Survival of patients with severe congenital aortic stenosis beyond third decade is uncommon. This report describes a 31 year old patient who underwent successful aortoplasty and in addition septal myectomy for complet...Survival of patients with severe congenital aortic stenosis beyond third decade is uncommon. This report describes a 31 year old patient who underwent successful aortoplasty and in addition septal myectomy for complete relief of left ventricular outflow obstruction.展开更多
Background： Percutaneous transluminal septal myocardial ablation （PTSMA） and modified Morrow septal myectomy （MMSM） are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyop...Background： Percutaneous transluminal septal myocardial ablation （PTSMA） and modified Morrow septal myectomy （MMSM） are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy （HCM）. This study aimed to determine the clinical outcome of these two strategies. Methods： From January 2011 to January 2015,226 patients with HCM were treated, 68 by PTSMA and 158 by MMSM. Both ultrasonic cardiograms and heart functional class were recorded before, alter operations and in the follow-up. Categorical variables were compared using Chi-square or Fisher＇s exact tests. Quantitative variables were compared using the paired samples t-test. Results： lnterventricular septal thickness was significantly reduced in both groups （21.27 ± 4.43 mm vs. 18.72 ±4.13 mm for PTSMA, t = 3.469, P 〈 0.001, and 21.83± 5.03 mm vs. 16.57 ± 3.95 mm for MMSM, t = 10.349, P 〈 0.001, respectively）. The left ventricular outflow tract （LVOT） pressure gradient （PG） significantly decreased after the operations in two groups （70.30 ± 44.79 mmHg vs. 39.78 ±22.07 mmHg for PTSMA, t = 5.041, P 〈 0.001, and 74.58 ± 45.52 mmHg vs. 13.95 ± 9.94 mmHg for MMSM, t = 16.357, P 〈 0.001, respectively）. Seven patients （10.29%） in the PTSMA group required a repeat operation in the follow-up. Eight （11.76%） patients were evaluated for New York I-lean Association （NYHA） Ill/IV in the PTSMA group, which was significantly more than the five （3.16%） in the same NYHA classes lbr the MMSM group at follow-up. Less than 15% of patients in the PTSMA group and none of the patients in the MMSM group complained of chest pain during follow-up. Conclusions： Both strategies can not only relieve LVOT PG but also improve heart function in patients with HCM. However, MMSM might provide a more reliable reduction in gradients compared to PTSMA.展开更多
BACKGROUND Managing left ventricular outflow tract obstruction(LVOTO)and systolic anterior motion(SAM)of the mitral valve can be challenging,especially in the context of circulatory shock and pulmonary edema post card...BACKGROUND Managing left ventricular outflow tract obstruction(LVOTO)and systolic anterior motion(SAM)of the mitral valve can be challenging,especially in the context of circulatory shock and pulmonary edema post cardiac surgery.CASE SUMMARY We describe a case of an 80-year-old female patient with a history of severe aortic stenosis and hypertrophic obstructive cardiomyopathy that underwent aortic valve replacement and myectomy.The patient presented with acute pulmonary edema and low blood pressure due to LVOTO and SAM post cardiac surgery in the intensive care unit.She was paced with an epicardial dual-chamber pacing system due to complete atrioventricular block and treated initially with norepinephrine,furosemide,and esmolol infusion and continuous positive pressure ventilation.The patient remained hypoxemic and kept deteriorating hemodynamically despite titrating up norepinephrine.The addition of vasopressin infusion and tapering of norepinephrine finally stabilized the patient with significant reduction of LVOTO,confirmed by transthoracic echocardiography assessment,improved oxygenation and increased urine output.CONCLUSION Vasopressin seems to be the preferred vasopressor for managing LVOTO and SAM post-cardiac surgery,because of its absence of inotropic effects.Echocardiography is crucial for early diagnosis and therapeutic management.展开更多
Hospital volume is regarded amongst many in the medical community as an important quality metric. This is especially true in more complicated and less commonly performed procedures such as structural heart disease int...Hospital volume is regarded amongst many in the medical community as an important quality metric. This is especially true in more complicated and less commonly performed procedures such as structural heart disease interventions. Seminal work on hospital volume relationships was done by Luft et al more than 4 decades ago, when they demonstrated that hospitals performing > 200 surgical procedures a year had 25%-41% lower mortality than those performing fewer procedures. Numerous volume-outcome studies have since been done for varied surgical procedures. An old adage "practice makes perfect" indicating superior operator and