ABSTRACT
@#Objective To investigate the clinical efficacy and application value of percutaneous interventional treatment for structural heart diseases under guidance of ultrasound. Methods The clinical data of 1 010 patients with structural heart diseases treated by transcutaneous ultrasound-guided occlusion in our hospital from December 2, 2015 to December 31, 2019 were retrospectively reviewed, including 360 males and 650 females, aged 1-50 years. There were 692 patients of atrial septal defect (603 with central type, 9 combined with arterial catheter, 80 with ethmoid type), 116 patent foramen ovale, 25 ventricular septal defects (3 combined with atrial septal defect), 132 patent ductus arteriosus, 32 pulmonary valve stenosis (3 combined with atrial defect), 1 main pulmonary artery window, and 3 aneurysm rupture of aortic sinus. All patients were diagnosed by transthoracic echocardiography (TTE) before operation. Treatment was accomplished intraoperatively through TTE or transesophageal echocardiography (TEE) via the femoral artery or femoral vein. After operation, echocardiography, electrocardiogram and chest radiograph were reexamined. Results Satisfactory results were obtained in 1 005 patients, and 1 patient failed to seal the ventricular defect and was repaired under direct vision, occluder detachment occurred in 5 patients after operation (3 patients of atrial septal defects underwent thoracotomy for Amplatzer device and were repaired, 1 patient of atrial septal defects was closed after removing Amplatzer device, 1 patient of patent ductus arteriosus underwent thoracotomy for Amplatzer device and was sutured), mild pulmonary valve regurgitation occurred after balloon dilation in 2 patients with pulmonary stenosis, a small amount of residual shunt was found in 2 patients with ventricular defect, which disappeared after 3 months of follow-up, and 1 patient of right bundle branch block occurred and disappeared after 1 week. After follow-up of 1-24 months, 3 patients of ethmoidal atrial septal defect were reexamined with mild shunt. The occluder was in good position and the pressure difference of pulmonary valve was significantly reduced. There was no complication such as hemolysis, arrhythmia, embolism or rupture of chordae tendinae. Conclusion Percutaneous transfemoral artery and vein guided by TTE or TEE is safe and effective, with little trauma, no radiation or contrast agent damage, and has significant clinical efficacy and application values.
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Background: Mortality due to infective endocarditis (IE) in Chile is close to 30%. Aim: To report the experience with patients admitted with the diagnosis of IE in a regional tertiary hospital. Material and Methods: Retrospective study of 107 patients aged 50 ± 16years (75% males) discharged with a definitive diagnosis of IE according to modified DUKE criteria, between years 2003 and 2010. Demographic variables, severity scores, clinical characteristics, bacteriology and hospital evolution were recorded. Results: Fifty nine percent of patients had concomitant cardiovascular problems. APACHE II and Sequential Organ Failure Assessment (SOFA) scores on admission were 8.4 ± 4.7 and 2.7 ± 2.8 respectively. Native valves were affected in 91% of cases (aortic and mitral valves in 62% and 50% of cases respectively). Prosthetic valves were affected in 9.3% of cases. Rheumatic heart disease was the predominant primary lesion in 10% of patients. Antibiotics were used in 45.1% before blood cultures were performed. In 68% of patients blood cultures were positive. S. viridans (30.8%), S.aureus (18.6%) and coagulase negative Streptocicci (5.6%) were the identified microorganisms. Intensive care unit admission was required in 48% of patients. Renal, heart and neurological deterioration was observed in 53, 34 and 14% of patients, respectively. Twenty percent of patients developed systemic embolism and 37% required heart surgery. Mean hospital stay was 28.3 ± 19.1 days and 27% of patients died. Conclusions: In this series of patients, IE has a high mortality. Most patients studied were admitted in bad conditions.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Endocarditis, Bacterial/mortality , Hospitalization/statistics & numerical data , Streptococcal Infections , Chile/epidemiology , Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/surgery , Retrospective Studies , Viridans Streptococci/isolation & purificationABSTRACT
Objective To investigate whether BNP(brain natriuretic peptide) could be relatively objective index for comprehensive risk stratification of exercise rehabilitation nursing in young and middle myocardial infarction patients. Methods BNP concentration and LVEF were measured respctively in young and middle myocardial infarction patients. Then the risk stratification was administrated based these index respectively and Barther Scores and significant statistical differences were calculated according to homogeneity test for variance. Results Blood BNP concentrations in acute phase among the divided group based on EF risk stratification were significant difference,hence the standard deviation is large,which led to variance nonhomogeneity,and stracification difference between groups is not clear and across-talking. Exercise rehabilitation nursing scores based on echocardiography EF value had significant difference even veariance is nonhomogeneity,hence the differ-ence is not clear beween groups.Exercise rehabilitation nursing scores based on BNP was administrated and significance is clear beween groups. Conclusions BNP concentration and LVEF value had certain relationship and cross-talking among them.Risk stratification based on BNP concentration had objective instructions for exercise rehabili tation nursing in actue infarction myocardial pa-tients.
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Objective To investigate the incidence rate, high risk factors and hemodynamic changes of patent ductus arteriosus (PDA) in premature infants, and to give suggestions abo ut clinical monitoring and management of PDA in premature infants. Methods Echocardiography was performed on 86 non-ventilated or weaned from ventilator-pr emature infants at 2 to 5 days of age,whose gestational age was 28 to 36 weeks. All premature infants diagnosed as PDA were followed up clinically and by Echoc ardiography until discharged. Results Twenty-two infants diagnosed as PDA at mean 3 days of age, mean gestational age was (33.l?2.0) weeks. Ductus in 16 infants (out of 20 infants) closed spontaneo usly when repeated echocardiography at mean 8.5 days of age. For 4 remaining PDA infants, ductus closed in 2 cases (l treated with indomethacin). One ductus reo pened because of sepsis, and 3 infants discharged with opened ductus at their 2l , 40 and 47 days of age respectively. Single and multiple Logistic analysis indi cated that the lower the birth-weight ,the higher the incidence of PDA (?2=2. 8907 P=0.0891); neonatal asphyxia and suffered from severe diseases (neonat al respiratory distress syndrome, sepsis) were high risk factors of PDA (?2= 4.3729 P=0.0365;?2=11.6590 P=0.0006). Premature infants with PDA h ad good heart function,although their LA/AO ratio increased slightly (1.0810?0. 18 vs 1.00?0.07,P= 0.048).Conclusions PDA incidence at 3 days of life in 33 weeks premature infants is 25.6%, 85% PDA disappeares spontaneously during follow-up. Low birth-weight asphyxia, severe diseases and symptomatic PDA are high risk factors of PDA. Ductus can reopen in premature infants. J Appl Clin Pediatr,2005,20(2):129-131