OBJECTIVE:To investigate the effect of preoperative use of high-dose simvastatin on the pulmonary artery pres-sure in congenital heart disease with left-to-right shunt. METHODS:86 patients with left-to-right shunt congenital heart disease who were planned to implement interventional occlusion therapy were randomly divided into control group(43 cases)and observa-tion group(43 cases). Patients in both groups were given digitalis,diuretics,anticoagulants and other basic treatments;On this basis, control group received Sildenafil citrate tablet,25 mg,3 times a day,orally given 1 h before a meal;observation group received Simvastatin tablet 80 mg,once every evening,orally. The treatment course for both groups was 7 d. Mean pulmonary hypertension (mPAP),N terminal prohormone brain natriuretic peptide (NT-proBNP),arterial oxygen saturation (SaO2),arterial oxygen ten-sion(PaO2),pulmonary blood circulation ratio(Qq/Qs),pulmonary pressure variation(Rp/Rs),pulmonary vascular resistance in-dex(PVRi)before and after treatment in 2 groups were observed,and related indicators of liver functions [alanine aminotransfer-ase (ALT),aspartate aminotransferase(AST)] and myocardial enzymes [lactate dehydrogenase (LDH),creatine kinase MB(CK-MB)] were detected. The incidence of adverse reactions were deteted. RESULTS:Before treatment,there were no significant differ-ences in mPAP,NT-proBNP,SaO2,PaO2,Qq/Qs,Rp/Rs,PVRi,ALT,AST,LDH and CKMB levels in 2 groups(P>0.05). Af-ter treatment,mPAP,NT-proBNP,Rp/Rs and PVRi levels were significantly lower than before,SaO2,PaO2,and Qq/Qs levels were significantly higher than before and Qq/Qs level in observation group was higher than these in control group.The difference was statistically significant(P<0.05). There was 1 patient showed severe liver injury in observation group and exited the test;the other 85 patients showed no obvious adverse reactions,with successful surgery and good prognosis. CONCLUSIONS:The preoper-ative use of high-dose simvastatin shows obvious effect on controlling mean pulmonary hypertension,reducing mPAP,NT-proB-NP,Rp/Rs and PVRi levels and increasing SaO2,PaO2,and Qq/Qs levels before operation,with good safety.

Objective: To analyze the risk factors of ischemic stroke prevalence in elder patients with non-valvular atrial ifbrillation (AF).
Methods: A total of 180 AF patients treated in our hospital from 2010-01 to 2014-12 were retrospectively studied. The diagnosis of ischemic stroke was conifrmed by CT/MRI, and the patients were divided into 2 groups: AF with ischemic stroke group,n=120 and AF alone group,n=60. The CHA2DS2-VASc score, CHADS2 score, plasma levels of homocysteine (HCY), ifbrinogen (FIB), left atrial diameter (LAD), blood lipid proifle and renal function were examined and compared between 2 groups.
Results: There were signiifcant differences on CHA2DS2-VASc score, CHADS2 score, HCY, FIB and LAD between AF with ischemic stroke group and AF alone group,P<0.05. Logistic regression analysis showed that CHA2DS2-VASc score, CHADS2 score, HCY, FIB and LAD were the independent risk factors for ischemic stroke occurrence in non-valvular AF patients. CHA2DS2-VASc score was different from CHADS2 score for stroke stritiifcation.
Conclusion: The CHA2DS2-VASc score and CHADS2 score system combining with plasma levels of HCY, FIB and LAD have the important clinical predictive value for the occurrence of ischemic stroke in elder patients with AF. CHA2DS2-VASc score is more appropriate for screening the low-risk patients, and CHADS2 score is rather appropriate for screening the high-risk patients.

ObjectiveTo approach the value of diagnosis with the 256-slice spiral CT in severe tetralogy of Fallot of infant.MethodsFrom January 2008 to December 2010,48 cases (severe tetralogy of Fallot of infant) were examined with 256-slice spiral CT preoperatively.All cases were then analyzed in workspace with maximum intensity projection(MIP),multiplanar reconstruction(MPR) and volume rendering (VR),while compared with transthoracic echocardiography (TTE) and surgical results.Results CT examination found that TTE misdiagnosis 4 cases of patent ductus arteriosus and 6 cases of aortic coarctation.Meanwhile,CT showed 6 aorta pulmonary collateral arteries in 5 cases.In 48 cases,surgical results confirmed 47 cases by 256-shce spiral CT,while 33 cases by TTE.The diagnosis accuracy rate of 256-slice spiral CT and TTE was 97.9％ (47/48) and 68.8％ (33/48) respectively.There was statistically significant difference of the two inspections in diagnostic accuracy (P ＜ 0.05).ConclusionThe inspection of 256-slice spiral CT can benefit the preoperative diagnosis and operation program in severe tetralogy of Fallot of infant.

