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Objective:To investigate the application value of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals.Methods:The clinical data of 51 patients with acute coronary syndrome who received treatment in Feng Tai People's Hospital from January 2020 to January 2022 were retrospectively analyzed. They were divided into a control group ( n = 25) and an observation group ( n = 26). The control group was given standard dual antiplatelet and statin drugs. The observation group underwent percutaneous coronary intervention and stent implantation based on conventional drug treatment. All patients were followed up for 1 year. Cardiac function indexes left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were compared between the two groups. The number of readmissions, length of hospital stay, quality of life score, medication, the incidence of complications, and the incidence of adverse cardiovascular events were compared between the two groups. Results:Before treatment, there were no significant differences in LVEF and LVEDD between the two groups (both P > 0.05). After treatment, LVEF was increased, and LVEDD was decreased in each group compared with before treatment. After treatment, LVEF and LVEDD in the observation group were (50.34 ± 5.97)% and (49.01 ± 5.02) mm, respectively, which were significantly superior to (45.61 ± 5.42)% and (52.12 ± 5.24) mm in the control group ( t = -2.96, 2.17, both P < 0.05). After treatment, the number of readmissions in the observation group was significantly less than that in the control group [(0.8 ± 0.1) times vs. (2.1 ± 0.3) times, t = 20.14, P < 0.001]. The length of hospital stay in the observation group was significantly shorter than that in the control group [(12.4 ± 3.1) days vs. (25.3 ± 3.9) days, t = 13.10, P < 0.001]. Quality of life score in the observation group was significantly higher than that in the control group [(85.3 ± 5.9) points vs. (72.5 ± 5.2) points, t = -8.19, P < 0.001]. After treatment, the incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group [3.9% (1/26) vs. 28.0% (7/25), χ2 = 3.94, P = 0.041). Conclusion:Use of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals is feasible. It can improve patients' cardiac function and has a remarkable clinical effect with a low incidence of adverse cardiovascular events.
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Objective:To investigate the predictive value of serum cystatin C (Cys-C) and renal artery resistance index (RRI) 24 h before coronary CT angiography (CTA) examination in contrast-induced nephropathy(CIN).Methods:Sixty-four patients with coronary heart disease who received coronary CTA examination in Hebei Petro China Central Hospital from January 2020 to March 2021 were selected as the research subjects. According to the incidence of CIN after coronary CTA examination, they were divided into the case group (25 patients) and the normal group(39 patients). Serum Cys-C level was measured by automatic biochemical analyzer at 24 h before CTA examination, and RRI value was measured by color Doppler ultrasound. Risk factors of CIN after CTA examination were analyzed by Logistic regression. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of serum Cys-C, RRI and the combination of the two indexes in CIN.Results:Compared with the control group, the dosage of contrast agent, patients with hypertension, serum Cys-C level at 24 h before CTA examination and RRI value in the case group were higher than those in the normal group: (85.53 ± 16.27) ml vs. (64.37 ± 15.08) ml, 80.00%(20/25) vs. 56.41%(22/39), (1.36 ± 0.18)mg/L vs.(1.02 ± 0.21) mg/L, 0.743 ± 0.093 vs. 0.632 ± 0.081, there were statistical differences ( P<0.05). Multivariate Logistic regression analysis showed that the amount of contrast agent, hypertension, serum Cys-C level at 24 h before CTA examination and RRI value were independent risk factor for CIN after CTA examination ( P<0.05). The results of ROC curve analysis showed that serum Cys-C (>1.318 mg/L) combined with RRI value (>0.653) at 24 h before CTA examination predicted CIN with the highest area under the curve was 0.922, sensitivity was 92.5% and specificity was 81.6%. Conclusions:The incidence of CIN after CTA is related to the dosage of contrastant, hypertension, serum Cys-C level and RRI value at 24 h before CTA. The combination of Cys-C level and RRI value has a high predictive value for the occurrence of CIN.
