Objective To evaluate the outcome of the cardiac catheter angiograplasty for patients after Norwood procedure. Methods 13 patients,who had undergone Norwood procedure (prior to Glenn procedure) received cardiac cathet...Objective To evaluate the outcome of the cardiac catheter angiograplasty for patients after Norwood procedure. Methods 13 patients,who had undergone Norwood procedure (prior to Glenn procedure) received cardiac catheterization and angiography. Interventional therapy展开更多
Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth.We present a clinical case of a successful surgical correction of a crit...Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth.We present a clinical case of a successful surgical correction of a critical aortic stenosis using a hybrid method applied in a newborn during the first day of life.The infant was diagnosed with a hypoplastic left heart complex with an intact atrial septum(aortic and mitral valves stenosis variant),that led to the cardiogenic shock and acute pulmonary edema.The procedure included bilateral banding of the pulmonary artery branches and atrioseptostomy with stenting of the interatrial septum.The surgery was performed through a median sternotomy.展开更多
Background:Bilateral banding of the branches of the pulmonary artery in patients with hypoplastic left heart syndrome(HLHS)and other duct dependent critical neonatal heart malformations can significantly reduce the in...Background:Bilateral banding of the branches of the pulmonary artery in patients with hypoplastic left heart syndrome(HLHS)and other duct dependent critical neonatal heart malformations can significantly reduce the incidence of severe complications in the postoperative period,especially in severely unstable patients.In our study we compared different surgical techniques of bilateral pulmonary artery banding(PAB)in respect to their success in balancing systemic and pulmonary blood flow.Methods:We included 44 neonates with a HLHS and congenital heart diseases(CHD)with a functional single ventricle underwent a hybrid operation:bilateral PAB and patent ductus arteriosus stenting.The hybrid surgery for method No.1 is performed as a one-stage procedure,together with patent ductus arteriosus(PDA)stenting.After median sternotomy,two Gore-Tex 1–2 mm wide bands with a diameter of 3–3.5 mm are put.When we apply method No.2 then the thread is used to create bands.Method No.3 is distinguished by intraoperative assessment of blood flow at the site of narrowing of the branches of the pulmonary artery and optional stenting of the PDA.The cuff for banding is made of Gore-Tex tubing.Effectiveness when applying method Nos.1 and 2 is assessed by the change in invasive blood pressure and oxygen saturation after narrowing of the branches of the pulmonary artery.Also,with these techniques PDA stenting by inserting the introducer via pulmonary artery trunk is performed.Results:HLHS with mitral or aortic valve atresia or both was present in 19 patients(43.1%),with severe left heart obstruction resulting in PDA dependent systemic circulation in 16 babies(36.4%).CHD with single ventricle physiology occurred in 9 patients(20.5%).14 babies(31.8%)undergo the procedure following the method No.1,8 patients(18.2%)method No.2 and 22 patients(50%)method No.3.Qp/Qs=1/1 was achieved in 30 patients(30/44,68.1%):as a result of the method No.1 was achieved in 5 patients(5/14,35.7%),method No.2 in 4 patients(4/8,50%),method No.3 in 21 patients(21/22,95.5%).Multivariate regression analysis revealed that method No.3 significantly increases the chances of hemodynamic efficacy operations(OR=35.0;p=0.005;CI(95%)3–411.5).Conclusion:Application of the operation technique No.3 in combination with the intraoperative assessment of blood flow parameters at the site of banding of the branches of the pulmonary artery are the most optimal criteria for achieving Qp/Qs=1/1.If there are signs of restriction at the level of the foramen ovale,atrioseptostomy should be done in the second stage after bilateral pulmonary banding.展开更多