Objective To study the correlation between radial artery graft patency and the degree of native coronary stenosis in coronary artery bypass grafting. Methods The clinical data of 290 patients who had underwent off-pump coronary artery bypass grafting were retrospectively analyzed. The left internal mammary artery, radial artery and saphenous veins were as grafts. The patients were divided into 3 groups according to the stenosis of right coronary artery before operation:group Ⅰ(right coronary artery stenosis 50%-75%, 85 cases), groupⅡ(right coronary artery stenosis 76%-89%, 95 cases) and group Ⅲ (right coronary artery stenosis 90%-100%, 110 cases). The patients were followed up for 2 to 5 years, and the graft patency was assessed using CT coronary angiography. Results There was no death and serious complications in 3 groups. Among the 3 groups, the total graft patency rate of left internal mammary artery grafts was 93.3% (270/290), the total graft patency rate of saphenous veins grafts was 70.2%(433/617), and the total graft patency rate of radial artery grafts was 69.7%(202/290). There was no statistical difference in the graft patency rate of radial artery grafts between group Ⅱ and group Ⅰ(P>0.05). The graft patency rate of radial artery grafts in group Ⅲwas significantly higher than that in groupⅡand group Ⅰ:85.5%(94/110) vs. 68.4%(65/95) and 50.6%(43/85), and there was statistical difference (P<0.05). The graft patency rate of radial artery grafts was significantly higher than the graft patency rate of saphenous veins grafts in group Ⅲ :85.5%(94/110) vs. 71.5%(168/235), and there was statistical difference (P<0.05). There were no statistical differences in the graft patency rates of left internal mammary artery grafts and saphenous veins grafts among 3 group (P>0.05). Conclusions The correlation between radial artery graft patency and the degree of native coronary stenosis is significant in coronary artery bypass grafting. Patients with severe proximal right coronary artery stenosis (≥90%) may have better patency rates at mid-term follow up after using radial artery grafts.

Objective To analyze the reasons and treatment methods of high transprothetic pressure gradient after aortic valve replacement. Methods The clinical data of 45 patients with high transprothetic pressure gradient after aortic valve replacement were retrospectively analyzed. The patients were followed up for average 24.6 (12 - 40) months. The postoperative effective orifice area (EOA) of artificial valve was measured by transthoracic color Doppler ultrasound. Compared with published referred EOA of different artificial valve, there were 2 kinds results:measured EOA=referred EOA and measured EOA0.85 cm2/m2 and EOAI<0.85 cm2/m2. The reasons of high transprothetic pressure gradient were analyzed according to the above different standard. Results In the 45 patients with high transprothetic pressure gradient after aortic valve replacement, prosthesis-patient mismatch (PPM) was in 33 cases, and prosthetic dysfunction was in 10 cases, among whom 5 cases were because of thrombus (3 cases improved after increasing the dosage of warfarin, 2 cases underwent re-aortic valve replacement), 3 cases were because of severe bioprosthetic calcification (underwent re-aortic valve replacement), and 2 cases were because of prosthetic ring pannus and influenced movement of the leaflets (underwent re-aortic valve replacement). High flow in the left ventricular outflow tract occurred in 2 cases. The patients had no obvious discomfort, and did not receive special treatment. Four cases died, among whom 2 cases were because of severe PPM, and the other 2 cases were because of noncardiac. Conclusions Many reasons can result to the high transprothetic pressure gradient, and the PMM is the most common reason. Choosing the right treatment plan can improve the survival rate of patients.

The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists. The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers, based on factors such as detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening. Not only it can provide a standardized procedure of oral ulceration, but also it can improve the diagnostic efficiency, in order to avoid misdiagnosis and missed diagnosis.
Consensus ; Humans ; Oral Ulcer/therapy*