Objective To analyze the risk factors for traumatic cerebral venous sinus occlusion (CVSO)and to investigate the strategies of early diagnosis of traumatic CVSO. Methods The clinical data of 212 patients with moderate to severe closed traumatic brain injury from January 2012 to December 2015 were analyzed retrospectively. Logistic regression analysis was used to evaluate the risk factors for traumatic CVSO. Results Of the 212 patients with traumatic brain injury, 16.5%(35/212) patients had CVSO. Ten patients had CVSO of thrombotic type (typeⅠ), 16 patients had CVSO of compression type (typeⅡ), and 9 patients had CVSO of mixed type (typeⅢ). Logistic regression analysis showed that skull fracture (OR = 8.141; 95%CI: 3.224-20.840) and epidural hematoma of crossing venous sinus (OR = 3.179; 95%CI: 1.470-7.037) were the risk factors for CVSO, and the former was more significantly correlated with CVSO. Female gender was the risk factor for CVSO typeⅠ(OR =10.425; 95%CI: 1.831-30.053), epidural hematoma of crossing venous sinus was the risk factor for CVSO typeⅡ(OR = 5.766; 95%CI: 1.885-18.197), and skull fracture, epidural hematoma of crossing venous sinus, and the previous history of vein thrombosis was the risk factors for CVSO type Ⅲ(OR =18.005, 4.596, 11.394; 95%CI: 2.021-58.836, 1.144-19.525, 1.436-46.558). Conclusions In the early diagnosis of traumatic CVSO, the crossing venous sinus fracture line and epidural hematoma should be given attention. Attention should be paid to the history of venous thrombosis. MR venography and CT venography contributes to early diagnosis of CVSO.

Objective To discuss the worthiness of real-time three-dimensional echocardiography in researching normal fetal heart ventricle growth and systolic function. Methods End-systolic volume(EDV),end-diastolic volume(ESV), struggle volume(SV) and ejection fraction(EF) of 54 normal fetal were acquired from 3-D data by Qlab software. The relation between ventricular growth with pregnant week was analysed and the difference of the volume and systolic function between left ventricle with right ventricle were compared. Results Ventricular volume of normal fetal heart (EDV,ESV,SV) were all increased with the gestational ages,there was linear relativity between them,while EF was not increased with pregnant weeks,there was no linear relativity between them. There was no statistics difference on EDV and ESV between left ventricle and right ventricle, while there was statistics difference on SV, EF between them. Conclusions The image of fetal endocarium could be derived clearly by real-time three-dimensional echocardiography, which help to get fetal heart ventricular volume and to study fetal heart growth and function.

Objective To assess the application of echocardiography in mini-invasive surgical device closure of ventricular septal defect (VSD). Methods 73 VSD patients including 35 with aneurysm formation and among them 21 with multi-defects in the aneurysm were treated by mini-invasive device closure. A closure device was positioned to the defect through parastemal mini-incision in all patients. TEE was used to monitor the whole procedure, to guide the device positioning and to evaluate the curative effect instantly after operation. All patients were evaluated by TTE one year postoperatively. Results All patients were successfully positioned closure devices by TEE guiding. 9 cases were found with trace to small amount residual shunt instantly after operation. 7 cases still had small amount residual shunt at the time of 48 hours after the operation. In the one year follow-up, 4 cases had residual shunt, but the size and volume of left ventricle were significantly reduced than those before operation, and the pulmonary artery systolic pressure was also reduced. Conclusion Echocardiography possesses an important role in preoperative indication screening, intraoperation monitoring and evaluating the curative effect postoperatively.

