Effects of atrial septal defects on the cardiac conduction system

The case report presented in this edition by Mu et al.The report presents a case of atrial septal defect(ASD)associated with electrocardiographic changes,noting that the crochetage sign resolved after Selective His Bundle Pacing(S-HBP)without requiring surgical closure.The mechanisms behind the appearance and resolution of the crochetage sign remain unclear.The authors observed the dis-appearance of the crochetage sign post-S-HBP,suggesting a possible correlation between these specific R waves and the cardiac conduction system.This editorial aims to explore various types of ASD and their relationship with the cardiac con-duction system,highlighting the diagnostic significance of the crochetage sign in ASD.

To What Extent Can Transcatheter Devices Replace Open-Heart Surgery in the Treatment of Cardiac Septal Defects?

Transcatheter treatments are widespread, having the advantages of being less invasive than surgery with quicker recovery times and reduced physical and psychological consequences. However correct patient selection is vital to optimise outcomes. In the case of an isolated atrial septal defect (ASD), transcatheter closure is preferred. Whilst multiple or large ASDs or ventricular septal defects (VSDs) are best treated through the transthoracic approach. Furthermore, the development of the transcatheter approach has yielded devices that can be used in the transthoracic approach resulting in hybrid techniques. This article aims to evaluate both transcatheter devices and open-heart surgery in the treatment of cardiac septal defects. A brief discussion follows on from the causes and history of cardiac defect treatments.

Complexity in interpreting cardiac valve-associated thrombus from tumors in Li-Fraumeni syndrome

Li-Fraumeni syndrome(LFS)is a well-defined autosomal dominant predisposition syndrome due to TP53 germline mutation that causes many cancer malig-nancies.This early-onset syndrome poses a state of widespread malignancy.Such an inherited condition possessing defective p53,guardian of the genome,in the germline has the potential to cause multiple cancers by predominantly affecting mesenchyme(connective tissues,blood cells),breast,brain,and adrenal cortex organs.The tumors initially identified in LFS can eventually propagate to cause secondary malignancies.LFS contributes to multiple cancers in individuals with defective p53 inheritance.When suspected to possess any mass,patients with other co-morbidities,in particular those with certain cardiovascular conditions,undergo screening using high-throughput techniques like transthoracic and transesophageal echocardiography or cardiothoracic magnetic resonance imaging to locate and interpret the size of the mass.In LFS cases,it is certain to presume these masses as cancers and plan their management employing invasive surgeries after performing all efficient diagnostic tools.There are only poor predictions to rule out the chances of any other pathology.This criterion emphasizes the necessity to speculate alternative precision diagnostic methods to affirm such new growth or masses encountered in LFS cases.Moreover,it has all the possibilities to ultimately influence surgical procedures that may be invasive or complicate operative prognosis.Hence,it is essential to strategize an ideal protocol to diagnose any new unexplored mass in the LFS community.In this editorial,we discuss the importance of diagnostic approaches on naïve pristine masses in LFS.

Changes of cTnI in myocardial ischemic and reperfusion injury during correction of cardiac defects in children

Objective The purpose of this study is to investgate changes of cTnI in myocardial ischemic and reperfusion injury during correction of cardiac defects in children. Methods From June, 1999 to May,2000,45 children (30 male, 15 female) undergoing correction of cardiac defects were divided into three groups randomly: group Ⅰ no myocardial ischemia,group Ⅱ myocardial ischemia less than 60 minutes, group Ⅲmyocardial ischemia 】 60 minutes. There were no significant differences in the three groups in age, sex ratio, C/T ratio, or left ventricular function. Blood samples for analysis were collected before skin incision and at time intervals up to 6 days postoperatively. Analysis of creatine kinase MB.LDH and cardiac-specific troponin I was used for the detection of myocardial damage. Meantime, the ECG was checked for myocardial infarction. After the reperfusion, myocardial tissue was obtained from the free wall of right ventricle myocardial structure studies. Results The level of cTnI was increased

Delayed cardiac tamponade after simultaneous transcatheter atrial septal defect closure and left atrial appendage closure device implantation: a particular case report

