Objective To analyze the long-term outcome of modified Morrow surgery (interventricular septal cardiomyectomy) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM) in children. Methods The clinical data of the children with HOCM (aged≤14 years) who underwent modified Morrow surgery from January 2010 to August 2022 in Guangdong Provincial People's Hospital were retrospectively analyzed, including changes in hospitalization status, perioperative period, and long-term 15-lead electrocardiogram and echocardiography. Results A total of 29 patients were collected, including 22 males and 7 females, aged 10.00 (5.00, 12.00) years. Five (17.9%) patients had New York Heart Association (NYHA) heart function grade Ⅲ or Ⅳ. Ventricular septal cardiomyectomy was performed in all patients. All 29 patients survived and their cardiac function recovered after operation. Before discharge, right bundle branch block was observed in 2 patients and left bundle branch block in 6 patients. After surgery, in the left ventricular septal cardiomyectomy, the left atrial diameter decreased (P＜0.001), left ventricular end-systolic diameter increased (P=0.009), the peak pressure gradient of left ventricular outflow tract decreased (P＜0.001), and the thickness of ventricular septum decreased (P＜0.001). The systolic anterior motion of mitral valve disappeared and mitral regurgitent jet area decreased (P＜0.001). The flow velocity and peak pressure gradient of right ventricular outflow tract also decreased in the patients who underwent right ventricular septal cardiomyectomy. The average follow-up of the patients was 69.03±10.60 months. All the patients survived with their NYHA cardiac function grading Ⅰ or Ⅱ. No new-onset arrythmia event was found. Echocardiography indicated that the peak pressure gradient of the left ventricular outflow tract remained low (P<0.001). Moderate mitral regurgitation occurred in 2 patients, and left ventricular outflow tract obstruction with moderate mitral regurgitation occurred in 1 patient after simple right ventricular septal cardiomyectomy. Conclusion Right ventricular or biventricular obstruction is frequent in the children with HOCM and they usually have more symptoms before surgery. Modified Morrow surgery can effectively relieve outflow tract obstruction and improve their cardiac function. The long-term outcome is satisfactory. However, the posterior wall of the left ventricle remains hypertrophic. Also, there is an increased risk of a conduction block.
In order to improve the reliability of cardiac pacemaker contact-less power supply technology, this paper proposes a novel application of wireless feedback voltage stabilizing technology to adjust heart disease patients with inner power supply filter circuit output voltage and current control method, to keep the output voltage stability, and to ensure that the super capacitor and cardiac pacemaker to get a stable power supply. To implement the real-time accurate voltage control with considering the primary and secondary side inductance coupling coefficient changes, the change of the external power supply voltage and load, it is necessary to test thee real-time and accurate output voltage and current value after rectifying filtering. Therefore, based on the chaotic control theory, we adopted method of phase diagram on the basis of the quick observation after rectifying filtering, so that the method of voltage and current could improve the detection time of the circuit. The phase diagram of proposed control method can be divided into 8 segments, and we got 7 zero-extreme points. When these zero-extreme points are detected, according to extreme points of the zero instantaneous values, the corresponding average values of voltage and current were obtained. Simulation and experimental results showed that using the above method can shorten the response time to less than switch devices 1/2 switching cycles, thus validating the effectiveness and feasibility of the proposed detection algorithm.
目的 探討心臟外科體外循環術后留置心外膜臨時起搏導線的康復經驗。 方法 選取 2015 年 9 月至 2016 年 4 月 69 例體外循環術后留置心外膜臨時起搏導線患者，其中男 26 例、女 43 例，平均年齡（50.2±11.5）歲。予術前及術后干預措施、出院指導和隨訪，評價康復效果。 結果 患者術后平均住院時間（9.8±2.6）d，69 例患者均順利出院，其中 57 例患者順利拔除心外膜臨時起搏器導線，1 例患者因Ⅲ度房室傳導阻滯繼續留置臨時起搏器電極，11 例患者殘留臨時起搏導線出院，出院后兩周隨訪發現 2 例患者的臨時起搏導線體內殘端露出體表。 結論 心外膜臨時起搏電極是心臟外科術后常見的風險防范手段之一，掌握臨時起搏器導線的管理及臨時起搏器應用的相關知識，合理管理能有效地降低術后并發癥的發生，可促進患者術后康復。做好患者宣教，避免因溝通不暢導致的醫患糾紛發生。
The biological pacemaker has become a new strategy in the treatment of severe bradycardias, in which a kind of ideal pacemaker cells is a pivotal factor. Here we reviewed the progress in the differentiation of bone-marrow mesenchymal stem cells and adipose-derived stem cells into pacemaker-like cells by means of gene transfer, chemical molecules, co-culture with other cells and specific culture media, and we also analyzed the potential issues to be solved when they are used as seeding cells of biological pacemaker.
Objective To review the current status and problems in developing cardiac biological pacemaker(CBP) by cell transplantation. Methods The l iterature over the past decade concerning CBP constructed through celltransplantation was reviewed and summarized. Results Experiments in vivo testified that the cell transplantation was feasible for CBP construction, and the transplantation of sinus atrial node cell and stem cell was still the predominant method for constructing CBP. However, such problems as difficult ampl ification of transferred cardio muscle cell, low success rate of CBP construction as well as unstable function of CBP make it lag behind the tremendous cl inical demands. The gene transfection technology might be one of the approaches to resolve these issues. Conclusion As one feasible method for CBP construction, the cell transplantation has a bright future in the cl inical appl ication and is worthy of further study.