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Objective： To explore the impact of resting heart rate (RHR) on evaluation of coronary artery elasticity and lesions by coronary CTA (CCTA). Methods： Data of 180 patients who underwent CCTA were retrospectively analyzed. The patients were divided into 3 groups according to RHR, i.e. group A, RHR≤60 bpm, group B, RHR 60-80 bpm and group C, RHR≥80 bpm (each n=60), and then were further divided into normal subgroup (no obvious lesion was found in CCTA) and diseased subgroup (CCTA found soft/hard plaques in coronary arteries) in each group. Data were reconstructed in 5% steps from 10% to 90% of the R-R interval, image quality was evaluated, and the best contraction and diastole reconstruction phases of right coronary artery (RCA), left anterior descending (LAD) and left circumflex branch (LCX) were obtained. Then distensibility coefficient (DC) of RCA, LAD and LCX in normal subgroups were measured at the best phase of 3 groups, and the number of plaques in the diseased subgroups were counted. Results： The best reconstruction phases of RCA, LAD and LCX in group A were 40%, 70% or 75% R-R interval, in group B were 45% and 75%, while in group C were 45% or 50%, 75% or 80% R-R interval, respectively. Differences of DC values for RCA, LAD and LCX were statistically significant among 3 normal subgroups (all P0.05). The differences of the number of plaques in RCA, LAD and LCX were statistically significant among 3 groups (all P0.05). Conclusion： During CCTA examination, patients with too high RHR may present reduced vascular elasticity and increased number of vascular plaques.
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Objective: To explore the value of quantitative parameters of CT pulmonary angiography in evaluating right heart function and prognosis of patients with central pulmonary embolism. Methods: Clinical data of 200 patients with central pulmonary embolism were retrospectively analyzed, including 35 cases died (death group) and 165 cases survived (survival group) during hospitalization. The quantitative parameters of CT pulmonary angiography and right heart function were compared between 2 groups. Results: Compared with the survival group, the pulmonary artery occlusion index, right ventricular short axis maximum diameter (RVSAMD), RVSAMD/left ventricular short axis maximum diameter (LVSAMD), pulmonary artery diameter in the death group all increased (all P< 0.001). There was no significant difference of LVSAMD between 2 groups (P=0.131). Multivariate Logistic regression analysis showed that CT pulmonary artery occlusion index, RVSAMD, RVSAMD/LVSAMD and increase of pulmonary artery diameter were the risk factors of death in patients with central pulmonary embolism (all P< 0.05). Pearson linear regression analysis showed that CT pulmonary artery occlusion index, RVSAMD/LVSAMD and pulmonary artery diameter were all positively correlated with RVSAMD (all P< 0.05). Conclusion: The quantitative parameters of CT pulmonary angiography have certain value in predicting right heart function and prognosis of patients with central pulmonary embolism.
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RESUMEN Se presenta el caso de un paciente, sin comorbilidades, que se interna por cuadro de infarto agudo de miocardio a repetición. En todas las ocasiones presentó dolor precordial típico y elevación de troponinas. En su primera cinecoronariografía no se encontraron lesiones angiográficas. Meses después vuelve a internarse por cuadro similar, se repite cinecoronariografía que informa nuevamente vasos coronarios sin lesiones angiográficas pero como hallazgo describe una imagen compatible con un puente muscular a nivel del tercio medio de la arteria descendente anterior, con efecto compresivo durante las sístoles y como responsable de las isquemias del miocardio. Finalmente se concluye como un infarto agudo de miocardio tipo 2 y se instaura tratamiento médico específico, respondiendo favorablemente.
ABSTRACT We present the case of a patient, without comorbidities, who is hospitalized due to recurrent acute myocardial infarction. On all occasions he presented typical precordial pain and elevated troponins. In his first cinecoronariography no angiographic lesions were found. Months later, he returned to hospital for a similar case, cinecoronariography is repeated that again reports coronary vessels without angiographic lesions but as a finding describes an image compatible with a muscular bridge at the level of the middle third of the anterior descending artery, with compressive effect during systoles and responsible for the myocardial ischemia. Finally, it is concluded as an acute type 2 myocardial infarction and specific medical treatment is established, responding favorably.
