Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previousl...Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previously. In our case report, a 63-year-old man presented with high fever and six episodes of recurrent pneumonias during the last half year. Echocardiography was performed, a solid mass was found in the right atrium. Transesophageal echocardiography proved a tumor mass in the inferior vena cava (IVC) extending into the right atrium, abdominal ultrasound revealed tumor mass in the IVC and a solid tumor in the liver. Combined liver and heart surgery was attempted in order to remove the tumor mass from both the liver and the right atrium. Acute cor pulmonale occurred during tumor removal from the right atrium and the patient expired. In addition to local factors the possibility of embolization should arise in the background of recurrent pneumonia. Occult carcinoma must be included in possible causes of recurrent pulmonary embolism. Searching for primary malignancy should include HCC as frequent cause of hypercoagulability. In case of HCC, echocardiography is suggested because of the possibility of expansion in IVC or right atrium and tumor-embolization.展开更多
The backscatter from sonicated albumin microbubbles (Albunex) was analyzed using acoustic densitometry in an in vitro pulsatile heart model to evaluate the effects of pressure on the backscatter from Albunex, and the ...The backscatter from sonicated albumin microbubbles (Albunex) was analyzed using acoustic densitometry in an in vitro pulsatile heart model to evaluate the effects of pressure on the backscatter from Albunex, and the cardiac cyclic changes of intracardiac backscatter from sonicated albumin microbubbles in 16 healthy persons were analyzed. It was found that the Albunex microbubbles were compressed in systole and decompressed in diastole, causing corresponding changes of backscatter in cardiac cycle. Although the intensities of backscatter in diastole and systole were related to the concentration of microbubbles, the concentration of microbubbles had no effect on the difference of end-diastolic and end-systolic backscatter. The difference of the backscatter was highly correlated with end-systolic pressure (r=0.96, P=0.001). In human studies, we also observed same intracardiac cyclic changes of backscatter from sonicated albumin microbubbles. Our study indicates that it is possible to evaluate the intracardiac pressure non-invasively by analyzing the intracardiac backscatter from the microbubbles with acoustic densitometry.展开更多
Objective： To investigate the expression of P2X receptors on rat intracardiac and paratracheal ganglion neurons. Methods： For preparation of intracardiac neurons, hearts were excised, the atria were separated and th...Objective： To investigate the expression of P2X receptors on rat intracardiac and paratracheal ganglion neurons. Methods： For preparation of intracardiac neurons, hearts were excised, the atria were separated and the medial region containing intracardiac ganglia was isolated and cut into pieces. For preparation of paratracheal neurons, the tracheas were removed and the superficial membranous layer containing paratracheal ganglia was rapidly isolated. Intracardiac and paratracheal ganglion neurons were dissociated after digestion by collagenase and trypsin. Whole-cell patch clamp recording was used to identify the pharmacological properties of P2X receptors in cultured neurons. Results：Neurons from these two ganglia responded to ATP with a rapidly activating, sustained inward current, αβ-meATP failed to evoke any re- sponses in paratracheal ganglion neurons while a few of intracardiac ganglion neurons responded to αβ- meATP with a tiny sustained inward current. ADP and UTP had no effect on intracardiac neurons. Lowering pH potentiated ATP responses in neurons from these two ganglia whereas increasing pH inhibited ATP responses. Co-application of Zn^2＋ potentiated ATP responses in intracardiac and paratracheal ganglion neurons. Conclusion： The receptor subtypes involved in intracardiac and paratracheal ganglia appear to be homomeric P2X2, while heteromeric P2X2/3 could not be completely excluded from intracardiac neurons.展开更多
Intracardic air embolism is uncommon, however it is a serious condition which frequently leads to catastrophic complications during or after invasive procedures resulting in significant morbidity and mortality. For a ...Intracardic air embolism is uncommon, however it is a serious condition which frequently leads to catastrophic complications during or after invasive procedures resulting in significant morbidity and mortality. For a successful re- suscitation of patients with intracardiac air embolism, hy- perbaric oxygen therapy is critical.~~2~ Still, due to a hyper- baric chamber＇s unavailability at many hospitals and con- cerns about patient movement resulting in further embolism during transport, such treatment method is gradually dimin- ishing.展开更多
