[Association between the morphology of the implanted atrial septal defect occluding umbrella and postoperative headache].
- 作者列表："Huang Y","Wang JM","Wang QG","Zhang DZ","Zhu XY
:Objective: To explore whether the atrial septal defect(ASD) size, the type of occlusion umbrella selected, and the morphological changes after release of occlusion umbrella affect the headache symptoms of ASD patients after operation. Methods: A total of 567 ASD ptients, who underwent successful implantion with a single occlude from January 2014 to December 2017 in General Hospital of Northern Theater Command were enrolled. The patients were divided into symptomatic group and asymptomatic group according to the presence or absence of headache symptoms after occlusion. X-ray catheter calibration method was used to measure the diameter(d), thickness（L）, maximum diameter of the left umbrella surface after release(D2) and the value of i (i = D2/L). Risk factors related to headache were analyzed by multivariate logistic regression analysis. linear regression analysis was used to detect the relationship between the type of occluder umbrella and ASD diameter in asymptomatic group. Results: A total of 567 patients with one occluder umbrella were included, and 148(26.1%) cases were male. The age was (34.4±19.4) years old. The follow-up time was (12.7±2.8) months. There were 51 cases in the symptomatic group and 516 cases in the asymptomatic group. In 29 patients who were treated by extending the course or increasing the dose of aspirin, the symptoms disappeared or improved. There was no significant difference in the maximum ASD diameter (TTE measured) and the size of occluder between the symptomatic group and asymptomatic group(both P>0.05). The value of d ((19.80±6.67)mm vs.(17.40±7.28) mm, P=0.041) D2 ((43.29±7.41）mm vs. (39.20±9.59)mm， P=0.013)and L((13.06±3.72)mm vs. (10.19±2.90) mm，P=0.025) of the symptomatic group were all higher than that of the asymptomatic group，while the i value was smaller((3.54±0.88）vs.(3.99±0.93)，P=0.010）. The results of multivariate logistic regression analysis showed that the value of L(OR=1.286，95%CI 1.176-1.406, P=0.002) and the value of i(OR=0.916，95%CI 0.867-0.968, P<0.001) were independent factors of headache symptoms in patients after ASD occlusion, while the value of d and the value of D2 were not independent factors (both P>0.05). Linear equations obtained from asymptomatic patients showed the size of occluder =1.121×the maximum ASD diameter of TTE measured +6.414. Conclusions: There is no correlation between the symptoms with the expanded diameter and the maximum diameter of left umbrella's surface after released. The Postoperative discomfort symptoms is significantly correlated to the thickness of the occluder and the value of i. It is suggested that headache could be induced by the oversized occlude, thus choosing the appropriate size of the occluder is essential to reduce the occurrence of postoperative headache symptoms. Increasing the size of occluder because of worrying about the abscission and removal of the occlude is unreasonable. The antiplatelet therapy should also be strengthened to reduce the occurrence of symptoms and improve the symptoms of the patients if the occluder's size is too large. This regression equation (The size of occluder =1.121 × the maximum ASD diameter of TTE measured +6.414) could be used as a reference for the suitable selection of ASD occluder. :目的： 探讨房间隔缺损（ASD）大小、封堵伞型号及封堵伞释放后形态变化等因素是否影响ASD患者在封堵术后出现头痛症状。 方法： 纳入自2014年1月至2017年12月在北部战区总医院成功行ASD封堵术患者567例。根据患者封堵术后有无头痛症状分为有症状组和无症状组。采用X线下导管校准法测量释放后封堵伞展开直径（d）、厚度（L）、封堵伞左侧伞面的最大直径（D2），并计算i值（计算公式为i=D2/L）。分析两组在年龄、性别等生理因素，缺损大小、i值等相关因素之间的差异，对有组间差异的因素进一步行多因素logistic回归分析，探讨ASD封堵术后出现头痛症状的影响因素。在无症状组中采用线性回归分析封堵伞型号与ASD直径的关系。 结果： 共纳入567例成功置入单封堵伞的继发孔型ASD患者，其中男性148例（26.1%），年龄（34.4±19.4）岁。随访时间为（12.7±2.8）个月。有症状组51例，无症状组516例。有症状组患者通过强化抗血小板治疗，有29例术后头痛症状消失或有不同程度减轻。有症状组和无症状组的ASD最大直径（TTE测量）和封堵伞型号差异无统计学意义（P均>0.05）。有症状组的d值[（19.80±6.67）mm比（17.40±7.28）mm，P=0.041]、D2[（43.29±7.41）mm比（39.20±9.59）mm，P=0.013]、L值[（13.06±3.72）mm比（10.19±2.90）mm，P=0.025]均大于无症状组，i值小于无症状组[（3.54±0.88）比（3.99±0.93），P=0.010]。多因素logistic回归分析结果显示，L值（OR=1.286，95%CI 1.176~1.406,P=0.002）和i值（OR=0.916，95%CI 0.867~0.968,P<0.001）为ASD封堵术后患者出现头痛症状的独立影响因素，而d值和D2值不是其独立影响因素（P均>0.05）。在非症状组患者中得到线性方程：封堵伞型号=1.121×ASD最大直径（TTE测得）+6.414。 结论： ASD封堵术后的头痛症状与封堵伞释放后展开直径及左侧封堵伞面的最大直径无关，而与封堵伞的厚度与i值有关，提示选择过大的封堵伞增加伞的厚度是引起术后头痛的主要原因。为降低头痛的发生，应尽量选择合适的封堵伞，术者不宜因担心封堵伞脱落移位而加大封堵伞型号；对封堵伞偏大者术后应加强抗血小板治疗以减少或改善患者的头痛症状。封堵伞型号=1.121×TTE测量ASD最大直径+6.414，可以作为临床选择ASD封堵伞型号的参考值。.