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Objective: To investigate the effect of modified inflatable compression method on patients underwent transradial CAG. Methods: Totally 100 patients underwent elective transradial CAG were randomly divided into modified group and control group (each n=50). Patients in modified group were treated with modified inflatable compression method after transradial CAG, and those in control group with conventional compression method. Swollen overflow and numerical pain rating scale (NPRS) were compared between the two groups at the end of compressing radial artery for 2 h and 4 h. When the compressor was removed after 6 h compression, the hemorrhage cases on radial artery puncture point were counted, and the cases of radial artery occlusion after 24 h were calculated and compared between the 2 groups. Results: Swollen overflow and NPRS at the end of 2 h and 4 h of compression were significantly lower in modified group than those in control group (all P<0.01). Hemorrhage after 6 h compression and removing the compressor was observed in 3 patients in modified group and 2 patients in control group (P=1.00). Radial artery occlusion was detected in 1 case in modified group and 2 cases in control group 24 h later (P=1.00). Conclusion: The modified inflatable compression method can reduce the postoperative limb swelling and pain of patients underwent transradial CAG without increase of hemorrhage at the puncture point nor vascular occlusion.
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Objective To evaluate the clinical value of CT angiography (CTA) in the diagnosis of acute pulmonary embolism (APE) after standardized chest pain assessment in patients with acute chest pain.Methods From January 2014 to May 2016,The clinical data of 43 patients with acute chest pain in Wuzhou Hospital of Traditional Chinese Medicine and Wuzhou Worker's Hospital received CTA examination were retrospectively analyzed.After standardized assessment,16 patients with suspected APE through pulmonary artery CTA scan screening were selected as observation group.27 cases of chest pain who were not received standardized assessment were selected as the control group,the chest CTA scan was used to investigate the causes of chest pain.The number of CTA confirmed by APE in two groups was compared.The effect of APE screening scale score and D-Dimer on the diagnosis of APE in the observation group was analyzed,and the application value of standardized evaluation of chest pain in APE was analyzed.Results The positive rate of CTA in the observation group was higher than that in the control group,and the difference between the two groups was statistically significant(x2 =3.93,P ＜ 0.05).The APE screening scale and D-Dimer in the observation group were (9.64 ±4.74) points and (886.73 ± 191.83) μg/L,respectively.which in the APE excluded patients were (2.20 ± 1.64) points,(587.20 ± 35.79) μg/L,respectively,the differences were statistically significant(t =3.363,3.402,all P ＜ 0.01).Conclusion Patients with acute chest pain and chest pain are standardized after the evaluation,optimization of CTA examination and improve the diagnostic rate of APE,reduce the rate of misdiagnosis and missed diagnosis,provide timely and accurate diagnostic basis for clinicians to gain valuable opportunity for further disposal.
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Objective To assess the diagnostic value of left ventricular angiography in patients with apical hypertrophic cardiomyopathy.Methods A total of 32 consecutively recruited patients aged from 61 to 78 with suspected apical hypertrophic cardiomyopathy from inconclusive apex imaging on conventional echocardiography from June 2016 to December 2017 underwent left ventricular opacification.A diagnosis of apical hypertrophic cardiomyopathy was made when the thickness of hypertrophied area of the apex was ＞ 1.5 cm,the ratio of the hypertrophied area to the non-hypertrophied area was ＞ 1.3,and no hypertrophy was found elsewhere.Results Twenty-four out of 32 patients (75.0％) were diagnosed with apical hypertrophic cardiomyopathy,all of whom had pure apical hypertrophy.The other 8 patients were excluded,with normal thickness in the apex.Patients with apical hypertrophic cardiomyopathy had apical wall thicknesses ranging from 15 mm to 21 mm,reduced myocardial motion amplitude in the apex and uneven echo at certain areas of the ventricular wall.All cases showed clear images of the apex with left ventricular opacification,and the apex of the heart lost its normal morphology and showed a pointed end,with ventricular cavity obliteration or uneven wall thickness in the apex.Conclusions Left heart ventricular angiography can be complimentary to conventional echocardiography in the diagnosis of apical hypertrophic cardiomyopathy by providing a clearer endocardial contour and more accurate estimates of apical wall thickness and therefore enhancing the diagnostic value of ultrasound for apical hypertrophic cardiomyopathy.
