心血管疾病与诊断

Background: Hypertrophic obstructive cardiomyopathy (HOCM) is an inherited disorder, characterized by left ventricle outflow tract obstruction. We performed this study to investigate the changes in left ventricular mechanics after surgical myectomy in patients with HOCM.
Materials and methods: We enrolled 15 patients with HOCM referred to surgical myectomy according to the recommendation of American Heart Association. All patients underwent transthoracic 2D speckle-tracking echocardiography to measure cardiac dimensions and mechanics before and after surgery. statistical analyses were performed using GraphPad Instat and MedCalc software.
Results: Following myectomy, all patients reported improved symptoms and increased functional capacity. Conventional echocardiographic measurements showed that surgical myectomy significantly decreased left atrial volume index (r=0.83, p˂0.0001), interventricular septum thickness (p˂0.0001, r=0.79), left-ventricular mass index (p˂0.0001, r=0.49) and resting left-ventricular outflow tract pressure gradient (p˂0.0001, r=-0.03). In terms of leftventricular function, we observed significant decreases in fractional shortening (r=0.16, p˂0.0001) and ejection fraction (p=0.01, r=-0.04) after the procedure in comparison to baseline functional data. We further significant postoperative reductions in terms of average circumferential strain (p˂0.0001, r=0.49), basal rotation (p=0.03, r=0.97), apical rotation (p˂0.0001, r=0.94) and LV twist (p˂0.0001, r=0.96). However, no significant changes were observed after myectomy in terms of most longitudinal strain and left ventricular synchrony measures.
Conclusion: Surgical myectomy improves symptoms, relieves left ventricular outflow tract obstruction and decreases left atrial volume index in patients with HOCM, but shows no significant changes in LV longitudinal strain and LV synchrony measures. Future studies should employ a larger sample size and more sensitive methods of synchrony detection.

Introduction: Myocardial infarction (MI) is 3rd leading disorder with worldwide prevalence. Males have more death risk because of hypoxia to cardiac myocytes due to thrombus formation resulted from cholesterol or fatty acid deposition. This blockage induces blood flow interruption causing atherosclerosis and embolism. Dysregulation in triglycerides, cholesterol and fatty acid increases the risk for MI in these individuals.
Materials and methods: A study was designed with real time (rt) mRNA measurement (RT-PCR) using LUX™ primer for Apolipoprotein E, Apolipoprotein C III and ACE II genes/products. Study looks for uncontrollable factors - sex, age and family history and controllable factors - Body Mass Index (BMI), BSF, Diabetes, duration of diabetes, physical activity, hypertension, blood pressure, smoking, education level, socioeconomic status, dyslipidaemia, sleeping/ awaking habit, consumption of fruit, use of vegetables and consumption of meat, number of tea/coffee cups, were looked at.
Results: Results indicates that long duration of diabetes (p=0.005) diabetes mellitus (p=0.042), and consumption of meat (chicken) (p=0.032) pose significant association MI and the genes. Apolipoprotein E has shown to effect myocardial infracted male patients in age group 23-33 years, Body Mass Index (BMI) (>16 kg/m2), diabetes mellitus, creatinine (170-190 mmol/L), systolic blood pressure (90-120 mmHg), low levels of triglyceride can be independently assistant to MI. In the study pan /naswar show high statistical significance with previous heart attack (p=0.001) and sleeping /awaking time (p=0.001) pattern.
Conclusion: In nutshell, duration diabetes, quantities of triglyceride, age, systolic blood pressure and interestingly sleeping/awaking time may be of great importance to draw a mathematical model.

Background: We have previously reported results from an initial study on a new implantable intracardiac wireless hemodynamic monitor in man, showing favourable results regarding accuracy of recordings over time and safety profile. The aim of this study was to follow up the intervention group of 16 patients with left atrial implants over a longer period to determine the systems longevity and dependability.
Material: The Titan™ monitoring system using a miniature pressure sensor was implanted in 16 patients undergoing open chest cardiac surgery. After discharge the system was used for left atrial pressure monitoring at home.
Findings: No major or minor adverse events were observed. As of July 2018, the average age of functioning left atrial implants providing high-quality hemodynamic curves was 3.75 years, ranging from 3.25 years to 5 years.
Conclusion: The system was reliable, provided high-quality pressure curves and was easy to use. Recalibration using the non-invasive Valsalva maneuver was accurate and easy to perform.

Aim: The purpose of this report is to convey our experience with the use of the new technique for the safe needle puncturing in the subclavian or brachiocephalic vein in patients with ipsilateral venous obstruction.
Methods: In the time period from June 2016 to June 2018, eleven patients who were candidates for implantation or upgrading of cardiac implantable electronic devices enrolled to do this technique; all patients which were showed to have subclavian vein obstruction through ipsilateral phlebography. By introducing the guiding catheter from femoral vein into the brachiocephalic vein, doing retrograde brachiocephalic venography, followed by passing of the guidewire, the over the wire balloon tracked the guidewire and was placed in a proper location.
Results: The balloon filled with contrast and worked as a landmark for needle puncturing. Between one to three attempts needle puncturing were performed to get to the vein successfully. Then, the valve peel away sheath(s) was/were indwelled over the anterograde guidewire that introduce through the needle and finally the lead(s) was/ were placed in the standard fashion. There were no complications at all and the procedure prevented time wasting.
Conclusion: Contrast-filled balloon guided needle puncturing technique in the presence of ipsilateral subclavian vein obstruction is a safe and feasible method.

The longer survival of patients with Duchenne muscular dystrophy due to advances in clinical care has increased the incidence of Duchenne muscular dystrophy -associated cardiomyopathy, a nearly consistent feature in the third decade of life. A 26-year-old patient with Duchenne muscular dystrophy experienced severe acute heart failure triggered by pneumonia. Levosimendan was effective in improving heart function.

We present a successful surgical repair of a single atrium (SA) in a 27-year-old woman, who had a complete missing of the atrial septum, without any coexisting valvular pathology. The SA diameter was 9.97 x 6.18 cm and the Qp/Qs were 4.1 due to single atrium. Surgical correction consisted in creating a new atrial septum, using doublevelor patch. First and second year follow up, patient in very good condition and without any symptoms present. We consider that the diagnoses of single atrium, especially in child bearing women is done in appropriate time, in order to avoid miscarriages and other complications associated.