The diminutive aorta presents technical challenges in the palliation of hypoplastic left heart syndrome. Furthermore, aortic arch caliber changes and variable great vessel relationships can add complexity to an alread...The diminutive aorta presents technical challenges in the palliation of hypoplastic left heart syndrome. Furthermore, aortic arch caliber changes and variable great vessel relationships can add complexity to an already difficult arch repair. We describe a technical approach that simplifies the aortic reconstruction and makes the procedure more generalizable and reproducible.展开更多
It is very important to understand that the univentricular heart surgery is just palliative, not being in anyway a definitive or curative surgery, but nowadays it’s the best initial treatment of this complex heart di...It is very important to understand that the univentricular heart surgery is just palliative, not being in anyway a definitive or curative surgery, but nowadays it’s the best initial treatment of this complex heart disease. The fundamental philosophy of treatment of every univentricular heart is to ensure the flow system and/or restrict the lung flow. Thus, initially a patient with univentricular heart who is undergoing surgery may need to ensure systemic flow (reconstruction of the aortic?arch type Norwood), to restrict the lung flow (pulmonary banding) or to provide enough?pulmonary flow (pulmonary-systemic fistulae). However, some heart diseases with univentricular physiology remain “balanced” autonomously, until the “second” stage of palliation is performed (cavo-pulmonary anastomosis type Glenn), but others require performance of pulmonary banding, if there’s no native lung protection and/or repair of the systemic circuit in a first stage, to reach next palliation steps in the best possible conditions.展开更多
目的:分析影响男性雄激素性脱发(AGA)严重程度的相关因素及不同严重程度的男性AGA患者的皮肤镜特征。方法:收集2021年8月—2022年4月就诊于武汉大学中南医院皮肤科门诊的男性AGA患者253例,年龄18~50岁,根据Norwood⁃Hamilton分级方法,将...目的:分析影响男性雄激素性脱发(AGA)严重程度的相关因素及不同严重程度的男性AGA患者的皮肤镜特征。方法:收集2021年8月—2022年4月就诊于武汉大学中南医院皮肤科门诊的男性AGA患者253例,年龄18~50岁,根据Norwood⁃Hamilton分级方法,将患者分为Ⅰ~Ⅶ级,其中轻中度患者142例,重度患者111例,收集研究对象的基本信息,包括身高、体重、家族史、吸烟、饮酒、运动、睡眠、熬夜的情况,并对每位患者进行皮肤镜检测,分别统计其单一毛发毛囊单位比例、黄点征、针尖样白点、毛周褐色环、分枝状血管、蜂窝状色素网、白色鳞屑的情况。采用SPSS 23.0统计软件进行Logistic回归分析,其中单毛囊的毛囊单位比例用t检验进行统计分析。结果:体质量指数(BMI)、家族史、吸烟、饮酒、熬夜、睡眠均与脱发严重程度呈正相关,OR值分别为1.192、2.051、1.001、0.99、1.344、0.553,P<0.05;运动与脱发严重程度不相关,P>0.05;皮肤镜表现:针尖样白点、蜂窝状色素网与脱发严重程度呈正相关,OR值分别为2.3、3.113,P<0.05;分枝状血管、白色鳞屑与脱发严重程度呈负相关,OR值分别为0.405、0.436,P<0.05;黄点征、毛周褐色环与脱发严重程度不相关,P>0.05;与轻中度组相比,重度组单一毛发毛囊单位比例显著升高(0.30 vs 0.17),P<0.05。结论:(1)BMI、家族史、吸烟、饮酒、熬夜、睡眠是AGA的加重因素;而运动不影响男性AGA的严重程度。(2)针尖样白点、蜂窝状色素网、分枝状血管、白色鳞屑可作为脱发严重程度的指标,单一毛发毛囊单位比例、针尖样白点、蜂窝状色素网是AGA的重度指标,分枝状血管、白色鳞屑是轻中度脱发的指标;黄点征、毛周褐色环不能作评价男性AGA严重程度的指标。展开更多
文摘Objective To evaluate the outcome of the cardiac catheter angiograplasty for patients after Norwood procedure. Methods 13 patients,who had undergone Norwood procedure (prior to Glenn procedure) received cardiac catheterization and angiography. Interventional therapy
文摘Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth.We present a clinical case of a successful surgical correction of a critical aortic stenosis using a hybrid method applied in a newborn during the first day of life.The infant was diagnosed with a hypoplastic left heart complex with an intact atrial septum(aortic and mitral valves stenosis variant),that led to the cardiogenic shock and acute pulmonary edema.The procedure included bilateral banding of the pulmonary artery branches and atrioseptostomy with stenting of the interatrial septum.The surgery was performed through a median sternotomy.