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Objective To compare the safety of octogenarian patients receiving non-cardiac surgery within 1 week versus within 1-3 weeks after coronary computed tomographic angiography(CTA).Methods Octogenarian patients who underwent non-cardiac surgery after coronary CTA in Fujian Medical University Union Hospital,were retrospectively analyzed.All patients were divided into two groups:those received surgery within 1 week after coronary CTA as group 1 (n =73),those within 1-3 week after coronary CTA as group 2,(n =35).The baseline clinical characteristics,the changes in pre-and postoperative serum creatinine levels (Scr)and estimated glomerular filtration rate(eGFR),and the incidence of acute kidney injury(AKI)were compared between two groups.The revised cardiac risk index(RCRI)score was evaluated for each octogenarian inpatient,and the RCRI sum score for different types of non-cardiac surgery were calculated.Finally,the RCRI sum score of the preoperative risk factors were compared between different types of non-cardiac surgery so as to assess their specifically safety.Results In 108 patients who performed coronary CTA,only one patients developed palpitation and three had injection site pain.All patients receiving different types of non-cardiac operation had low revised cardiac risk index(RCRI ≤ 2).Death was not found.The serum levels of Scr and eGFR were similar between two groups before coronary CTA and after operation(all P＞0.05).Conclusions Octogenarian patients with low preoperative cardiac risk index(RCRI ≤ 2) are safe for performing non-cardiac surgery within 1 week after coronary CTA.
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OBJECTIVES@#To check the isolated heart by coronary angiography to discover the location, nature and degree of the coronary artery lesions more accurately and increase the comprehensive evaluation ability of cardiovascular disease.@*METHODS@#Ten fresh isolated hearts with different causes of death were extracted and injected with barium sulphate as contrast substance by ring injector, then developed under Xper FD20 angiography equipment. The obtained pictures and image data were handled by three-dimensional angiography images with the software attached to the angiography equipment. The coronary artery tissues were HE stained and observed by microscope. The HE staining results were compared with the angiographic results.@*RESULTS@#The imaging data obtained from the 10 cases for examination showed 8 cases without coronary artery stenosis and 2 cases with Ⅲ, Ⅳ coronary artery stenosis, which were consistent with HE staining results of coronary artery organization and the both results were confirmed.@*CONCLUSIONS@#Isolated coronary angiography has an unique advantage for accurate grading of classification of coronary artery stenosis, examination of vascular malformation and tiny lesions, which can provide reference for the localization of small lesions and basis during the autopsy for identification conclusion.
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Humans , Autopsy , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Coronary Vessels/pathology , Heart/diagnostic imaging , Imaging, Three-Dimensional , In Vitro TechniquesABSTRACT
ObjectiveTo check the isolated heart by coronary angiography to discover the location, na-ture and degree of the coronary artery lesions more accurately and increase the comprehensive evaluation ability of cardiovascular disease.MethodsTen fresh isolated hearts with different causes of death were extracted and injected with barium sulphate as contrast substance by ring injector, then developed under Xper FD20 angiography equipment. The obtained pictures and image data were handled by three-dimen-sional angiography images with the software attached to the angiography equipment. The coronary artery tissues were HE stained and observed by microscope. The HE staining results were compared with the angiographic results.ResultsThe imaging data obtained from the 10 cases for examination showed 8 cases without coronary artery stenosis and 2 cases with Ⅲ, Ⅳcoronary artery stenosis, which were consistent with HE staining results of coronary artery organization and the both results were confirmed. ConclusionIsolated coronary angiography has an unique advantage for accurate grading of classification of coronary artery stenosis, examination of vascular malformation and tiny lesions, which can provide reference for the localization of small lesions and basis during the autopsy for identification conclusion.