Percutaneous left atrial appendage(LAA)occlusion evolved as an alternative treatment to the patients who are contraindicated or cannot tolerate oral anticoagulants with nonvalvular atrial fibrillation(AF)at risk of stroke or systemic embolism.[1]Abnormal hemodynamic changes in elder atrial septal defect(ASD)patients cause remodeling of the left atrium,which eventually leads to right heart failure.[2]As the ASDs elderly are associated with a higher incidence of AF,simultaneous transcatheter ASD and LAA closure has become a new effective therapeutic strategy.However,only a limited number of articles involving cardiac tamponade complications have been published in the literature.What’s more,previous studies involving early hemodynamically irrelevant pericardial effusion after the procedure attribute to multiple repositioning attempts of LAA occluder or delivery sheath injured the atrial wall.

Cardiac resynchronization therapy for heart failure induced by left bundle branch block after transcatheter closure of ventricular septal defect

A 54-year-old female patient with congenital heart disease had a persistent complete left bundle branch block three months after closure by an Amplatzer ventricular septal defect occluder. Nine months later, the patient suffered from chest distress, palpitation, and sweating at daily activities, and her 6-min walk distance decreased significantly （155 m）. Her echocardiography showed increased left ventricular end-diastolic diameter with left ventricular ejection fraction of 37%. Her symptoms reduced significantly one week after received cardiac resynchronization therapy. She had no symptoms at daily activities, and her echo showed left ventricular ejection fraction of 46%and 53%. Moreover, left ventricular end-diastolic diameter decreased 6 and 10 months after cardiac resynchronization therapy, and 6-min walk dis-tance remarkably increased. This case demonstrated that persistent complete left bundle branch block for nine months after transcatheter closure with ventricular septal defect Amplatzer occluder could lead to left ventricular enlargement and a significant decrease in left ventricular systolic function. Cardiac resynchronization therapy decreased left ventricular end-diastolic diameter and increased left ventricular ejection fraction, thereby improving the patient’s heart functions.

The Effect of Atrial Septal Defect Closure on Cardiac Volumetric Changes in Adults, Transcatheter Versus Surgical Closure, a Pilot Cardiac Magnetic Resonance Study

Background:Closure of an atrial septal defect(ASD)reduces right-side heart volumes by abolishing shunting with simultaneous improvement of the left ventricle(LV)filling and functions due to ventricular interdependence,thereby improving symptoms.Furthermore,studies conducted on atrial volume changes after ASD closure are limited.Cardiac magnetic resonance(CMR)is considered as the gold standard method for measuring cardiac volume and mass.Objective:We aimed to study the effect of transcatheter and surgical closure of secundum ASD on cardiac volumes and systolic functions as well as the fate of tricuspid regurgitation(TR),using CMR analysis.Methods:We prospectively enrolled 30 adult patients with isolated secundum ASD who were referred to ASD closure.CMR evaluation of cardiac chambers indexed volumes,systolic function,myocardial mass index,and tricuspid regurgitant fraction were done at before and 6 months after closure.Results:RV volumes decreased in both groups when compared to baseline(p-value 0.001),the device group had more reduction in volumes and more improvement in RV function after closure(p-value 0.001)when compared to the surgical arm.The changes in the RV mass index were insignificant between both groups(p-value 0.31).Functional TR improved to the same extent in both groups.Left ventricular end diastolic volume index(LVEDVI)and LV mass index increased sig-nificantly in both groups when compared to baseline in both groups but with no difference between groups p-value 0.01),left ventricular end systolic volume index(LVESVI)changes were insignificant.LV systolic function improved in patients who underwent device closure only(63.53±3.85 vs.67.13±4.34,p-value 0.01).There was a significant reduction in right atrial(RA)volumes and an insignificant decrease in left atrial(LA)volumes,with no difference between groups.Conclusion:Transcatheter and surgical secundum ASD closure resulted in volumetric changes in some cardiac chambers with better improvement in bi-ventricular systolic function in the transcatheter arm and no difference in the TR reduction between the two groups at 6 months follow-up by CMR.

