- 作者列表："Ip HL","Menahem S
BACKGROUND:Innocent murmurs are common in childhood. Echocardiography may diagnose almost all congenital cardiac abnormalities. Earlier studies have suggested that it may be unnecessary when a clinical diagnosis of an innocent murmur is made by an experienced cardiologist. Yet, echocardiography is commonly performed despite such a diagnosis. Is that justifiable? METHODS:Patients referred to a paediatric cardiologist for evaluation of a murmur were assessed. If an innocent murmur was clinically diagnosed, an echocardiogram and an electrocardiogram were ordered when requested. The cardiologist completed a questionnaire documenting the reasons for the investigations and his degree of confidence in the clinical diagnosis. The parents and patients were informed of the diagnosis and the results of the investigations. RESULTS:In almost all 62 cases whose murmurs were clinically considered to be innocent, the referring doctor expected an echocardiogram to be performed. Following echocardiography, one patient was found to have a small muscular ventricular septal defect. On review, the murmur was consistent with that diagnosis. Three (3) others had abnormal echocardiograms namely congenitally corrected transposition of great arteries, partial anomalous right upper lobe pulmonary vein, and left ventricular non-compaction. All on review were still considered clinically to have innocent murmurs. CONCLUSIONS:Despite the competency of the cardiologist, echocardiography diagnosed important but relatively uncommon cardiac abnormalities with prognostic implications that would have been missed if only the clinical examination was performed. Over and above the referring doctor's expectations for an echocardiogram to be performed is the need for the cardiologist to provide a complete and definitive diagnosis.
背景: 儿童时期常见的是无辜的杂音。超声心动图可诊断几乎所有先天性心脏异常。早期的研究表明，当由有经验的心脏病专家进行临床诊断时，可能没有必要。然而，尽管有这样的诊断，超声心动图通常被执行。这合理吗？ 方法: 对患者转诊至儿科心脏病学家评估杂音进行评估。如果临床诊断为无痛性杂音，则应要求进行超声心动图和心电图检查。心脏病专家完成了一份调查问卷，记录了调查的原因和他对临床诊断的信心程度。父母和患者被告知诊断和调查结果。 结果: 几乎62例临床上认为杂音是无辜的病例，转诊医生期望进行超声心动图检查。超声心动图检查后，发现1例患者有小的肌部室间隔缺损。复查，杂音与诊断相符。另有3例超声心动图异常，即先天性矫正大动脉转位、部分右上叶肺静脉异常和左心室致密化不全。所有患者在复查时，临床上仍认为有无痛性杂音。 结论: 尽管有心脏病专家的能力，但超声心动图诊断出重要但相对不常见的心脏异常，具有预后意义，如果仅进行临床检查，可能会漏诊。除了转诊医生对要执行的超声心动图的期望之外，还需要心脏病专家提供完整和明确的诊断。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.