Objective To compare the formation and evolution of left ventricular flow between the patients with the bileaflet artificial mechanical mitral valve and normal adult using vector flow mapping (VFM). Methods Thirty healthy controls and 30 severe mitral stenosis patients with bileaflet prosthesis mitral valve were involved. The left ventricular flow and the vortex description parameters were comparatively studied between two groups. Results Two small symmetric rotating vortexes and a big counter-clockwise rotating vortex appeared alternately in the left ventricular through cardiac cycle with control group. In case group,only large vortex could be seen in the mid-late diastolic and maximum vector velocity was faster than that in control group in statistics( P <0. 05). Especially the postoperative direction of blood flow was clockwise shif ting from the interventricular septum to the posterior and lateral left ventricular wall inversely to control group. Conclusions VFM can show the complex vortex flow patterns in left ventricular in the patients with bileaflet prosthesis mitral valve preliminarily and may be useful to assess and improve the function of prosthesis valve in future.

rative.

Objective To determine the capability of echocardiography to identify primary cardiac valve myxomatous degeneration (PCVMD) compared to pathological findings and to determine the echo features of PCVMD. Methods Echocardiograms were retrospectively compared with pathological findings of 1080 patients who underwent surgery for moderate or severe valve regurgitation. PCVMD of the mitral,aortic and tricuspid valves was retrospectively identified, with a comparison of the echocardiography and pathology findings,to calculate the prevalence of PCVMD,and to summarize its echocardiography features.Results A total of 104 patients were diagnosed with PCVMD (prevalence of 9. 62%) with 117 lesions.Valvular regurgitation were confirmed by echocardiography in all patients( 100 % ). Valve morphology change including valve prolapsed, valve thickening and redundancy were confirmed by echocardiography in 101 lesions(86.3 % ), but suggestive diagnosis were done by echocardiography in only two patients. Conclusions In patients undergoing surgery for valvular regurgitation,a high prevalence of PCVMD was found. PCVMD had distinctive echocardiographic features,suggesting its preoperative diagnosis.

Objective The cardiac synchronization therapy (CRT) was proven to have good treatment for the cardiac conduction disorders patients with serious heart failure. But many disadvantages were gradually be noticed, such as difficulty of sinus electrode implantation, coronary sinus injury and bleeding, still one third CRT cases remain unchanged cardiac function.Recently the epicardial lead CRT therapy by the cardiac surgeons appears promising to provide better clinic resynchronization.The aim of this research is to explore the clinical value of surgical epicardial lead CRT for the cardiomyopathy heart failure with micro-invasive thoracoscopy techniques. Methods During April 2007 to Sep 2009 eleven patients were diagnosed as advanced heart failure with cardiac dysynchronization proven by the ECG and tissue Doppler echo examination. The dysynchronization parameters of tissue Doppler echo includes left ventricle maximize delay time , the left dysynchronization index (Ts-SD), the inter-ventricle mechanical delay time (IVMD), left ventricle end-dilation diameters (LVEDD) and the left ventricle ejection fraction (LVEF). All the patients got the consent agreement before the surgery. In the hybrid operation room the right atrial and ventricle endocardial electrodes were placed firs guided by X ray under the general anesthesia and double lumnen incubation. Then the thoracoscope techniques were used to explore the left ventricle lateral wall. The right atrial and ventricle electrodes were connected into the three chamber pacemaker. The Tissue Doppler Echo TEE technique was used to check which part of the left ventricle lateral wall is suitable for the idea CRT therapy. Usually the latest activated part of the left ventricle wall is the goal place. Then the epicardial electrode was fixed with 4-0 prolene suture at the idea place. All the cases were performed by the same surgeons group in the same medical center. The resynchronization features were examined after surgery and during the follow up. Results The endocardial and epicardial electrodes were implanted successfully without any serious complication. All patients were weaned and discharged without any adverse cardiac episodes. There is no mortality during the follow up period. All the patients received the β-blokers, diuretics, ACEI/ARB and other traditional medicine for the heart failure.The Tissue Doppler showed the E peak wave separated form the A peak which means the good resynchronization between the atrium and the ventricle. After surgery during the follow up the left ventricle maximize delay time decreased from (393.4 ±40.2 ) ms to ( 102.1 ± 34.6) ms, the left dysynchronization index (Ts-SD) decreased from (145.2±29.3)ms to(51.0±21.4) ms, the inter-ventricle mechanical delay time (IVMD) decreased from (59.1 ±23.4) ms to (31.2 ± 11.5 ) ms, left ventricle end-dilation diameters increased from (73.1 ± 13.4) mm to (63.2 ± 6.7) mn and the left ventricle ejection fraction increased from 0.32 ±0.04 to 0.41 ±0.07. Conclusion The micro-invasive surgical synchronization therapy could get good CRT result for the cardiomyopathy heart failure patients. Some patients traditionally in the waiting list for the heart transplant could be considered for the CRT therapy candidates.