Modification of Serum Galectin-3 and Reversal of Cardiac Remodeling Following Pediatric Transcatheter Atrial Septal Defect Closure

Objectives:We aimed to evaluate the effect of percutaneous atrial septal defect(ASD)closure in children using right heart indices and serum galectin-3(Gal-3),as potential biomarkers of right heart remodeling.Methods:This case–control prospective study included 40 children with ASD and 25 control subjects.An echocardiographic evaluation was performed before the procedure,as well as 24 h,1 month,and 6 months after intervention.Serum Gal-3 was measured before,and 1 month after the procedure.Results:Serum Gal-3 concentration,right atrial(RA)dimensions,right ventricular(RV)dimensions,indexed RA area,and right index of myocardial performance(RIMP)were significantly increased in children with ASD compared with control subjects while tricuspid annular plane systolic excursion(TAPSE)was significantly decreased.Six months after closure,RA,and RV dimensions significantly decreased and RVfunction improved(RIMP decreased and TAPSE increased).Gal-3 oncentration significantly decreased 1 month after ASD closure,but it did not reach normal range compared with control subjects.A positive correlation between Gal-3 and age at closure,RA area,RV dimensions,and RIMP was observed.A positive correlation was observed between the decrease in Gal-3 concentration and the decrease in RA area and RV dimensions 1 month after ASD closure.A significant negative correlation was observed between TAPSE and Gal-3 concentration before and after intervention.Conclusions:Percutaneous ASD closure can improve right-sided indices and decrease serum Gal-3 concentration.Gal-3 can be used as a sensitive biomarker of right heart remodeling,with a decrease in Gal-3 concentration suggesting reversal of maladaptive remodeling.

Current Advances in Transcatheter Intervention for Children Born with Congenital Heart Defects: A Review of Literature

This review aims to sum up the improvements witnessed in the field of interventional cardiology during recent times. The last decade has witnessed significant technical advances in the field of radiological imaging and also in interventional cardiology which has helped to offer more non-invasive solutions for the management of congenital heart defects. This has resulted from the use of advanced 3-dimensional fusion imaging instead of conventional 2-dimensional angiography, applying interactive real-time enhancement and using computed tomography and Magnetic Resonance Imaging for interventional procedures. Similarly the introduction of next generation devices, have not only improved the final outcome of the procedure but also has helped in reducing the challenges that were faced before and with the initial generation of devices. These advances have helped not only in reducing the radiation exposure, the use of contrast medium dose but also have resulted in improved early survival. The field of neonatal cardiology has advanced at an unprecedented pace. The transcatheter closure of patent ductus arteriosus has evolved over time and now it has been made possible at much lower body weight. Similarly, early use of stents for aortic coarctation has been found effective in some patients, especially when surgical intervention had been denied. The application of the hybrid approach for the management of complex congenital heart defects has also been effectively applied. More recently transcatheter placement of the pulmonary valve has been introduced for severely stenotic and/or regurgitant pulmonary valve in adolescents and adults. It is anticipated that in near future, this procedure would be available for relatively younger patients. In conclusion: last 2 decades have improvised pediatric interventional cardiology to incorporate less invasive solutions for CHD. The current advances in radio-diagnostic imaging, gadgetry and technical expertise have improved significantly and led to manage many of such defects by trans-catheter approach. This has led also, to replace the early surgical intervention with a more subtle hybrid approach, thus reducing not only the major surgical trauma but also been found to be cost-effective due to a shorter hospital stay. But a learning curve for performers is required for optimum results and also such procedures should be performed in a fully developed facility with an optimum surgical backup.