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Objective To observe the correlation between cardiac two-dimension global strain-speckle tracking imaging (2D-STI) and coronary artery disease index (CADi) scores in patients with acute myocardial infarction(AMI). Methods Eighty patients with AMI were chosen and given myocardial motion analysis using 2D-STI. The global longitudinal strain (GLS), global radial strain (GRS) and global circumferential strain (GCS) was calculated. All patients were given scoring according to CADi scores standard by coronary angiography. The correlations between 2D-STI indexes and CADi scores were analyzed. The area under curve(AUC) of the receiver operating characteristic curve (ROC) of critical coronary stenosis was calculated. Results GLS, GRS and GCS was all correlated to CADi scores (r=0.670, -0.621, 0.525, all P < 0.01). The sensitivity, specificity and AUC of GLS for critical coronary stenosis was 82.35%, 80.43% and 0.831. The sensitivity, specificity and AUC of GCS for critical coronary stenosis was 76.47%, 76.09% and 0.797. The sensitivity, specificity and AUC of GRS for critical coronary stenosis was 97.06%, 78.26% and 0.880. The AUC of GLS and GRS was larger than that of GCS, and the sensitivity, specificity for critical coronary stenosis was larger. Conclusions 2D-STI indexes have correlation with CADi scores. GLS and GRS has correlation with coronary artery stenosis.
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Objective To investigate imaging features and clinical characteristics of the small coronary-bronchial artery fistula (CBF). Methods By retrospective analysis of image data from May 2007 to November 2011 for coronary angiography in 30 284 patients without chronic lung or pulmonary vascular disease patients, 13 cases of small CBF (diameter of the end of fistula near coronary artery< 2 mm) were detected. Incidence of CBF was counted, its morphology was described, and its clinical features were preliminarily analyzed and summarized. Independent sample t test and χ2 test were used to compare diameters and incidences of CBF originatng from left and right coronary arteries. Results In this study primary CBF detection rate was 0.043%(13/30 284). The ends of CBFs near coronary arteries were slender and their diameter average was (1.57 ± 0.75) mm. In this study all of the CBF were from the right coronary artery and left circumflex coronary artery, finding no cases starting from the left anterior descending coronary artery. There was no significant difference between incidence of CBFs originating from the right coronary artery and left circumflex coronary artery coronary and the diameters of CBFs. In 13 cases of CBF, 9 cases of myocardial ischemic symptoms were caused by coronary artery stenosis, which was proven by angiography;Four cases without myocardial ischemic symptoms or with very atypical symptoms were finally diagnosed as cardiac neurosis. After branching, the CBF diameters of these coronary arteries were seen no evindently reduced, which suggested that the coronary bypass had less blood flow, and therefore had no significant hemodynamic significance. Conclusions Congenital CBF can exist in populations without chronic lung or pulmonary vascular disease. The main image features are that their diametes were small and all originate from the right coronary artery and left circumflex coronary artery. The most fundamental clinical features are that there're no symptoms of myocardial ischemia due to coronary artery steal and no obviously hemodynamic significance. It is important to well recognize this type of CBF for enriching radiographic knowledge, identifying various anatomic variations, and carrying out clinical diagnosis and treatment.
