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Objective To summarize the experience of surgical treatment of 18 cases of severe aortic stenosis with ventricular septum hypertrophy.Methods Clinical data of 18 patients with severe aortic stenosis admitted to the first affiliated hospital of zhengzhou university from January 2013 to December 2016 were collected.There were 7 males and 11 females.The mean age was (50.4 ±4.2) years old.All patients were diagnosed with severe stenosis of main artery valve by echocardiography before surgery,with mean aortic valve orifice area (0.57 ±0.11) cm2,cardiac function (NYHA classification) grade Ⅱ in 4 patients,grade Ⅲ in 9 patients,and grade ⅣV in 5 patients.There were 8 patients with mild aortic valve insufficiency,4 patients with mild to moderate mitral valve insufficiency,2 patients with moderate to severe aortic valve insufficiency,3 patients with ascending aorta dilatation (ascending aorta inner diameter ＞ 4.5 cm),and 1 patient with atrial fibrillation.Interventricular septum thickness (15.82 ± 2.04) mm,left ventricular posterior wall thickness (14.04 ± 1.28) mm,ratio of interventricular septum thickness to left ventricular posterior wall thickness (IVS/LVPW) 1.12 ±0.91,inner diameter of left ventricular outflow tract (19.01 ± 1.74) mm,cross-lobe differential pressure (102 ± 8.40) mmHg (1 mmHg =0.133 kPa),left ventricular ejection fraction (LVEF) mean 0.49 ± 0.05.Left ventricular end-diastolic diameter (LVEDD) (53.33 ± 4.00)mm,left ventricular end-systolic diameter (LVESD) (27.11 ± 1.99) mm,and left ventricular mass index (277.1 ± 37.3) g/m2.All patients underwent aortic valve replacement (AVR) and partial interventricular septum resection under general anesthesia and conventional extracorporeal circulation,2 patients underwent mitral valve formation (artificial valve ring),2 patients underwent ascending aorta formation,and 1 patient underwent ascending aorta wrapping.During the operation,the time of extracorporeal circulation,aortic occlusion,number of defibrillation during the operation,type of valve implantation and postoperative complications were recorded.Regular follow-up was conducted to analyze the changes of various indexes at different preoperative and postoperative time.Results There was no death in the whole group.2 patients were treated with temporary pacemakers.After drug treatment,sinus rhythm was restored on the 3rd and 6th day after surgery,and temporary pacemakers were removed.Echocardiography reexamination 1 week after the operation showed that all patients had a good artificial valve function and 2 patients had minor regurgitation of mitral valve.The difference in pressure across the valve,inner diameter of the left ventricular outflow tract,cardiac function classification,ventricular septum thickness,valve orifice area,and left ventricular mass index were significantly improved compared with the preoperative level (P ＜ 0.05).LVEF,LVEDD,and LVESD were compared with the preoperative level (P ＜ 0.05).After 6 months of follow-up,the difference in LVEF and LVEDD was statistically significant compared with the preoperative level (P ＜ 0.05).Conclusion Severe aortic stenosis combined with ventricular septum hypertrophy and partial ventricular septal muscle resection is a simple additional procedure in the AVR process,which does not increase the surgical risk and has a significant effect,and is conducive to postoperative left ventricular function recovery.