Effects of General Anesthesia on the Results of Cardiac Catheterization in Pediatric Patients with Ventricular Septal Defect

Background:There is no gold standard sedation method for pediatric cardiac catheterization.In congenital heart diseases with intracardiac shunts,hemodynamic parameters are prone to change depending on the ventilation conditions and anesthetics,although few studies have examined these effects.The purpose of this study was to investigate the effects of two different sedation methods on the hemodynamic parameters.Methods:This study retrospectively evaluated consecutive patients with ventricular septal defect(VSD)below 1 year of age who underwent cardiac catheterization at Aichi Children’s Health and Medical Center,who were divided into age-and VSD diameter-matched general anesthesia(GA)and monitored anesthesia care(MAC)under the natural airway groups(n=40 each),for comparison of hemodynamic parameters.Results:In the GA group,arterial blood pH and arterial partial pressure of oxygen were significantly higher(p<0.01),whereas arterial partial pressure of carbon dioxide was significantly lower than in the MAC group(p<0.01).Mean pulmonary artery pressure(p<0.05)and systemic blood pressure(p<0.01)were lower in the GA group.Pulmonary vascular resistance index(p<0.01)and systemic vascular resistance index(p<0.01)were also significantly lower in the GA group than the MAC group.There were no significant differences in pulmonary blood flow index,systemic blood flow index,and pulmonary/systemic blood flow ratio between the two groups.Conclusions:Cardiac catheterization under GA in VSD patients results in different hemodynamic parameters compared to that under MAC.In particular,when using pulmonary artery pressure and pulmonary vascular resistance measured under GA for judgment regarding the surgical indications or perioperative management,consideration should be given to the fact that these parameters might be lower compared to those measured under MAC.

运动康复在先天性心脏病术后患儿中的应用进展

运动康复是根据疾病特点和患儿自身功能状况,依据力学原理进行主被动运动以改善身体功能,提高身体素质的治疗性运动。先天性心脏病患儿的运动耐力及心肺功能都低于正常儿童,且术后会出现不同程度的下降。运动康复能够安全、有效地促进快速康复,增强患儿心肺功能,提高运动耐力,改善生活质量并促进快速康复。但运动耐力评价指标、个体化运动处方、患儿院外支持系统及随访管理仍有待进一步研究和完善。该文就运动康复对先天性心脏病术后患儿的意义、影响因素、实施过程等进行综述,以期为临床实践提供参考依据。

胎儿室间隔缺损未愈合超声心动图四腔心切面及与遗传学检测相关性

目的:探讨胎儿室间隔缺损(VSD)未愈合超声心动图四腔心切面(4CV)及与遗传学检测的相关性。方法:选取2020年1月至2022年12月于我院收治的128例胎儿VSD孕妇作为研究对象,均行超声心动图检查以及遗传学检测,以产后结果作为金标准,分为未愈合组(100例)和愈合组(22例),其余6例发生失联或者流产,对两组患者临床特点差异进行比较,采用多元Logistic回归模型分析胎儿VSD未愈合的影响因素,并构建预模型,使用ROC曲线、校准曲线及临床决策曲线评价模型的诊断效能。结果:本研究中122例胎儿VSD孕妇行超声心动图诊断VSD未愈合的准确度为97.54%,灵敏度为98.00%,特异度为95.45%,阳性预测值为98.99%,阴性预测值为91.30%,与金标准诊断VSD未愈合的一致性较高(Kappa值=0.918);超声心动图诊断胎儿VSD未愈合检出率为97.00%,4CV检出率为31.00%;122例VSD胎儿中羊水样本中,14例(11.48%)检出异常,其中4例(3.27%)有致病性,其CNVs大小均在0.38~3.23 Mb之间,均为已知的微缺失/微重复综合征,3例(2.46%)临床意义不明,但胎儿父母均未同意进行溯源性CNV检测验证;未愈合组与愈合组(宫内愈合及出生1年内)在年龄、家族遗传史、孕期早期服药、足月、临床分型、缺损口直径、胎儿贫血、胎儿出生体重、Hb、ALB、TC、铁蛋白、TBA、HCY方面差异显著(均P<0.05);多元Logistic回归模型结果表明,家族遗传史、孕期早期服药、临床分型、缺损口直径、Hb、ALB是影响VSD胎儿未愈合的关键因素(P<0.05);最后基于关键因素进行列线图预测模型构建,回归方程为Logit(P)=-2.567+0.961×X1+0.398×X2+1.553×X3+1.557×X4+0.594×X5+0.683×X6;绘制ROC曲线显示,AUC为0.886(95%CI:0.798~0.890),灵敏度为0.803,特异度为0.798;校准曲线及临床决策曲线表明该预测模型具有良好的准确度和临床实用性。结论:超声心动图4CV对胎儿VSD愈合具有一定的评估作用,超声心动图多切面结合遗传学检测使得诊断结果得到验证,又能够互为补充,可为胎儿VSD孕妇遗传咨询和预后评估提供参考依据。