BACKGROUND Patent foramen ovale(PFO)is the most common congenital heart disease and is associated with several diseases,including stroke and migraine.PFO diagnosis involves transoesophageal echocardiography,transthora...BACKGROUND Patent foramen ovale(PFO)is the most common congenital heart disease and is associated with several diseases,including stroke and migraine.PFO diagnosis involves transoesophageal echocardiography,transthoracic echocardiography,and transcranial Doppler.Recent studies have shown that intracardiac echocardiography(ICE)can be used to diagnose and guide percutaneous transcatheter closure.CASE SUMMARY A 70-year-old male presented with paroxysmal dizziness and limb weakness for the past 3 mo.Magnetic resonance imaging revealed a history of stroke,and a bubble test revealed the presence of PFO.The patient was then transferred to our hospital for PFO closure.Under ICE guidance,the separation of the septum primum and septum secundum was unclear;we then used a Swartz catheter to confirm PFO by applying physical pressure on the right part of the atrial septum without using any contrast.The ICE continuously and clearly guided the procedure.CONCLUSION ICE can guide PFO closure in patients with a history of stroke.When PFO is not evident under ICE,a Swartz catheter can be used.展开更多
Carbon monoxide (CO) poisoning is a frequent cause of emergency room admissions, especially during winter days, the symptoms are varied ranging from a simple headache to a serious cardiac and neurological impairment t...Carbon monoxide (CO) poisoning is a frequent cause of emergency room admissions, especially during winter days, the symptoms are varied ranging from a simple headache to a serious cardiac and neurological impairment that can be deadly. Diagnosis is based on the circumstances of occurrence as well as the dosage of carboxyhemoglobin in the blood. Exposure to CO has serious consequences, neurological and cardiac manifestations are not negligible and vary from repolarization disorders to heart attack. Treatment is urgent with normobaric or hyperbaric oxygen therapy. We report a case of a 2-year male child admitted to the emergency room for CO intoxication with an intracardiac thrombus subsequently complicated by an ischemic stroke with a fatal outcome in order to highlight this complication rarely described in literature.展开更多
Context:Intracardiac masses(ICMs)are detected during the exploration of cardiovascular pathologies or discovered incidentally.They include intracardiac thrombi,cardiac tumors and valvular vegetations.Method:This was a...Context:Intracardiac masses(ICMs)are detected during the exploration of cardiovascular pathologies or discovered incidentally.They include intracardiac thrombi,cardiac tumors and valvular vegetations.Method:This was a descriptive study retrospectively collected within the cardiology department from January 1,2011 to March 31,2013.All the patients diagnosed and hospitalized for intracardiac masses and followed-up for at least three months were included in the study.Outcomes:Among the 1066 patients admitted in the period of study,80 patients had intracardiac masses,corresponding to a hospital frequency of 7.5%.The average age was 48.4±17.4 years.ICM was detected during a thromboembolic complication in 18 cases(22.5%)and during a cardiological check-up for heart disease in 62 cases(77.5%).Thromboembolic complications were dominated by strokes in 55.6% of cases.Cardiology check-up was done because of exertional dyspnea(62 patients)in 77.5% of cases.Among these intracardiac masses(ICMs),intracardiac thrombosis(ICT)was observed in 41 cases(50.6%),followed by intracardiac vegetations in 32 cases(39.5%).The curative treatment of intracardiac masses consisted of anticoagulants in 65%of cases,antibiotics in 58.8%of cases and instrumental treatments in 1.3%of cases.We didn’t use cardiac surgery as a therapeutic means in our study.Twenty patients(25%)died during hospitalization,six of whom(30%)died as a result of thromboembolic complications.Conclusion:Intracardiac masses visualized on ultrasound are most often due to thrombi,vegetations or myxomas.In our study,intracardiac thrombosis was the most common masses,accounting for 50.6%of cases.展开更多
