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Objective:To investigate the clinical characteristics and risk factors of paroxysmal atrial fibrillation(AF)and persistent atrial fibrillation in elderly patients, in order to provide a theoretical basis for clinical diagnosis and treatment and risk assessment of adverse prognosis.Methods:A total of 201 non-valvular AF patients aged 60-90 years admitted to Heji Hospital from Jan.2017 to Aug.2019 were enrolled in this retrospective study.Of the 201 patients, 102 cases met the diagnostic criteria for paroxysmal AF and 99 cases met the diagnostic criteria for persistent AF.During the same period, 100 healthy elderly people from the physical examination center were included.Clinical data, laboratory test results and echocardiography data were collected.Differences in clinical parameter values between the two groups were analyzed by Hotelling's Trace multivariate analysis.Risk factors for AF were analyzed by comparison of correlation factors, single factor analysis and unconditional logistic regression multivariate analysis.Results:The paroxysmal AF group had a mean age of (70.2±6.5) years old, with 73 males(73.7.6%)and 26 females(26.3%), while the persistent AF group’s mean age was (65.3±5.23), with 61 males(59.8%)and 41 females(40.2%). There were a significant difference in age between the paroxysmal AF group and the persistent AF group( t=5.99, χ2=4.39, P<0.05). Hotelling's Trace multivariate analysis indicated differences in clinical parameter values between the two groups( F=6.26, P<0.01). Levels of serum uric acid, homocysteine(Hcy), high sensitivity C-reactive protein(hs-CRP)and D-dimer, and anterior and posterior diameter of the left atrium were higher in the persistent AF group than in the paroxysmal AF group( P<0.05), while levels of total cholesterol, platelet count and left ventricular ejection fraction(LVEF)were higher in the paroxysmal AF group than in the persistent AF group( P<0.05). History of hypertension( OR=8.92, 95% CI: 4.18-19.05)and smoking history( OR=4.47, 95% CI: 1.87-10.71)were risk factors for persistent AF, while history of hypertension( OR=9.11, 95% CI: 4.21-19.69), smoking history( OR=3.56, 95% CI: 1.44-8.81)and drinking history( OR=9.32, 95% CI: 2.49-34.96)were risk factors for paroxysmal AF. Conclusions:The incidences of AF can be significantly reduced by controlling hypertension within an ideal range and quitting smoking and drinking.High concentrations of serum Hcy, D-dimer, hs-CRP and uric acid and increased anterior and posterior diameter of the left atrium may contribute to the persistence of AF.
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OBJECTIVE@#To investigate the outcomes of hybrid procedure in treating 10 infants/children with pulmonary stenosis under transesophageal echocardiographic guidance. @*METHODS@#Between September, 2009 and December, 2015, 10 infants/children underwent hybrid procedure of transthoracic balloon pulmonary valvuloplasty for pulmonary stenosis in the Second Xiangya Hospital, Central South University. The age, height and weight at the time of admission were 0.7-42 (14.8±15.8) months, 53-97 (74.8±16.3) cm, and 4-15.5 (9.3±4.1) kg, respectively. Atrial septal defect, patent foramen ovale, patent ductus arteriosus, muscular ventricular septal defect, persistent left superior vena cava and tricuspid regurgitation were found in 2, 6, 1, 2, 1 and 5 cases, respectively. @*RESULTS@#After the operation, all patients were sent into ICU. The mean duration mechanical ventilation, ICU stay and hospitalization were 0.5-41(6.8±12.3) h, 2-85 (31.1±22.8) h, and 6-20 (11.4±5.1) d, respectively. Postoperative transvalvular pressure gradient reduced to 16-45 (31.1±9.8) mmHg, which was decreased significantly compared with that in preoperative (P<0.001). There was no death during hospitalization and follow-up. @*CONCLUSION@#Hybrid procedure of transthoracic balloon pulmonary valvuloplasty for pulmonary stenosis under transesophageal echocardiographic guidance is a safe and effective treatment.
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Child , Humans , Infant , Echocardiography, Transesophageal , Heart Septal Defects, Atrial , Heart Septal Defects, Ventricular , Pulmonary Valve Stenosis , Treatment OutcomeABSTRACT
Objective To investigate the early surgical outcomes of 86 patients with complete atrioventricular septal defect.Methods Between January 2007 and December 2014,consecutive 86 cases received surgical repair in our department.There were 44 male patients,and 42 female patients.Two-patch repair was performed in 69 cases,and modified single-patch repair in 17 cases.The mean age,height,and weight at the time of operation were (32.3 ± 46.5)months with a range from 1 month to 17 years,(82.1 ±27.6) cm with a range from 53 to 165 cm,and (10.8 ± 8.7) kg with a range from 4.1 to 43 kg,respectively.Rastelli A type was found in 67 cases,B type in 15 cases,and C type in 4 cases.Down's syndrome was complicated in 6 cases.Preoperative mild regurgitation of common atrioventricular valve was shown in 32 cases,moderate regurgitation in 38 cases,and moderate to severe regurgitation in 16 cases.Mild pulmonary hypertension was observed in 15 cases,moderate in 54 cases,and severe in 17 cases.Results After operation,all patients were sent into intensive care units (ICU).The mean duration mechanical ventilation,ICU stay,and hospitalization were (30.9 ± 47.7) h with a range from 2.5 to 244 h,(87.7 ± 76.8) h with a range from 14 to 306 h,and (16.4 ±9.2)d with a a range from 6 to 50 d,respectively.We encountered 4 operatively mortalities (4.7％),including 3 in two-patch repair group,and 1 in modified single-patch repair group.The cause of death was mitral regurgitation.Conclusions Modified single-patch and two-patch technique have a satisfied early outcomes.