A DiGeorge Syndrome Case Report—Challenges of Diagnosis and Management

Background: DiGeorge syndrome (also known as velo-cardio-facial syndrome) is a rare multisystem genetic disorder occurring in approximately 1 in 4000 to 1 in 6000 live births [1]. Although advances in genetic screening have improved diagnosis in developed countries, the condition remains underdiagnosed in developing nations such as the Republic of Moldova, where access to genetic testing and family planning services is limited. Routine prenatal screening usually includes regular ultrasounds, monitoring of blood pressure, complete blood counts, coagulation studies, glucose, urine protein, and urine culture. Current ultrasound techniques have limitations in detecting this syndrome due to variability in interpretation, and genetic testing is often performed based on clinical discretion. The ultrasound could potentially point towards a genetic problem, as in DiGeorge, if multiple cardiac malformations are spotted in utero, but most cases such as this one are diagnosed after birth while being described as totally normal on prenatal ultrasound. Purpose: This study aims to highlight the diagnostic challenges and the need for comprehensive evaluation in identifying DiGeorge syndrome, emphasizing the importance of considering the syndrome as a whole rather than focusing on isolated organ system issues. Method: We present a case report of a 6-month-old girl who, after an uneventful pregnancy and normal prenatal ultrasound, presented with cardiac insufficiency. Following extensive investigations and multiple surgical interventions, DiGeorge syndrome was diagnosed at 9 months of age. Results: The patient’s diagnosis was delayed due to the lack of prenatal markers and the reliance on separate investigations of affected organ systems. Despite several interventions aimed at managing her symptoms, the final diagnosis was made after observing the association of multiple clinical features and conducting comprehensive genetic testing. Conclusions: This case underscores the importance of a holistic approach to diagnosis, which involves a thorough patient history, integration of diverse diagnostic tests, and recognition of the syndrome’s multi-system nature. It highlights the necessity for improved diagnostic protocols and increased awareness in regions with limited access to advanced genetic testing to prevent delays in identifying DiGeorge syndrome and to facilitate timely and appropriate management.

TEE引导下右腋下小切口室间隔缺损封堵术对膜周部室间隔缺损患儿的疗效及安全性分析

目的探究经食管超声心动图(TEE)引导下右腋下小切口室间隔缺损封堵术治疗膜周部室间隔缺损(PmVSD)的疗效,并分析其安全性。方法选取2020年5月至2021年5月在河南省儿童医院行手术治疗的PmVSD患儿98例,依据术式分为封堵组(50例)和修补组(48例)。封堵组男28例,女22例,年龄(3.25±0.40)岁;修补组男26例,女22例,年龄(3.68±0.31)岁。封堵组行TEE引导下右腋下小切口室间隔缺损封堵术治疗,修补组行体外循环下经右腋下直切口外科修补术,对两组患儿均进行2年的术后随访。统计两组患儿的手术情况,比较两组患儿心肌损伤、心功能的差异。行t检验、χ2检验、Fisher确切概率法。结果封堵组和修补组的手术成功率分别为98.00%(49/50)和100.00%(48/48),两组比较差异无统计学意义(P>0.05);但封堵组手术时间、住ICU时间以及住院时间均短于修补组[(74.25±11.58)min比(133.69±28.78)min,(4.60±1.00)h比(6.82±1.23)h,(4.05±0.69)d比(7.03±1.25)d](均P<0.05),且其术后24 h引流量少于修补组[0比(67.50±15.69)ml](P<0.05)。封堵组患儿术后24 h的心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)水平均较修补组低(均P<0.05)。两组患儿术前、术后2年的各心功能指标比较差异均无统计学意义(均P>0.05)。两组术后2年残余分流、三尖瓣新发返流发生情况比较差异均无统计学意义(均P>0.05),但封堵组术后3、6、12、24个月的新发异常心电图发生率均较修补组低[10.00%(5/50)比27.08%(13/48)、6.00(3/50)比20.83%(10/48)、4.00%(2/50)比16.67%(8/48)、2.00%(1/50)比12.50%(6/48)](均P<0.05)。结论TEE引导下右腋下小切口室间隔缺损封堵术与外科修补手术治疗PmVSD远期随访效果良好,但相较而言TEE引导下右腋下小切口室间隔缺损封堵术具有术后恢复更快、心肌损伤小以及切口更加微创的优势。