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Objective To compare the value of color Doppler echocardiography in the diagnosis of coarctation of the aorta (COA) in comparison with CT angiography (CTA). Methods Ninety-two patients with COA were retrospectively analyzed that were confirmed by surgery from January 2009 to September 2013 and diagnosed by color Doppler echocardiography and CTA. Results Among 92 COA patients conifrmed by surgery, 87 patients were diagnosed correctly by echocardiography while 91 patients were diagnosed by CTA, and the accuracy of echocardiography and CTA were 95%(87/92) and 99%(91/92), respectively without significant difference (χ2=1.550, P=0.213). According to surgical findings, there were 222 anatomic abnormalities including 110 intra-cardiac, 13 heart-vessel connection and 99 vessel abnormalities. For 110 intra-cardiac abnormalities, echocardiography detected all abnormalities while CTA found 92 with 18 missed including 11 valve or valve ring lesions, 3 patent foramen ovale, 2 atrial septal defect, 1 ventricular septal defect and 1 endocardial cushion defect. The accuracy of echocardiography for intra-cardiac abnormalities was signiifcantly higher than that of CTA (100%, 110/110 vs 84%, 92/110,χ2=18.801, P=0.000). CTA and echocardiography detected all abnormalities of heart-vessel connection. For 99 vessel abnormalities, CTA showed an accuracy of 98%(97/99) with 2 missed lesions including 1 collateral circulation between the aorta and the pulmonary artery and 1 membranous narrow of the aorta, while echocardiography misdiagnosed 1 COA as interruption of aortic arch and missed 15 lesions, including 4 COA, 3 collateral arteries, 2 patent ductus arteriosus, 2 aberrant right subclavian artery, 2 brachiocephalic vein abnormality, 1 partial anomalous pulmonary venous drainage and 1 persistent left superior vena cava. The accuracy of CTA for detection of vessel abnormalities was signiifcantly higher than that of echocardiography (98%, 97/99 vs 84%, 83/99,χ2=11.350, P=0.000). Conclusions Both CTA and echocardiography are effective diagnostic modalities for COA and CTA is superior to echocardiography for detecting vessel anomalies whereas echocardiography is superior to CTA for detecting intra-cardiac abnormalities. The combination of both modalities will provide more accurate information for clinical diagnosis.
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Objective To study the long-term effect of total right heart bypass on pulmonary perfusion after extracardiac total cavopulmonary connection (ETCPC).Methods Fifty-three patients (29males,24 females; average age (10.8±6.1) years) undergoing ETCPC from March 1990 to December 2005were retrospectively analyzed.Forty-three patients had full set of pulmonary perfusion data at 1 month and 5years postoperation.The perfusion ratios of each lung segment were calculated based on 99Tcm-MAA radionuclide imaging.The PVR and pulmonary artery index were calculated from angiocardiography measurements.All data were compared with paired t test.Results Compared with the early postoperative data,the perfusion ratio of superior/inferior segment(0.72±0.20 vs 0.75±0.01; t =2.54,P＜0.05),the PVR ((142.98±2.61) vs (146.95±2.54) dyn · s · cm-5; t=2.08,P＜0.05; 1 dyn · s · cm-5 =0.1 kPa · s · L-1) and vena cava pressure ((9.35±0.24) vs (9.95±0.23) mmHg; t=2.69,P＜0.05; 1 mmHg=0.133 kPa) decreased significantly in follow-up data; while the ratio of posterior basal segment perfusion increased significantly (0.12±0.00 vs 0.10±0.03; t=2.16,P＜0.05).The arterial oxygen saturation ((92.70±0.30)％ vs (92.86±0.29) ％ ; t =1.12,P＞0.05),the total pulmonary nuclear counts ((701.91 ± 8.26) × 103 vs (698.93 ± 12.0) ×103 ; t=0.38,P＞0.05) and the perfusion ratio of inferior vena cava to the right lung (0.61±0.06 vs 0.60±0.06 ; t =0.74,P ＞ 0.05) were similar between the two terms of follow-up.The early angiographic and radionuclide perfusion studies did not match in 5 patients.Conclusions Hypostatic redistribution of pulmonary blood flow is the characteristics in long-term follow-up of ETCPC patients.The radionuclide imaging is superior to angiocardiography in revealing functional pulmonary blood perfusion.