Background Cardiac resynchronization therapy （CRT） with biventricular pacing improves cardiac function,functional capacity and quality of life in selected patients with heart failure.The current study aimed to evalu...Background Cardiac resynchronization therapy （CRT） with biventricular pacing improves cardiac function,functional capacity and quality of life in selected patients with heart failure.The current study aimed to evaluate the efficacy of the intracardiac electrogram （IEGM）-based optimization method,QuickOptTM,in Chinese patients treated with CRT.Methods Aortic time velocity integrals （AVTI） achieved at the sensed atrioventricular （AV）,paced AV and interventricular （VV） interval settings recommended by both QuickOptTM and standard echocardiographic optimization were measured in 101 patients.Consistency and the strength of the relationship between the two timing cycle optimization methods were assessed by intra-class correlation coefficient （ICC）.Results The ICC showed good agreement and correlation with what the AVTI achieved at the optimal sensed AV （ICC=0.9683 （0.9535-0.9785））,paced AV （ICC=0.9642 （0.9475-0.9757）） and VV （ICC=0.9730 （0.9602-0.9817）） interval settings determined by the two optimization methods.The average time required by echocardiographic optimization and by QuickOptTM were （78.32±32.40） minutes and （1.98±1.64） minutes respectively （P 〈0.0001）.Conclusion The QuickOptTM algorithm provides a quicker,simpler and reliable alternative to the standard method for timing cycle optimization.（ClinicaITrial.gov Reference Number：NCT00918294）展开更多
目的 探讨在心腔内超声(ICE)引导下行零射线心房颤动(简称房颤)射频消融术的可行性及安全性。方法入选我院2014年1月至2023年12月期间行房颤射频消融的患者297例,根据手术过程中是否使用ICE,分为ICE引导组与X线引导组。对比两组患者基...目的 探讨在心腔内超声(ICE)引导下行零射线心房颤动(简称房颤)射频消融术的可行性及安全性。方法入选我院2014年1月至2023年12月期间行房颤射频消融的患者297例,根据手术过程中是否使用ICE,分为ICE引导组与X线引导组。对比两组患者基线特征及手术相关数据。结果 ICE引导组共入组111例,X线引导组共186例。ICE引导组持续性房颤的比例更高[46(41.4%) vs 17(9.1%)],左心房内径更大[(42.7±5.2) mm vs(39.2±4.7) mm],P值均<0.05;其他一般资料和临床基线特征均无显著差异。与X线引导组相比,ICE引导组房间隔穿刺次数、穿刺时间、X射线暴露时间明显减少或缩短,两组在并发症发生率、手术时间等方面无统计学差异。由于ICE引导组与X线引导组在房颤类型、左心房内径、射血分数等基线数据方面存在明显差异,故使用R4.3.3统计软件按1∶1进行倾向性匹配,两组各81例。与X线引导组相比,ICE引导组房间隔穿刺次数更少[(1.1±0.3) vs(1.8±1.0),P<0.05]、穿刺时间更短[(2.5±0.8) min vs(3.7±2.1) min,P<0.05]、且消融手术时间明显缩短[(191.2±47.3) min vs(228.0±60.5) min,P<0.05]。结论 ICE引导下消融治疗房颤房间隔穿刺次数少,穿刺时间短,X射线暴露时间短,且手术安全有效。展开更多
文摘Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previously. In our case report, a 63-year-old man presented with high fever and six episodes of recurrent pneumonias during the last half year. Echocardiography was performed, a solid mass was found in the right atrium. Transesophageal echocardiography proved a tumor mass in the inferior vena cava (IVC) extending into the right atrium, abdominal ultrasound revealed tumor mass in the IVC and a solid tumor in the liver. Combined liver and heart surgery was attempted in order to remove the tumor mass from both the liver and the right atrium. Acute cor pulmonale occurred during tumor removal from the right atrium and the patient expired. In addition to local factors the possibility of embolization should arise in the background of recurrent pneumonia. Occult carcinoma must be included in possible causes of recurrent pulmonary embolism. Searching for primary malignancy should include HCC as frequent cause of hypercoagulability. In case of HCC, echocardiography is suggested because of the possibility of expansion in IVC or right atrium and tumor-embolization.
基金This Project was supported by a grant from the NationalSciences Foundtion of China (No. 39970 30 8)
文摘The backscatter from sonicated albumin microbubbles (Albunex) was analyzed using acoustic densitometry in an in vitro pulsatile heart model to evaluate the effects of pressure on the backscatter from Albunex, and the cardiac cyclic changes of intracardiac backscatter from sonicated albumin microbubbles in 16 healthy persons were analyzed. It was found that the Albunex microbubbles were compressed in systole and decompressed in diastole, causing corresponding changes of backscatter in cardiac cycle. Although the intensities of backscatter in diastole and systole were related to the concentration of microbubbles, the concentration of microbubbles had no effect on the difference of end-diastolic and end-systolic backscatter. The difference of the backscatter was highly correlated with end-systolic pressure (r=0.96, P=0.001). In human studies, we also observed same intracardiac cyclic changes of backscatter from sonicated albumin microbubbles. Our study indicates that it is possible to evaluate the intracardiac pressure non-invasively by analyzing the intracardiac backscatter from the microbubbles with acoustic densitometry.