不同入路房间隔缺损修补术后患者心脏结构近期改变的比较

目的比较不同入路房间隔缺损修补术后患者心脏结构的近期改变。方法选取房间隔缺损修补术患者104例,根据入路方式分为左房微小切口组、右外侧切口组和正中切口组。比较各组体外循环时间、机械通气时间、术后引流量、术后住院时间、切口长度、重症监护时间、心脏结构变化及并发症情况。结果与正中切口组比较,左房微小切口组和右外侧切口组机械通气时间、术后住院时间、重症监护时间、切口长度缩短,术后引流量减少(P<0.05)。与术前比较,术后各组右房左右径和上下径、右室前后径缩小,左室舒张期末内径增大(P<0.05),且术后3个月较术后3天比较差异更显著(P<0.05),术后3天左房微小切口组和右外侧切口组与正中切口组比较差异更显著(P<0.05);术后3个月各组上述指标比较差异无显著性(P>0.05)。各组并发症比较差异无显著性(P>0.05)。结论左房微小切口、右外侧切口较正中切口入路房间隔缺损修补术近期矫正效果较好,但应根据患者实际情况选择合适术式。

心脏三节段法诊断胎儿圆锥动脉干畸形

目的探讨应用心脏三节段法超声心动图诊断胎儿圆锥动脉干畸形的价值。方法应用心脏三节段法对胎儿进行筛查,检出或疑似圆锥动脉干畸形胎儿167胎,对其超声心动图资料进行分析。结果 167胎圆锥动脉干畸形,包括法洛四联症40胎,大动脉转位25胎,右心室双出口36胎,永存动脉干66胎。其中84胎经产后病理证实,13胎经产后超声心动图确诊,11胎产前超声诊断结果与产后病理结果不符,59胎失访。结论心脏三节段法是产前诊断胎儿圆锥动脉干畸形的可靠方法,具有较好的临床应用价值。

时间-空间关联成像技术评估圆锥动脉干畸形胎儿心功能

目的应用时间-空间关联成像(STIC)技术评价圆锥动脉干畸形(CTD)胎儿心功能。方法选取经胎儿超声心动图诊断的39胎CTD胎儿(CTD组)和39胎正常胎儿(对照组)。采用STIC技术评估2组胎儿的心功能,包括肺动脉(PA)内径、左心室舒张末期内径(LVDD)和右心室舒张末期内径(RVDD)、左心室收缩末期内径(LVDS)、右心室收缩末期内径(RVDS)、缩短分数(FS)、左心室舒张末期容积(LVEDV)、右心室舒张末期容积(RVEDV)、左心室收缩末期容积(LVESV)、右心室收缩末期容积(RVESV)、每搏输出量(SV)和射血分数(EF)等指标,并比较2组间的差异。结果与对照组比较,CTD组胎儿PA内径及PA/AO均减小(P均<0.001),LVDD、LVDS、RVDD、RVDS、LVEDV、LVESV、RVEDV及RVESV差异均无统计学意义(P均>0.05),左、右心室FS、EF及SV均降低(P均<0.05),LVDD/RVDD明显升高(P均<0.01)。CTD组中,RVEDV高于LVEDV(P<0.05),左心室SV及EF均低于右心室(P均<0.05)。结论CTD在产前即可对胎儿心功能造成影响,右心室功能有代偿性增强表现,而右心扩大不明显。