文摘Background:Bilateral banding of the branches of the pulmonary artery in patients with hypoplastic left heart syndrome(HLHS)and other duct dependent critical neonatal heart malformations can significantly reduce the incidence of severe complications in the postoperative period,especially in severely unstable patients.In our study we compared different surgical techniques of bilateral pulmonary artery banding(PAB)in respect to their success in balancing systemic and pulmonary blood flow.Methods:We included 44 neonates with a HLHS and congenital heart diseases(CHD)with a functional single ventricle underwent a hybrid operation:bilateral PAB and patent ductus arteriosus stenting.The hybrid surgery for method No.1 is performed as a one-stage procedure,together with patent ductus arteriosus(PDA)stenting.After median sternotomy,two Gore-Tex 1–2 mm wide bands with a diameter of 3–3.5 mm are put.When we apply method No.2 then the thread is used to create bands.Method No.3 is distinguished by intraoperative assessment of blood flow at the site of narrowing of the branches of the pulmonary artery and optional stenting of the PDA.The cuff for banding is made of Gore-Tex tubing.Effectiveness when applying method Nos.1 and 2 is assessed by the change in invasive blood pressure and oxygen saturation after narrowing of the branches of the pulmonary artery.Also,with these techniques PDA stenting by inserting the introducer via pulmonary artery trunk is performed.Results:HLHS with mitral or aortic valve atresia or both was present in 19 patients(43.1%),with severe left heart obstruction resulting in PDA dependent systemic circulation in 16 babies(36.4%).CHD with single ventricle physiology occurred in 9 patients(20.5%).14 babies(31.8%)undergo the procedure following the method No.1,8 patients(18.2%)method No.2 and 22 patients(50%)method No.3.Qp/Qs=1/1 was achieved in 30 patients(30/44,68.1%):as a result of the method No.1 was achieved in 5 patients(5/14,35.7%),method No.2 in 4 patients(4/8,50%),method No.3 in 21 patients(21/22,95.5%).Multivariate regression analysis revealed that method No.3 significantly increases the chances of hemodynamic efficacy operations(OR=35.0;p=0.005;CI(95%)3–411.5).Conclusion:Application of the operation technique No.3 in combination with the intraoperative assessment of blood flow parameters at the site of banding of the branches of the pulmonary artery are the most optimal criteria for achieving Qp/Qs=1/1.If there are signs of restriction at the level of the foramen ovale,atrioseptostomy should be done in the second stage after bilateral pulmonary banding.
文摘The diminutive aorta presents technical challenges in the palliation of hypoplastic left heart syndrome. Furthermore, aortic arch caliber changes and variable great vessel relationships can add complexity to an already difficult arch repair. We describe a technical approach that simplifies the aortic reconstruction and makes the procedure more generalizable and reproducible.
文摘It is very important to understand that the univentricular heart surgery is just palliative, not being in anyway a definitive or curative surgery, but nowadays it’s the best initial treatment of this complex heart disease. The fundamental philosophy of treatment of every univentricular heart is to ensure the flow system and/or restrict the lung flow. Thus, initially a patient with univentricular heart who is undergoing surgery may need to ensure systemic flow (reconstruction of the aortic?arch type Norwood), to restrict the lung flow (pulmonary banding) or to provide enough?pulmonary flow (pulmonary-systemic fistulae). However, some heart diseases with univentricular physiology remain “balanced” autonomously, until the “second” stage of palliation is performed (cavo-pulmonary anastomosis type Glenn), but others require performance of pulmonary banding, if there’s no native lung protection and/or repair of the systemic circuit in a first stage, to reach next palliation steps in the best possible conditions.
文摘目的:分析影响男性雄激素性脱发(AGA)严重程度的相关因素及不同严重程度的男性AGA患者的皮肤镜特征。方法:收集2021年8月—2022年4月就诊于武汉大学中南医院皮肤科门诊的男性AGA患者253例,年龄18~50岁,根据Norwood⁃Hamilton分级方法,将患者分为Ⅰ~Ⅶ级,其中轻中度患者142例,重度患者111例,收集研究对象的基本信息,包括身高、体重、家族史、吸烟、饮酒、运动、睡眠、熬夜的情况,并对每位患者进行皮肤镜检测,分别统计其单一毛发毛囊单位比例、黄点征、针尖样白点、毛周褐色环、分枝状血管、蜂窝状色素网、白色鳞屑的情况。采用SPSS 23.0统计软件进行Logistic回归分析,其中单毛囊的毛囊单位比例用t检验进行统计分析。结果:体质量指数(BMI)、家族史、吸烟、饮酒、熬夜、睡眠均与脱发严重程度呈正相关,OR值分别为1.192、2.051、1.001、0.99、1.344、0.553,P<0.05;运动与脱发严重程度不相关,P>0.05;皮肤镜表现:针尖样白点、蜂窝状色素网与脱发严重程度呈正相关,OR值分别为2.3、3.113,P<0.05;分枝状血管、白色鳞屑与脱发严重程度呈负相关,OR值分别为0.405、0.436,P<0.05;黄点征、毛周褐色环与脱发严重程度不相关,P>0.05;与轻中度组相比,重度组单一毛发毛囊单位比例显著升高(0.30 vs 0.17),P<0.05。结论:(1)BMI、家族史、吸烟、饮酒、熬夜、睡眠是AGA的加重因素;而运动不影响男性AGA的严重程度。(2)针尖样白点、蜂窝状色素网、分枝状血管、白色鳞屑可作为脱发严重程度的指标,单一毛发毛囊单位比例、针尖样白点、蜂窝状色素网是AGA的重度指标,分枝状血管、白色鳞屑是轻中度脱发的指标;黄点征、毛周褐色环不能作评价男性AGA严重程度的指标。