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Objective Analysis of myocardial microvascular perfusion in patients with chronic total coronary occlusion (CTO) who underwent a coronary artery bypass graft (CABG) use real-time myocardial contrast echocardiography (RTMCE),to provide an effective method of detecting viable myocardium and a reference for the choice of CABG indications.Methods Twenty-seven patients with CTO underwent RTMCE 1 week before CABG,they underwent follow-up echocardiography and coronary artery 256-slice multislice computed tomography aagiography 1 year after CABG.Myocardial viability was defined as a postoperative ultrasound wall motion significantly improved ≥ 1 point.Semi-quantitative analysis of contrast images,myocardial viability was defined as myocardial perfusion score ≤ 2 points.Viable myocardium by quantitative assessment of myocardial blood flow (MBF) was determined by analyses of receiver-operating characteristic (ROC) curves.Results Patients with LVEF increased significantly after CABG (P ＜ 0.01),Of 259 segments with wall motion abnormality,149 (58％) showed wall motion significantly improved ≥ 1 point after CABG,considered viable myocardium,110 (42％) were not observed in wall motion improved,considered to be non-viable.The viable myocardial segments were significantly greater than non-viable myocardial segments in A,β,A × β value (P ＜ 0.01).Compared with the semi-quantitative analysis,quantitative analysis of MBF increased the sensitivity and accuracy of RTMCE for detecting viable myocardium (P ＜ 0.05).Conclusion RTMCE could accurately assess myocardial viability and provide a strong reference for clinical decision making and judging prognosis.
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ObjectiveTo study the pulmonary arterial development over five years in patients underwent extracardiac total cavopulmonary connection (ETCPC).Methods43 survived patients,who had undergone ETCPC were examined with pulmonary perfusion at one month and five year following the operation.Central venous pressure (CVP) and arterial oxygenation saturation (SatO2 ％ ) were measured by right cardiac catheter,pulmonary arterial index (PAI) and pulmonary vascular resistance (PVR) were calculated.Pulmonary blood distribution were measured and calculated by 99m Tc-MAA perfusion imaging.ResultsThe PAI and PVR of the follow-up group reduced significantly ( t =2.41,P ＜ 0.05 ; t =2.08,P ＜ 0.05 ),CVP also reduced significantly ( t =2.69,P ＜ 0.05 ),but SatO2 ％ did not changed significantly.Total radionuclide counts and the ratio of rightorleft pulmonary perfusion did not change significantly.( t =0.38,P ＞ 0.05 ;t =1.12,P ＞ 0.05 ),but the ratio of the superior and inferior lobe decreased significantly( t =2.54,P ＜ 0.05 ).ConclusionThe weak pulsation and low dynamic of Fontan circulation also can promote pulmonary vascular development.However,the improvement of hemodynamic in pulmonary circulation at mid-term follow will not lead to an increased amount of pulmonary perfusion or oxygen supply,which is probably due to the massive opening of the arteriovenous shunt and increased futile circulation.