institutional experience at higher volume hospitals is believed to primarily contribute to the volume outcome relationship. Compelling evidence from a slew of recent publications has also highlighted the role of hospital volume in predicting superior post-procedural outcomes following structural heart disease interventions. These included transcatheter aortic valve repair, transcatheter mitral valve repair, septal ablation and septal myectomy for hypertrophic obstructive cardiomyopathy, left atrial appendage closure and atrial septal defect/patent foramen ovale closure. This is especially important since these structural heart interventions are relatively complex with evolving technology and a steep learning curve. The benefit was demonstrated both in lower mortality and complications as well as better economics in terms of lower length of stay and hospitalization costs seen at high volume centers. We present an overview of the available literature that underscores the importance of hospital volume in complex structural heart disease interventions.展开更多
Spasmodic dysphonia is a laryngeal dystonia that can present as adductor,abductor,or mixed types,with or without tremor.The etiology is not understood fully.Comprehensive evaluation is required to establish the diagno...Spasmodic dysphonia is a laryngeal dystonia that can present as adductor,abductor,or mixed types,with or without tremor.The etiology is not understood fully.Comprehensive evaluation is required to establish the diagnosis.Treatments include voice therapy,medications,botulinum toxin injection,laryngeal surgery,deep brain stimulation,and others.In most patients,it is possible to improve fluency.展开更多
To the Editor:Hypertrophic cardiomyopathy(HCM),a genetic disorder characterized by asymmetric left ventricular hypertrophy,has an estimated prevalence of 0.5%in the general population.In patients with left ventricular...To the Editor:Hypertrophic cardiomyopathy(HCM),a genetic disorder characterized by asymmetric left ventricular hypertrophy,has an estimated prevalence of 0.5%in the general population.In patients with left ventricular outflow tract(LVOT)obstruction,the primary pathophysiological mechanism involves basal septal hypertrophy and systolic anterior motion(SAM)of the anterior mitral leaflet.Current invasive septal reduction therapies(SRT),including surgical septal myectomy(SSM)and alcohol septal ablation(ASA),aim to alleviate LVOT obstruction.Although SSM and ASA remain cornerstone treatments,emerging minimally invasive and image-guided techniques may reshape therapeutic paradigms.This article provides an overview of recent advances in the field,with a particular focus on innovations in interventional therapy.展开更多
文摘Survival of patients with severe congenital aortic stenosis beyond third decade is uncommon. This report describes a 31 year old patient who underwent successful aortoplasty and in addition septal myectomy for complete relief of left ventricular outflow obstruction.
基金This work was supported by grants from the National Natural Science Foundation of China （No. 81370328, and No. 81770371）.
文摘Background： Percutaneous transluminal septal myocardial ablation （PTSMA） and modified Morrow septal myectomy （MMSM） are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy （HCM）. This study aimed to determine the clinical outcome of these two strategies. Methods： From January 2011 to January 2015,226 patients with HCM were treated, 68 by PTSMA and 158 by MMSM. Both ultrasonic cardiograms and heart functional class were recorded before, alter operations and in the follow-up. Categorical variables were compared using Chi-square or Fisher＇s exact tests. Quantitative variables were compared using the paired samples t-test. Results： lnterventricular septal thickness was significantly reduced in both groups （21.27 ± 4.43 mm vs. 18.72 ±4.13 mm for PTSMA, t = 3.469, P 〈 0.001, and 21.83± 5.03 mm vs. 16.57 ± 3.95 mm for MMSM, t = 10.349, P 〈 0.001, respectively）. The left ventricular outflow tract （LVOT） pressure gradient （PG） significantly decreased after the operations in two groups （70.30 ± 44.79 mmHg vs. 39.78 ±22.07 mmHg for PTSMA, t = 5.041, P 〈 0.001, and 74.58 ± 45.52 mmHg vs. 13.95 ± 9.94 mmHg for MMSM, t = 16.357, P 〈 0.001, respectively）. Seven patients （10.29%） in the PTSMA group required a repeat operation in the follow-up. Eight （11.76%） patients were evaluated for New York I-lean Association （NYHA） Ill/IV in the PTSMA group, which was significantly more than the five （3.16%） in the same NYHA classes lbr the MMSM group at follow-up. Less than 15% of patients in the PTSMA group and none of the patients in the MMSM group complained of chest pain during follow-up. Conclusions： Both strategies can not only relieve LVOT PG but also improve heart function in patients with HCM. However, MMSM might provide a more reliable reduction in gradients compared to PTSMA.