: 目的: 探讨房间隔缺损 (ASD) 大小、选择的封堵伞类型、封堵伞松解后形态学改变是否影响ASD患者术后头痛症状。方法: 选择2014年1月至2017年12月在北方战区总医院接受单孔封堵术成功植入的ASD患者567例。根据闭塞后有无头痛症状将患者分为有症状组和无症状组。使用x射线导管校准方法测量直径 (d) 、厚度 (L) 、释放后左侧伞表面的最大直径 (D2) 和i的值 (i = D2/L)。采用多因素logistic回归分析头痛相关危险因素。采用线性回归分析检测无症状组封堵器伞型与ASD直径的关系。结果: 共纳入567例单支封堵器伞的患者，148例 (26.1%) 为男性。年龄 (34.4 ± 19.4) 岁。随访时间为 (12.7 ± 2.8) 个月。有症状组51例，无症状组516例。在通过延长病程或增加阿司匹林剂量治疗的29例患者中，症状消失或改善。症状组与无症状组的最大ASD直径 (TTE测量) 和封堵器大小差异均无统计学意义 (均P>0.05)。d值 ((19.80 ± 6.67)mm vs.(17.40 ± 7.28) mm，P = 0.041) D2值 ((43.29 ± 7.41)mm vs. (39.20 ± 9.59)mm，P = 0.013) L值 ((13.06 ± 3.72)mm vs. (10.19 ± 2.90) mm，P = 0.025) 有症状组均高于无症状组，而i值较小 ((3.54 ± 0.88)vs。(3.99 ± 0.93)，P = 0.010)。多因素logistic回归分析结果显示，L值 (OR = 1.286 CI 1.176-1.406，P = 0.002) 和i值 (OR = 0.916 CI 0.867-0.968，P<0.001) d值和D2值是影响ASD封堵术后患者头痛症状的独立因素 (均P>0.05)。从无症状患者获得的线性方程显示封堵器的大小 = 1.121 × TTE测量的最大ASD直径 + 6.414。结论: 左伞面扩张直径和最大直径与左伞面松解后症状无相关性。术后不适症状与封堵器厚度和i值显著相关，提示封堵器过大可诱发头痛，因此选择合适的封堵器尺寸对减少术后头痛症状的发生至关重要。由于担心封堵器的脱落和去除而增加封堵器的尺寸是不合理的。如果封堵器体积过大，还应加强抗血小板治疗，以减少症状的发生，改善患者的症状。该回归方程 (封堵器尺寸 = 1.121 × TTE测量的最大ASD直径 + 6.414mm) 可作为合理选择ASD封堵器的参考。 : 目的: 探讨房屋间隔缺损(ASD)大小、大小。方法: 纳入自2014年1月至2017年12 567例。。(d)、厚度(L)、封口左侧翼面的最大直径(D2)，并计算量值 (计算公式i = D2/L)。分析两个组合在年龄、性别等生理因素、缺乏尺寸、i值等相关因素之间的差异、、。。结果: 共纳入567例，其他中男性148例(26.1%)，年龄(34.4 ± 19.4)岁。随机访问时间为(12.7 ± 2.8)个月。有症状组51例，无症状组516例。，有29。(测量)和封型号差异统计意义 (p> 0.05)。有症状组的数值 [(19.80 ± 6.67)mm比(17.40 ± 7.28)mm，P = 0.041]、D2[(43.29 ± 7.41)mm比(39.20 ± 9.59)mm，P = 0.013]、l值[(13.06 ± 3.72)mm比(10.19 ± 2.90)mm，P = 0.025]均小于无症状组[(3.54 ± 0.88)比(3.99 ± 0.93)，P = 0.010]。多因素逻辑回归分析结果显示，L值(OR = 1.286 CI 1.176 ~ 1.406，P = 0.002)和i值(OR = 0.916 CI 0.867 ~ 0.968，P<0.001)，而且值和D2值不是其它独立影响因素(P> 0.05)。在非症状组患者中得到线性方程: 封堵器型号 = 1.121 × 最大直径 (t测试得)+ 6.414。结论:，与封装的厚重与i值有关，。为降低头部疼痛的发生，应尽可能选择合适的密封伞，;。封印型号 = 1.121 × ttetemetasasdmaxidom直径 + 6.414，。
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.