Objective To explore the important anatomic structures associated with pulmonary veins and similar sections to transthoraeic echocardiography using 64一slice spiral CT and tO locate the pulmonary veins on echocardiography. Methods The transthoracic echocardiography and 64-slice spiral CT were performed in 12 patients with atrial fibrillation.The 3-dimensional information of four pulmonary veins on CT was analyzed and the relationship between the locations of four pulmonary veins and adjacent anatomic structures were observed.The comparison of CT and echocardiography for assessing the location of pulmonary veins was performed.Results All of the pulmonary veins were demonstrated optimally without abnormal structures and anatomic variations.The ostium of right superior pulmonary vein adjoined the atrial septum and the proximal of the right superior pulmonary vein was near to the superior vena cava.The right inferior superior pulmonary was a little bit far from atrial septum.The left superior pulmonary vein adjoined the left atrial auricle.The left inferior pulmonary vein was a little bit far from the 1eft atrial auricle and adjoined the thoracic descending aorta.According to adjusting the angle of the probe on echocardiography,the four pulmonary veins could be demonstrated in the standard parasternal left ventricular long-axis view, parasternal short-axis view and apical four chamber view.The non-standard views assisted in identifying the pulmonary veins.Conclusions Transthoracic echocardiography can demonstrate all the four pulmonary veins and also locate the spatial location based on the adjacent anatomic structures.

Objective To discover regularities behind critical values in an effort to provide scientific evidences for a better critical value report system.Methods Collection, analysis and statistical assessments for critical value items and ranges appropriate for the hospital Results The occurrence rate of critical values is found to be 0.14%.By means of clinical evaluation, statistic analysis and reference to literature and clinical specialists, the clinical labs revised the ranges of PO2, GLU, PT and APTT, and added ALT, MYO, CTnl and K+ , GLU, BILl for newborns, and canceled AMY.All of these changes were put in practice upon approval of the Medical Department of the hospital Conclusion Regular evaluation and continuous improvement of the critical value report system may help with saving lives, improving quality of care of the labs and doctors" diagnosis as well

OBJECTIVESTo analyse the characteristics of interventional treatment for anterior communicating artery aneurysm (AcoAA) and improve curative effects.

METHODSIn 126 patients, detachable microcoils were used to embolize the AcoAA via endovascular approach. Those patients failed to be embolized were treated by surgical clipping.

RESULTSOf the 109 patients who were embolized successfully, 97 were achieved 100% occlusion, 12 95% - 98% occlusion. In the other 17 patients who failed to interventional treatment 15 were treated surgically and 2 no treatment because of cerebral vascular spasm. 123 patients were cured, one died, and 2 had aneurysms disappeared without any operations, as proved by follow-up for 5 months to 1 years. Of 32 patients checked by cerebral angiography 3 weeks to 30 months after operation, 30 showed disappeared of aneurysms and 2 had recurrence. The recurred aneurysms were successfully reembolized.

CONCLUSIONSMost of AcoAAs can be cured by endovascular interventional treatment. Those who failed to be treated by embolization can be cured surgically. Few patients may be healed spontaneously. The long term effects of treatment should be followed-up for a long time.

Adult ; Cerebrovascular Circulation ; Embolization, Therapeutic ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; therapy ; Male ; Middle Aged ; Treatment Outcome