基金Supported by the National Natural Foundation of China (No. 30570597)
文摘Objective： To investigate the expression of P2X receptors on rat intracardiac and paratracheal ganglion neurons. Methods： For preparation of intracardiac neurons, hearts were excised, the atria were separated and the medial region containing intracardiac ganglia was isolated and cut into pieces. For preparation of paratracheal neurons, the tracheas were removed and the superficial membranous layer containing paratracheal ganglia was rapidly isolated. Intracardiac and paratracheal ganglion neurons were dissociated after digestion by collagenase and trypsin. Whole-cell patch clamp recording was used to identify the pharmacological properties of P2X receptors in cultured neurons. Results：Neurons from these two ganglia responded to ATP with a rapidly activating, sustained inward current, αβ-meATP failed to evoke any re- sponses in paratracheal ganglion neurons while a few of intracardiac ganglion neurons responded to αβ- meATP with a tiny sustained inward current. ADP and UTP had no effect on intracardiac neurons. Lowering pH potentiated ATP responses in neurons from these two ganglia whereas increasing pH inhibited ATP responses. Co-application of Zn^2＋ potentiated ATP responses in intracardiac and paratracheal ganglion neurons. Conclusion： The receptor subtypes involved in intracardiac and paratracheal ganglia appear to be homomeric P2X2, while heteromeric P2X2/3 could not be completely excluded from intracardiac neurons.
文摘Intracardic air embolism is uncommon, however it is a serious condition which frequently leads to catastrophic complications during or after invasive procedures resulting in significant morbidity and mortality. For a successful re- suscitation of patients with intracardiac air embolism, hy- perbaric oxygen therapy is critical.~~2~ Still, due to a hyper- baric chamber＇s unavailability at many hospitals and con- cerns about patient movement resulting in further embolism during transport, such treatment method is gradually dimin- ishing.
基金Supported by the National Key Research and Development Program of China,No.2017YFC0908800。
文摘BACKGROUND Patent foramen ovale(PFO)is the most common congenital heart disease and is associated with several diseases,including stroke and migraine.PFO diagnosis involves transoesophageal echocardiography,transthoracic echocardiography,and transcranial Doppler.Recent studies have shown that intracardiac echocardiography(ICE)can be used to diagnose and guide percutaneous transcatheter closure.CASE SUMMARY A 70-year-old male presented with paroxysmal dizziness and limb weakness for the past 3 mo.Magnetic resonance imaging revealed a history of stroke,and a bubble test revealed the presence of PFO.The patient was then transferred to our hospital for PFO closure.Under ICE guidance,the separation of the septum primum and septum secundum was unclear;we then used a Swartz catheter to confirm PFO by applying physical pressure on the right part of the atrial septum without using any contrast.The ICE continuously and clearly guided the procedure.CONCLUSION ICE can guide PFO closure in patients with a history of stroke.When PFO is not evident under ICE,a Swartz catheter can be used.
文摘Carbon monoxide (CO) poisoning is a frequent cause of emergency room admissions, especially during winter days, the symptoms are varied ranging from a simple headache to a serious cardiac and neurological impairment that can be deadly. Diagnosis is based on the circumstances of occurrence as well as the dosage of carboxyhemoglobin in the blood. Exposure to CO has serious consequences, neurological and cardiac manifestations are not negligible and vary from repolarization disorders to heart attack. Treatment is urgent with normobaric or hyperbaric oxygen therapy. We report a case of a 2-year male child admitted to the emergency room for CO intoxication with an intracardiac thrombus subsequently complicated by an ischemic stroke with a fatal outcome in order to highlight this complication rarely described in literature.
