic blood pressure and the treatment
of hypertension during halothane anesthesia in clinical practice. 相似文献
10.
D. Chemla P. Démolis M. Thyrault D. Annane Y. Lecarpentier and JF Giudicelli 《Fundamental & clinical pharmacology》1996,10(4):393-399
Summary— The influence of local resistance and cardiac performance on peripheral blood acceleration was investigated in 14 healthy male volunteers. Steady and pulsatile flow was studied in the brachial and in the common carotid arteries, ie, two territories that exhibit marked differences in resistive characteristics. Instantaneous blood velocity (V), mean blood velocity (Vm ) and artery diameter (D) were evaluated at rest by an ultrasonic range-gated pulsed Doppler flowmeter using a double transducer probe, thus allowing the calculation of mean blood flow (Q). Mean local resistance (R) was obtained by dividing the mean arterial pressure by Q. The peak value of the local acceleration of the blood was obtained by computer-assisted calculation of the first derivative of instantaneous blood velocity (Gmax = +dV/dtmax ). Peak aortic blood acceleration (GAo) was simultaneously measured from the suprasternal notch using a pulsed Doppler velocity meter. In the brachial and the common carotid arteries, Gmax was of a similar magnitude (551 ±30 and 555 ± 44 cm/s2 , respectively) despite major differences in the respective D, Vm , Q and R values. In neither artery was there a relationship between Gmax and either resting Q or R. At the brachial artery level, Gmax was positively related to GAo ( r = 0.79, P = 0.0008). At the common carotid artery level, there was a weak, although non significant relationship between Gmax and GAo ( P = 0.08). Our results indicate that the local acceleration of peripheral blood flow in the brachial artery is related rather to upstream central impulse than to downstream hemodynamics, and suggest some regional differences in the hemodynamic determinants of the local acceleration of peripheral blood flow. 相似文献