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Objective:To describe the characteristics and management of right-sided infective endocarditis (RSIE) during pregnancy.Methods:The clinical manifestation, blood culture, echocardiography, diagnosis, treatment, and maternal and infant outcomes of seven patients with RSIE during pregnancy from Capital Medical University Affiliated Beijing Anzhen Hospital from January 2009 to March 2020 were retrospectively collected and described.Results:The incidence of RSIE during pregnancy was 0.27‰ (7/25 832). All patients had a history of congenital heart disease, with a mean age of (26.0±2.7) years and a mean gestational age at onset of (28.7±6.6) weeks. Cardiac murmur, fever, dyspnea, cough, expectoration, and pulmonary rales were the common symptoms. Seven cases were complicated by anemia, seven with hypoproteinemia, six with hypoxemia, five with pulmonary hypertension, and five with positive blood culture. Echocardiography indicated that vegetations were mainly attached to the pulmonary valves (four cases), followed by the tricuspid valves (three cases) and the right ventricular outflow tract (three cases). Four patients were diagnosed with septic pulmonary embolism by chest X-ray. All patients were treated with intravenous antibiotics. Cesarean section was performed on five cases in the third trimester and one in the second trimester due to intrauterine death. The other case underwent vaginal delivery in the third trimester. Cardiac surgery was conducted during the hospitalization in four cases and not in the other three. The mean length of stay was 26 days (12-76 days). Six cases were cured, and one died after discharge. Among the six neonates, one had asphyxia and was died after withdrawal of treatment. The remaining five infants survived and developed well during the follow-up of 5 years (3-10 years).Conclusions:Pregnancy complicated by RSIE is a rare and critical condition, requiring early diagnosis to make optimal treatment strategies, reducing maternal and infant fatality.
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Objective To explore the feasibility of evaluating cardiac structure, coronary artery,pulmonary artery and cardiac function in one single scan by 320-row CT ECG-gated double phase cardiac function scan mode. MethodsForty patients underwent the 320-detector row CT double phase cardiovascular angiography. The pulmonary phase and aortic phase were reconstructed in order to evaluate the pulmonary and coronary artery. MPR reconstructions of both pulmonary and aortic phase were used to analyze the function of the two ventricles. And the results of the cardiac function were compared with those of transthoracic echocardiography. Thirty-five cases could be analyzed and diagnosed, while the other 5 cases had to be given up because of the poor imaging quality. The mean heart rate was (71.2 ± 11.2) beat per min (bpm). No arrhythmia case included. Results ( 1 ) Pulmonary embolism were diagnosed in 11 cases,coronary artery disease (CAD) were found in 5 cases, while post-stent implantation were observed in 7 cases. Six cases of congenital heart disease were diagnosed with 3 ASD and 3 primary pulmonary hypertension. Another one was diagnosed with left atrial myxoma, and 5 cases were pulmonary embolism associated with CAD. All of above cases were verified by final clinical diagnosis. (2) The heart function parameters including LVEDd , RVEDd, LVESd, RVESd and LVEF were (36.7 ±3.3), (43.3 ± 3.4) mm,(31.6±5.1), (41.3 ±5.1) mm and (47.1 ±15.1) for CT, while those were (40.3 ±3.1), (47.3 ±4.2) mm,(37.3 ±5.6), (45.3 ±3.3) mm,and (46.0 ± 14.8) for ultrasound, respectively. The CT results were correlated with the ultrasound ( n = 35, r = 0.886-0.988, P ＜ 0.01 ). (3) The average radiation exposure was ( 5.4 ± 0.5 ) mSv. Conclusions 320-row CT ECG-gated double phase cardiac function scan mode is feasible for the "one-stop-shop" examination of the cardiovascular disease. This noninvasive method is recommended for the diagnosis, differential diagnosis, treatment and prognosis of cardiovascular disease.
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Objective To investigate the diagnostic value of dual-energy CT pulmonary angiography (DE-CTPA) and dual-energy CT lung perfusion (DE-CTLP) in the assessment of pulmonary embolism comparing with pulmonary ventilation-perfusion scintigraphy. Methods Fifty patients suspected of PE (26 males, 24 females) underwent both DE-CTPA, DE-CTLP and pulmonary ventilation-perfusion scintigraphy. The results were compared and the correlation between the intravascular clots in DE-CTPA and the perfusion defects in DE-CTLP was analyzed. The sensitivity, specificity and accuracy of DE-CTLP for PE were assessed according to scintigraphic results which was considered as a "gold" standard. Result ( 1 ) Of 50 cases,920 segments in 46 cases were diagnostable, 4 cases were not included because of the poor image quality. lntravascular clots were found in 262 segments on DE-CTPA and perfusion defects in 266 segments were identified on DE-CTLP, while 268 segments were positive on scintigraphy. (2) The perfusion defects on DE-CTLP were correlated well with the clots on CTPA ( r = 0. 883, P < 0. 01 ). The Dual energy CT Lung perfusion imaging had a good consistence with scintigraphy (Kappa = 0. 940, P <0. 01 ). The sensitivity, specificity, positive and negative predictive value were 96. 2% (279/290), 98.0%(641/654), 95. 5% (279/292) and 98. 3% (641/652), respectively. (3)The radiation dose of DE-CTPA and CE-CTLP scan was(4. 37 ± 0. 47) mSv by using CareDose 4D technique. Conclusion DE-CTPA and CE-CTLP can provide pulmonary vascular morphology and parenchyma perfusion information which are useful and valuable for the diagnosis of PE.