文摘Context:Intracardiac masses(ICMs)are detected during the exploration of cardiovascular pathologies or discovered incidentally.They include intracardiac thrombi,cardiac tumors and valvular vegetations.Method:This was a descriptive study retrospectively collected within the cardiology department from January 1,2011 to March 31,2013.All the patients diagnosed and hospitalized for intracardiac masses and followed-up for at least three months were included in the study.Outcomes:Among the 1066 patients admitted in the period of study,80 patients had intracardiac masses,corresponding to a hospital frequency of 7.5%.The average age was 48.4±17.4 years.ICM was detected during a thromboembolic complication in 18 cases(22.5%)and during a cardiological check-up for heart disease in 62 cases(77.5%).Thromboembolic complications were dominated by strokes in 55.6% of cases.Cardiology check-up was done because of exertional dyspnea(62 patients)in 77.5% of cases.Among these intracardiac masses(ICMs),intracardiac thrombosis(ICT)was observed in 41 cases(50.6%),followed by intracardiac vegetations in 32 cases(39.5%).The curative treatment of intracardiac masses consisted of anticoagulants in 65%of cases,antibiotics in 58.8%of cases and instrumental treatments in 1.3%of cases.We didn’t use cardiac surgery as a therapeutic means in our study.Twenty patients(25%)died during hospitalization,six of whom(30%)died as a result of thromboembolic complications.Conclusion:Intracardiac masses visualized on ultrasound are most often due to thrombi,vegetations or myxomas.In our study,intracardiac thrombosis was the most common masses,accounting for 50.6%of cases.
文摘Background Cardiac resynchronization therapy （CRT） with biventricular pacing improves cardiac function,functional capacity and quality of life in selected patients with heart failure.The current study aimed to evaluate the efficacy of the intracardiac electrogram （IEGM）-based optimization method,QuickOptTM,in Chinese patients treated with CRT.Methods Aortic time velocity integrals （AVTI） achieved at the sensed atrioventricular （AV）,paced AV and interventricular （VV） interval settings recommended by both QuickOptTM and standard echocardiographic optimization were measured in 101 patients.Consistency and the strength of the relationship between the two timing cycle optimization methods were assessed by intra-class correlation coefficient （ICC）.Results The ICC showed good agreement and correlation with what the AVTI achieved at the optimal sensed AV （ICC=0.9683 （0.9535-0.9785））,paced AV （ICC=0.9642 （0.9475-0.9757）） and VV （ICC=0.9730 （0.9602-0.9817）） interval settings determined by the two optimization methods.The average time required by echocardiographic optimization and by QuickOptTM were （78.32±32.40） minutes and （1.98±1.64） minutes respectively （P 〈0.0001）.Conclusion The QuickOptTM algorithm provides a quicker,simpler and reliable alternative to the standard method for timing cycle optimization.（ClinicaITrial.gov Reference Number：NCT00918294）
文摘目的 探讨在心腔内超声(ICE)引导下行零射线心房颤动(简称房颤)射频消融术的可行性及安全性。方法入选我院2014年1月至2023年12月期间行房颤射频消融的患者297例,根据手术过程中是否使用ICE,分为ICE引导组与X线引导组。对比两组患者基线特征及手术相关数据。结果 ICE引导组共入组111例,X线引导组共186例。ICE引导组持续性房颤的比例更高[46(41.4%) vs 17(9.1%)],左心房内径更大[(42.7±5.2) mm vs(39.2±4.7) mm],P值均<0.05;其他一般资料和临床基线特征均无显著差异。与X线引导组相比,ICE引导组房间隔穿刺次数、穿刺时间、X射线暴露时间明显减少或缩短,两组在并发症发生率、手术时间等方面无统计学差异。由于ICE引导组与X线引导组在房颤类型、左心房内径、射血分数等基线数据方面存在明显差异,故使用R4.3.3统计软件按1∶1进行倾向性匹配,两组各81例。与X线引导组相比,ICE引导组房间隔穿刺次数更少[(1.1±0.3) vs(1.8±1.0),P<0.05]、穿刺时间更短[(2.5±0.8) min vs(3.7±2.1) min,P<0.05]、且消融手术时间明显缩短[(191.2±47.3) min vs(228.0±60.5) min,P<0.05]。结论 ICE引导下消融治疗房颤房间隔穿刺次数少,穿刺时间短,X射线暴露时间短,且手术安全有效。