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Objective@#To summarize the experience of surgical treatment of 18 cases of severe aortic stenosis with ventricular septum hypertrophy.@*Methods@#Clinical data of 18 patients with severe aortic stenosis admitted to the first affiliated hospital of zhengzhou university from January 2013 to December 2016 were collected. There were 7 males and 11 females. The mean age was (50.4±4.2) years old. All patients were diagnosed with severe stenosis of main artery valve by echocardiography before surgery, with mean aortic valve orifice area (0.57±0.11) cm2, cardiac function (NYHA classification) grade Ⅱ in 4 patients, grade Ⅲ in 9 patients, and grade Ⅳ in 5 patients. There were 8 patients with mild aortic valve insufficiency, 4 patients with mild to moderate mitral valve insufficiency, 2 patients with moderate to severe aortic valve insufficiency, 3 patients with ascending aorta dilatation (ascending aorta inner diameter>4.5 cm), and 1 patient with atrial fibrillation. Interventricular septum thickness (15.82±2.04)mm, left ventricular posterior wall thickness (14.04±1.28)mm, ratio of interventricular septum thickness to left ventricular posterior wall thickness (IVS/LVPW) 1.12±0.91, inner diameter of left ventricular outflow tract (19.01±1.74)mm, cross-lobe differential pressure (102±8.40) mmHg (1 mmHg=0.133 kPa), left ventricular ejection fraction (LVEF) mean 0.49±0.05. Left ventricular end-diastolic diameter (LVEDD) (53.33±4.00) mm, left ventricular end-systolic diameter (LVESD) (27.11±1.99) mm, and left ventricular mass index (277.1±37.3) g/m2. All patients underwent aortic valve replacement (AVR) and partial interventricular septum resection under general anesthesia and conventional extracorporeal circulation, 2 patients underwent mitral valve formation (artificial valve ring), 2 patients underwent ascending aorta formation, and 1 patient underwent ascending aorta wrapping. During the operation, the time of extracorporeal circulation, aortic occlusion, number of defibrillation during the operation, type of valve implantation and postoperative complications were recorded. Regular follow-up was conducted to analyze the changes of various indexes at different preoperative and postoperative time.@*Results@#There was no death in the whole group. 2 patients were treated with temporary pacemakers. After drug treatment, sinus rhythm was restored on the 3rd and 6th day after surgery, and temporary pacemakers were removed. Echocardiography reexamination 1 week after the operation showed that all patients had a good artificial valve function and 2 patients had minor regurgitation of mitral valve. The difference in pressure across the valve, inner diameter of the left ventricular outflow tract, cardiac function classification, ventricular septum thickness, valve orifice area, and left ventricular mass index were significantly improved compared with the preoperative level (P<0.05). LVEF, LVEDD, and LVESD were compared with the preoperative level (P<0.05). After 6 months of follow-up, the difference in LVEF and LVEDD was statistically significant compared with the preoperative level (P<0.05).@*Conclusion@#Severe aortic stenosis combined with ventricular septum hypertrophy and partial ventricular septal muscle resection is a simple additional procedure in the AVR process, which does not increase the surgical risk and has a significant effect, and is conducive to postoperative left ventricular function recovery.
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Objective To investigate the effect of the multi-material artifact reduction (MMAR) algorithm of wide-detector CT system in reducing the beam hardening artifacts in brain CT imaging. Methods Nine tubes with various iodine concentrations (0.1-16.0 mgI/ml) were placed in a uniform phantom filled with soft-tissue equivalent material. The phantom was scanned using different combinations of the tube voltage and current as follows:80 kV/530 mA, 100 kV/295 mA, 120 kV/190 mA and 140 kV/135 mA. The scanning was performed using the GE Discovery 750 and GE Revolution CT scanners, respectively. The CT values and standard deviations of the uniform areas between tubes were measured. The artifact index (AI) was calculated by using the standard deviation value outside the tubes as background noise. The artifact index values under different kV/mA combinations with different scanners were compared. CT brain images of 36 patients (n=18 on Discovery CT and n=18 on Revolution CT) were randomly selected. CT values of normal brain tissue and dark bands areas in the posterior fossa were measured for each case. The AI was calculated for these cases as for the phantom study. Paired t test was performed for phantom data analysis, and independent t test was performed for the clinical cases data analysis. Results The average AI values with Revolution CT(4.96±1.39, 4.80±1.57, 4.56±1.45, 4.76±1.57) were smaller than those of Discovery 750 (11.90 ± 6.61, 11.17 ± 5.61, 8.85 ± 4.59, 8.77 ± 3.85) under different tube voltage settings(t=3.714, 4.186, 3.745, 4.634,P<0.001). The higher the iodine concentration difference between tube pairs was, the higher the artifact index;As for clinical data, the difference in AI values between Revolution CT(2.31 ± 0.95) and Discovery 750(3.91 ± 1.32) was found statistically significant(t=4.066,P<0.001). Conclusion The multi-material artifact reduction algorithm implemented on the wide-detector Revolution CT scanner can significantly reduce beam hardening artifacts.