Objective To construct the expression short hairpin RNA （shRNA） targeting gene kir2. 1 in rat myocardial cells, named pEGFP6 kir2. 1, and to observe the effects on the expression of messenger RNA（mRNA） and protein of gene kir2. 1 as well as the changes of myocardial beating rates. Methods Five RNA interference （RNAi） sites targeting the rat kir2. 1 gene was selected, designed and synthesized five pairs of oligonucleotides fragments ,annealed them to double-strand, then cloned them into the vectors containing U6 promoter,obtained the vector expressing five aim genes. Rat myocardial cells were divided into three groups： Experimental group, negative plasmid control group and normal control group. Reverse transcription-polymerase chain reaction（RT PCR） and Western-blot were carried out to detect the expression of the mRNA and protein of gene kir2.1 and the beating rates of myocardial cells were observed after 72 h. Results The expression of mRNA and protein of gene kir2. 1 of experimental group were markedly lower than that of other two control groups after 72 h（P〈0.01）. There was no statistically significant between two control groups. The beating rate in experimental group was much faster than other two control groups （P〈0.01）, remained unchanged in both negative plasmid control group and normal control group. Conclusion Plasmid pEGFP6-kir2.1 could suppress the expression of the mRNA and protein of kir2.1 and increase the rat cardiac muscle cell beats.
Coronary angiography (CAG) as a typical imaging modality for the diagnosis of coronary diseases hasbeen widely employed in clinical practices. For CAG-based computer-aided diagnosis systems, accurate vessel segmentation plays a fundamental role. However, patients with bradycardia usually have a pacemaker which frequently interferes the vessel segmentation. In this case, the segmentation of vessels will be hard. To mitigate interferences of pacemakers and then extract main vessels more effectively in CAG images, we propose an approach. At first, a pseudo CAG (pCAG) image is generated through a part of a CAG sequence, in which the pacemaker exists. Then, a local feature descriptor is employed to register the relative location of pacemaker between the pCAG image and the target CAG image. Finally, combining the registration result and segmentation results of main vessels and pacemaker, interferences of pacemaker are removed and the segmentation of main vessels is improved. The proposed method is evaluated based on 11 CAG images with pacemakers acquired in clinical practices. An optimization ratio of the Dice coefficient is 12.04%, which demonstrates that our method can remove overlapping pacemakers and achieve the improvement of main vessel segmentation in CAG images.Our method can further become a helpful component in a CAG-based computer-aided diagnosis system, improving its diagnosis accuracy and efficiency.
ObjectiveTo compare the X-ray projection doses during leadless pacemaker implantation and conventional single chamber ventricular pacemaker (VVI) implantation. MethodsThis study included all patients who underwent leadless pacemaker implantation and VVI pacemaker implantation performed by the same principal investigator team using the same digital subtraction angiography (DSA) machine in the West China Hospital of Sichuan University from August 3rd, 2018 to February 18th, 2020. Among the enrolled patients, 27 who underwent leadless pacemaker implantation were included in the case group, whereas 38 who underwent conventional VVI implantation were included in the control group. Data regarding the intraoperative dose area product (DAP), air kerma (AK), duration of X-ray fluoroscopy, number of exposed sequences on the film, total number of frames on the film, operation time, and BMI were collected to investigate the causes of the differences. ResultsThe case group received a higher X-ray projection dose than the control group, and there were statistically significant differences between the two groups in terms of DAP, AK, duration of X-ray fluoroscopy, the number of exposed sequences on the film, the total number of frames on the film, and operation time (P<0.05). ConclusionPatients who underwent leadless pacemaker implantation are exposed to more radiation than those who underwent conventional VVI implantation.
目的 調查安置永久性人工心臟起搏器的老年患者術前焦慮狀況，為制訂護理對策提供依據。 方法 2004年7月-2008年7月收治需安置永久性人工心臟起搏器的心臟病患者78例，術前采用焦慮自評量表（SAS）對其進行問卷調查，并采用自制一般情況問卷調查了解情況。 結果 植入永久性心臟起搏器的老年患者術前SAS得分高于國內常模（Plt;0.05）。根據自制調查問卷結果，差異有統計學意義（Plt;0.05）的項目:老年患者隨年齡增長焦慮量表評分降低；喪偶者焦慮評分高于有配偶者；完全公費、部分公費、自費的焦慮量表評分依次增高；老年患者對起搏器知識了解程度越少，焦慮評分越高；無家人陪伴者比有家人陪伴者焦慮評分高。而性別、文化水平差異無統計學意義。 結論 植入永久性起搏器的老年患者術前多數存在焦慮情緒，且焦慮與年齡、婚姻、費用支付方式、有無家人陪伴、相關知識等有一定關系，醫護人員應針對性地做好患者術前護理，幫助患者面對現實，以積極的心態接受手術治療。