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ObjectiveTo evaluate the diagnostic value of multi-slice CT (MSCT) and multi-dimensional reconstructions for congenital pulmonary stenosis (PS) in children.MethodsThe enhanced thin CT images of 33 patients with PS were retrospectively analyzed,the data was transmitted to the workstation for multi-planar reformation ( MPR),volume rendering technique (VRT) and maximum intensity projection (MIP).The CT imaging features of PS were analyzed combining with operation resul ts and Ultrasonic Cardiogram (UCG).ResultsIn 33 cases of PS,there were 17 cases with pulmonary valve stenosis (PVS),10 cases with right ventricular infundibulum stenosis (RVIS),and 6 cases with pulmonary trunk stenosis (PTS).The first two were correctly diagnosed by UCG,5 cases of PVS and Icases of RVIS were correctly diagnosed by MSCTA,the later was correctly diagnosed by UCG and MSCTA.In 14 cases with collateral circulations between aorta and pulmonary artery ( APC ),all were correctly diagnosed by MSCTA,only 3 case was diagnosed by UCG,1 case was misdiagnosed as PDA.UCG can clearly demonstrate the others intra-cardiac deformities,such as ASD,VSD,RVH,PFO,SV,DORV,TECD and TBD,the accuracy rate of MSCTA was 39.4％,and MSCTA can clearly demonstrate the origin,course and diameter of extracardiac vascular abnormalities,such as PDA,RAA,TGA,TAPVD,CoA,PLSV and VLSA,the accuracy rate of UCG was 697％.ConclusionsMSCT and multi-dimensional reconstruction were a kind of non-invasive method,it was a good approach for extra-cardiac vascular malformations and APC in PS.Combining with UCG,it can further be used to improve the diagnostic accuracy of intra-cardiac malformation and supply diagnostic evidence for clinical treatment.
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Objective To explore the value of transthoracic echocardiographic suprasternal view in the diagnosis of the subtype of the patent ductus arteriosus(PDA).Methods Sixty-five cases with PDA were examined by transthoracic echocardiographic suprasternal view and parasternal great artery short axis view respectively before closure therapy.The diameters of both the aotic and pulmonary side were detected,and subtype diagnoses were made.The results were compared with those from digital subtraction angiography (DSA).Results The demonstrated rates of PDA were 100％ on the parasternal great artery short axis and suprasternal views.Of the 65 cases,12 cases,19 cases and 19 cases were the funnel type of PDA checked on the parasternal great artery short axis view,suprasternal view and DSA respectively.The demonstrated rate of the parasternal great artery short axis view was lower than that of the suprasternal view (x2 =5.14,P ＜0.025 ).The diameter of the aotic side of PDA was (8.31 ± 2.76)mm,(10.87 ± 3.26) mm and (11.15±3.29)mm and the diameter of the pulmonary side of PDA was (5.69± 2.82)mm,(5.75 ± 2.63)mm and (6.09 ± 2.78) mm respectively on the above two views and DSA.Conclusions The diameter of the aotic side of PDA can be accurately detected by using superasternal view,which would be helpful for the diagnosis of PDA subtype.
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Objective To evaluate pulmonary hypertension(PH) and surgical therapeutic effects using radionuclide pulmonary perfusion imaging in patients of valvular heart disease. Methods And material 115 patients accumulated with valvular disease were included from May 2001 to August 2007. Echocardiography and first-pass radionuclide pulmonary perfusion imaging(FPPPI) were performed in all patients before surgery,7days after surgery and 3 months after surgery(33cases). Patients were divided into four groups. Pulmonary artery pressure (PAP) is normal group[mean pulmonary arterial pressure (MPAP)≤20mm Hg(1 mm Hg =0. 133 kPa)]; PAP slightly rise group[20 mm Hg < MPAP≤30 mm Hg]; PAP moderate rise group[30 mm Hg < MPAP≤50 mm Hg]; PAP weighty rise group[MPAP >50 mm Hg]. Results Lung Equilibrium Time (LET)by FPPPI were(18.87 ± 4.80) s, (26. 17 ± 7.09) s, (38.48 ± 7.09) s and (54.59 ± 7.96) s in this four groups before surgery. LET were 17.58 ±4.52, 21.51 ±6.44, 23.94 ±5.85, 27.29 ±6.70 in this four groups 7 days after surgery (P<0.001). There were no siguificantly differences of LET in 33 cases 3 months after surgery compared with those of 7 days after surgery. Conclusion Pulmonary arterial pressure siguificantly decreased 7 days after surgery in patients with PH of valvular heart disease, especially in those of slightly and moderate rise groups. FPPPI is an accuracy method in evaluating surgical therapeutic effects in valvular heart disease.