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Objective To review and summarize the experience of surgical treatment of primary cardiac tumors in children from a heart center of China.Methods The pathological studies of 11 cases of primary cardiac tumor (except myxoma) were retrospectively analyzed.Results The mean age for all patients was (23 ± 16) months,and the average weight was 3.1 ～ 15.3 (13 ± 5.7) kg at the time of the established diagnosis.The most common reason of admission was the heart murmur,and the most common pathological type of cardiac tumors was rhabdomyoma (5 cases),followed by fibrous tumor (3 cases),angiofibroma (2 cases),and fibrosarcoma (1 case).All of the patients underwent tumor resection due to the corresponding symptoms.One of them,the operation findings showed the aortic root,superior vena and sinoatrial node were involved into the tumor body,and therefore,the tumor debark resection was performed and the child died 2 years later due to the remained tumor progression.One of other children (pericardial fibrosarcoma) died 1 year late because of tumor recurrence.The others were followed-up for duration of 2 ～9 years and all kept in good condition.Conclusions The surgical resection is mandatory for children suffering with symptomatic primary cardiac tumors and the short-term and long term surgical outcomes for the majority are acceptable.
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Objective To achieve the best chance and optimize the method of operation,the clinical outcomes of 76 cases with complete atrioventricular septal defect (CAVSD) were summarized.Methods According to the Rastelli classification,there were 57 cases of type A,6 type B,and 13 type C.The repaired procedures included the two-patch technique for atrioventricular septal defect (65 cases),direct closure of ventricular septal defect (7 cases),and the Glenn bidirection shunt (4 cases).Results Two patients died.Of them,one was concomitant with double outlet right ventricle (DORV) and total anomalous pulmonary venous connection (TAPVC),died of low cardiac output syndrome; another was complicated with severe pulmonary hypertension,and the death reason was hypoxaemia and respiratory function failure.The survived patients were followed up,and the follow-up period was varied from one to ten years,mitral valve regurgitation was found in 12 cases,3 were middle and 9 were mild.Conclusions In order to prevent deteriorated condition of these patients and improve the survival rate,CAVSD should be operated as soon as the diagnosis is certain,and the co-exist malformation also should be corrected.
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Objective To analyze the clinical manifestations,diagnosis,treatment and prognosis of patients with splenic abscess.Method The clinical data,including baseline clinical data,clinical features,past history,pathogen culture result,treatment and the prognosis were retrospectively analyzed in the patients with the discharge diagnosis splenic abscess from January 1991 to March 2012 in Peking Union Medical College Hospital.Results The media time from onset to Peking Union Medical College Hospital of the 19 patients were 29 days.Among them,9 patients were cured,8 were improved and 2 died.Risk factors,such as tumor burden,diabetes,and using immunosuppressive agents etc,can be found in most patients with splenic abscess.All the 19 patients had splenic image changes and non-specific clinical features.The most common three clinical symptoms were fever(18 cases),chills (12 cases) and shivering (11 cases).The most common three signs were abdominal tenderness (9 cases),left upper quadrant sensitive to percussion (7 cases) and splenomegaly (4 cases).The most common etiological culture results were gram negative bacilli (9 cases),gram positive coccus (8 cases),and fungi (4 cases).Conclusions Clinical features are non-specific in splenic abscess patients.Related exam such as ultrasound should be performed on patients with splenic abscess risk factors to avoid misdiagnosis.Empiric antibiotic administration should begin right after the diagnosis based on the image.Pathogen culture should be timely conducted after pus collection.Individual therapeutical protocol should be chosen according to patient's condition.
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Objective To compare the biological characteristics of Culex pipiens pallens between permethrin-resistant strain and the susceptible strain. Methods In laboratory, the biological characteristics about bloodsucking, reproduction and development of permethrin-resistant and susceptible strains were observed and recorded. Life table of the experimental populations was constituted. Results The bloodsucking rate of resistant strain was lower than susceptible strain and the difference was significant. The life-span of adults of resistant strain and the developmental duration of eggs, larvae and pupae were longer than susceptible strain and the difference was significant. The death rate of eggs of resistant strain was higher than that of susceptible strain and the difference was significant. The permethrin-resistant strain showed a fitness value of 0