文摘BACKGROUND Managing left ventricular outflow tract obstruction(LVOTO)and systolic anterior motion(SAM)of the mitral valve can be challenging,especially in the context of circulatory shock and pulmonary edema post cardiac surgery.CASE SUMMARY We describe a case of an 80-year-old female patient with a history of severe aortic stenosis and hypertrophic obstructive cardiomyopathy that underwent aortic valve replacement and myectomy.The patient presented with acute pulmonary edema and low blood pressure due to LVOTO and SAM post cardiac surgery in the intensive care unit.She was paced with an epicardial dual-chamber pacing system due to complete atrioventricular block and treated initially with norepinephrine,furosemide,and esmolol infusion and continuous positive pressure ventilation.The patient remained hypoxemic and kept deteriorating hemodynamically despite titrating up norepinephrine.The addition of vasopressin infusion and tapering of norepinephrine finally stabilized the patient with significant reduction of LVOTO,confirmed by transthoracic echocardiography assessment,improved oxygenation and increased urine output.CONCLUSION Vasopressin seems to be the preferred vasopressor for managing LVOTO and SAM post-cardiac surgery,because of its absence of inotropic effects.Echocardiography is crucial for early diagnosis and therapeutic management.
文摘Hospital volume is regarded amongst many in the medical community as an important quality metric. This is especially true in more complicated and less commonly performed procedures such as structural heart disease interventions. Seminal work on hospital volume relationships was done by Luft et al more than 4 decades ago, when they demonstrated that hospitals performing > 200 surgical procedures a year had 25%-41% lower mortality than those performing fewer procedures. Numerous volume-outcome studies have since been done for varied surgical procedures. An old adage "practice makes perfect" indicating superior operator and institutional experience at higher volume hospitals is believed to primarily contribute to the volume outcome relationship. Compelling evidence from a slew of recent publications has also highlighted the role of hospital volume in predicting superior post-procedural outcomes following structural heart disease interventions. These included transcatheter aortic valve repair, transcatheter mitral valve repair, septal ablation and septal myectomy for hypertrophic obstructive cardiomyopathy, left atrial appendage closure and atrial septal defect/patent foramen ovale closure. This is especially important since these structural heart interventions are relatively complex with evolving technology and a steep learning curve. The benefit was demonstrated both in lower mortality and complications as well as better economics in terms of lower length of stay and hospitalization costs seen at high volume centers. We present an overview of the available literature that underscores the importance of hospital volume in complex structural heart disease interventions.
文摘Spasmodic dysphonia is a laryngeal dystonia that can present as adductor,abductor,or mixed types,with or without tremor.The etiology is not understood fully.Comprehensive evaluation is required to establish the diagnosis.Treatments include voice therapy,medications,botulinum toxin injection,laryngeal surgery,deep brain stimulation,and others.In most patients,it is possible to improve fluency.
基金This work was supported by the Zhejiang Medical Association Clinical Medical Research Funds(No.2024ZYC-Z14)Hangzhou Medicine and Health Science and Technology Funds(No.ZD20250246)
文摘To the Editor:Hypertrophic cardiomyopathy(HCM),a genetic disorder characterized by asymmetric left ventricular hypertrophy,has an estimated prevalence of 0.5%in the general population.In patients with left ventricular outflow tract(LVOT)obstruction,the primary pathophysiological mechanism involves basal septal hypertrophy and systolic anterior motion(SAM)of the anterior mitral leaflet.Current invasive septal reduction therapies(SRT),including surgical septal myectomy(SSM)and alcohol septal ablation(ASA),aim to alleviate LVOT obstruction.Although SSM and ASA remain cornerstone treatments,emerging minimally invasive and image-guided techniques may reshape therapeutic paradigms.This article provides an overview of recent advances in the field,with a particular focus on innovations in interventional therapy.