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Objective To investigate the effect of the multi-material artifact reduction (MMAR) algorithm of wide-detector CT system in reducing the beam hardening artifacts in brain CT imaging. Methods Nine tubes with various iodine concentrations (0.1-16.0 mgI/ml) were placed in a uniform phantom filled with soft-tissue equivalent material. The phantom was scanned using different combinations of the tube voltage and current as follows:80 kV/530 mA, 100 kV/295 mA, 120 kV/190 mA and 140 kV/135 mA. The scanning was performed using the GE Discovery 750 and GE Revolution CT scanners, respectively. The CT values and standard deviations of the uniform areas between tubes were measured. The artifact index (AI) was calculated by using the standard deviation value outside the tubes as background noise. The artifact index values under different kV/mA combinations with different scanners were compared. CT brain images of 36 patients (n=18 on Discovery CT and n=18 on Revolution CT) were randomly selected. CT values of normal brain tissue and dark bands areas in the posterior fossa were measured for each case. The AI was calculated for these cases as for the phantom study. Paired t test was performed for phantom data analysis, and independent t test was performed for the clinical cases data analysis. Results The average AI values with Revolution CT(4.96±1.39, 4.80±1.57, 4.56±1.45, 4.76±1.57) were smaller than those of Discovery 750 (11.90 ± 6.61, 11.17 ± 5.61, 8.85 ± 4.59, 8.77 ± 3.85) under different tube voltage settings(t=3.714, 4.186, 3.745, 4.634,P<0.001). The higher the iodine concentration difference between tube pairs was, the higher the artifact index;As for clinical data, the difference in AI values between Revolution CT(2.31 ± 0.95) and Discovery 750(3.91 ± 1.32) was found statistically significant(t=4.066,P<0.001). Conclusion The multi-material artifact reduction algorithm implemented on the wide-detector Revolution CT scanner can significantly reduce beam hardening artifacts.
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Objective To study the relationship between the washout speed in the contrast-enhanced ultrasound (CEUS) and the differentiation grading in pathology in patients with hypervascular hepatocellular carcinoma (HCC).Methods Totally 271 patients who underwent complete resection for hypervascular HCC from April 2009 to December 2014 at Nanchong Central Hospital were included in this study.CEUS examinations were perfomred in all patients 2-3 days before liver resection.A timer on the ultrasound screen displayed the time elapsed since the saline flush was used to determine time to washout.The washout rate were categorized into four levels based on enhancement in portal venous phase and delayed phase.The differentiation grade and the washout speed were compared using Kruskal-Wallis test.Results All 271 (100％) lesions were arterially enhanced with different washout rate.Washout speed 1 was found in 19 patients (7.0％),while speed 2 in 157 patients (57.9％),speed 3 in 65 (24.0％),and speed 4 in 30,respectively.The washout speed had a significant correlation with the differentiation (x2=179.8238,P ＜ 0.001).The faster washout speed,the higher differentiated.Washout speed 1 could distinghuish well-differentiated from the poor and moderately differentiated tumor.The sensitivity and specificity of preoperative washout speed 1 to identify well histologic grade were 98.0％ and 77.8％,the positive predictive value and negative predictive value were 96.0％ and 48.8％,and the positive likelihood ratio and negative likelihood ratiowere were 1.9 and 0.01.Washout speed 4 could distinghuish poor differentiated from well and moderately differentiated tumor The sensitivity and specificity of preoperative washout speed 4 to identify poor histologic grade were 24.3％ and 97.0％,the positive predictive value and the negative predictive value were 65.3％ and 61.3％,and the positive likelihood ratio and negative likelihood ratiowere were 3.2 and 0.7.Conculsions Washout speed can reflect the degree of differentiation roughly.Washout speed can effectively diagnose the well-differentiated HCC,but it is difficult for moderate and poor differentiated HCC.
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@#Objective To investigate the therapeutic efficacy and side-effect of pulsed radiofrequency and radiofrequency thermocoagulation for gasserian ganglion guided by spiral CT on trigeminal neuralgia. Methods 100 patients diagnosed as idiopathic trigeminal neuralgia were treated with pulsed radiofrequency or radiofrequency thermocoagulation for gasserian ganglion. They were assessed with numeric rating scales (NRS) before and 1 d，3 d，1 week， 1 month, 6 months and 12 month after treatment. The side effects were recorded. Results There was significant decrease in the scores of NRS after treatment compared with those before (P<0.01) in both groups. No serious side effects were observed. Conclusion Pulsed radiofrequency for gasserian ganglion for trigeminal neuralgia was effective and less side-effect.