ABSTRACT
Objective To evaluate the value of real-time three-dimensional transesophageal echocardiography (TEE) in the diagnosis of mitral valve structure in mitral valve prolapse, the significance of determining the prosthetic mitral valve ring size in the surgical treatment and the evaluation of immediate postoperative effect. Methods From November 2016 to March 2017, 19 patients with mitral prolapse performed with surgical treatment were diagnosed by transthoracic echocardiography at the echocardiography and vascular ultrasound center in the First Affiliated Hospital of Zhejiang University. All 19 patients underwent real-time three-dimensional TEE examination after anesthesia and before cardiopulmonary bypass. When the heart was recovered immediately after the operation, TEE was performed again to check the valve and the images were recorded in real time. During the whole examination, the images were observed by sonologists, surgeons and anesthesiologists, and the sonographic results were compared with the intraoperative findings. Totally 19 patients with moderate to severe mitral valve prolapse were examined and measured with real time three-dimensional ultrasound reconstruction. The mitral valve and tendons were observed and the mitral valve ring, the length of the valve and the diameter of the fiber triangle were measured. Results Intraoperative TEE examination could clearly display the anatomical structure and movement of mitral valve, annulus, chordae tendineae and papillary muscles from any angle. Real time observation of mitral valve thickness, mobility, calcification, vegetations and chordae tendineae rupture was effective. It was able to diagnose the thrombosis and patent foramen ovale. In the 19 patients, the TEE diagnosis of mitral valve prolapse was almost consistent with operative findings, and P2 was the most common area. The etiology was detected in 15 cases caused by rupture of mitral chordae tendineae, which was consistent with operative findings, and the accuracy rate was 100%. The size of the prosthetic ring provided by TEE in 14 cases was consistent with operative findings among 19 patients. The accuracy rate was 73.7% (4/9). Four cases were selected 1 size down than TEE, and 1 case was selected 1 size up than TEE. Conclusions The application of real-time three-dimensional ultrasound reconstruction can objectively reflect the pathogeny and pathological changes of prolapse, and provide a visual stereoscopic image, which is of great reference value for the formulation of the operation scheme. It also provides a basis for selecting the size of the forming ring and saves the operative time. It has practical clinical guiding significance. The function of the autologous valve is evaluated immediately after the operation, and the ventricular wall movement and left ventricular systolic function are detected in real time, and the left heart gas could be monitored. It is helpful to the intraoperative monitoring of the anesthesiologist and increase the success rate of the operation.
ABSTRACT
Objective To determine the pathological mechanism of gastrolithiasis formation in vitro and the effects of pectinase on gastrolithiasis. Methods The test in vitro was divided randomly into two groups:(1) Haws and persimmons(25g respectively) were chewed and put into two clean containers filled with fresh gastric juice.(2) Wine containing 30% alcohol(50ml) was added to the container. Each group included 4 collections.All two groups were placed in 37℃ calorstat box to observe the course and time of gastrolith formation. After gastrolith formation, 2g pectinase was added to the container and observed the decomposition of pectinase to gastrolith and the time was recorded. The effects of pectinase on 54 patients with gastrolithiasis were also investigated. Results The mean time of haws juice coagulation and persimmons was 23 minutes and 25 minutes respectively in the group without wine; but in the group with wine, the mean time of haws juice coagulation and persimmons was 14 minutes and 19 minutes respectively. After adding pectinase, the mean time of clot initiated decomposition was about 17 minutes in both groups, but complete decomposition needed 34 minutes. All the 54 patients with gastrolithiasis who received pectinase were cured.The gastrolith disappeared 6 hours after taking pectinase confirmed by barium meal examination. Conclusions Haws and/or persimmons mixed with gastric juice could induce gastrolith formation. The effects of pectinase on patients with haws or persimmons gastrolithiasis are good, this therapeutic procedure is simple, and the gastrolith resolves quickly.Pectinase may be widely used in the treatment of gastrolithiasis.