国产室间隔缺损封堵器的安全性和疗效评价

目的:评价国产室间隔缺损(VSD)封堵器的安全性和疗效。 方法:312例先天性心脏病(先心病)膜周部VSD患者,男144例,女168例,年龄2-65岁,平均(16.44±9.09)岁。超声测量VSD直径2-15 mm,平均(5.08±2.79)mm。应用7F-10F输送鞘管从右心系统送入封堵器。在超声和X线指导下放置封堵器。术后连续心电监护5天。出院前,术后1个月、6个月和1年定期做心电图、超声心动图检查。 结果:312例中302例患者封堵成功,成功率96.79％。左心室造影测量的VSD直径2-20 mm,平均(4.96±2.67)mm。封堵器直径为4-20 mm,平均(7.09±3.60)mm。X线透视时间5-60 min,平均(14.92±8.09)min,操作时间30-160 min,平均(55.67±7.25)min。随访1个月至3年期间,未发生心律失常、感染性心内膜炎、血栓栓塞等并发症。 结论:国产VSD封堵器经导管封堵膜部VSD使用安全,操作简便,疗效可靠。

11～14周正常胎儿心脏超声检查

目的对妊娠11^＋0～14^＋6周正常胎儿心脏结构进行观察，获得该孕周内正常胎儿心脏的生理参数。方法对100位孕妇在妊娠11^＋0～14^＋6周进行常规经腹超声检查，同时观察胎儿心脏各切面结构并进行测量。结果胎儿心脏各切面显示率不同，四腔心显示率最高，其次是动脉交叉，而动脉导管的显示率最低。妊娠13周以后胎儿心脏结构超声可清晰显示。胎儿心脏周长、面积及各心室内径的增加与孕周有相关性，而心脏周长与胸廓周长比值，心脏面积与胸廓面积比值，左右心房比值以及房室率均相对衡定，与孕周之间无明显相关性。结论由于在妊娠13周以后胎儿心脏结构能够清晰显示，因此，可以将胎儿超声心动图检查时间提前至妊娠中期的早期。主要筛查与四腔心切面相关的严重的胎儿先天性心脏畸形，有利于胎儿严重先天性心脏畸形的早期诊断。

膜周部室间隔缺损介入治疗的临床评价

目的:评价膜周部室间隔缺损(VSD)经导管封堵治疗的临床效果。 方法:456例患者,经胸超声心动图测量VSD直径为3-18(6.2±3.1)mm,VSD距主动脉右冠瓣距离0.5-5.0(2.3±1.0)mm。其中6例合并动脉导管未闭,7例合并房间隔缺损,1例合并动脉导管未闭和房间隔缺损。19例伴轻度主动脉右冠瓣脱垂。先行左心室造影,通过VSD建立动静脉轨道,应用7-10F输送鞘管从右心系统送入封堵器。 结果:左心室造影测量VSD直径为3-20(6.4±3.0)mm,VSD距主动脉右冠瓣距离0.5-6.0(2.4±1.1)mm,其中86例患者VSD距主动脉右冠瓣距离<2 mm。391例伴膜部瘤形成。448例患者封堵成功,成功率为98％。未成功的8例中,2例导管未能通过缺损处,2例术中导丝通过VSD出现Ⅲ度房室传导阻滞(AVB),2例封堵后出现间歇性Ⅲ度AVB,2例伴主动脉右冠瓣轻度脱垂患者封堵后有少-中量主动脉瓣反流而放弃封堵治疗。所选封堵器大小为4-22(8.6±3.1)mm。封堵器到位后即刻左心室造影示微量残余分流68例,6个月复查超声心动图有1例微量残余分流。术后发生高度AVB 6例,1例安装永久起搏器。封堵器向膜部瘤出口明显移位1例,外科取出封堵器并行手术修补VSD。溶血2例,三尖瓣中量反流1例。合并动脉导管未闭6例、房间隔缺损7例、合并动脉导管未闭和房问隔缺损1例,同时成功封堵。