BACKGROUND & AIMS: :In this study, several electrocardiogram (ECG)-derived indices corresponding to both ventricular depolarization and repolarization were evaluated during acute myocardial ischemia in an experimental model of myocardial infarction produced by 40 min coronary balloon inflation in 13 pigs. Significant changes were rapidly observed from minute 4 after the start of coronary occlusion, achieving their maximum values between 11 and 22 min for depolarization and between 9 and 12 min for repolarization indices, respectively. Subsequently, these maximum changes started to decrease during the latter part of the occlusion. Depolarization changes associated with the second half of the QRS complex showed a significant but inverse correlation with the myocardium at risk (MaR) estimated by scintigraphic images. The correlation between MaR and changes of the downward slope of the QRS complex, [Formula: see text], evaluated at the two more relevant peaks observed during the occlusion, was r = -0.75, p < 0.01 and r = -0.79, p < 0.01 for the positive and negative deflections observed in [Formula: see text], temporal evolution, respectively. Repolarization changes, analyzed by evaluation of ST segment elevation at the main observed positive peak, also showed negative, however non-significant correlation with MaR: r = -0.34, p = 0.28. Our results suggest that changes evaluated in the latter part of the depolarization, such as those described by [Formula: see text], which are influenced by R-wave amplitude, QRS width and ST level variations simultaneously, correlate better with the amount of ischemia than other indices evaluated in the earlier part of depolarization or during the ST segment.

背景与目标： ：在这项研究中，在急性心肌缺血期间，在13只猪的40分钟冠状动脉球囊扩张产生的心肌梗塞实验模型中，评估了与心室去极化和复极化同时对应的几个心电图（ECG）衍生指标。从开始进行冠状动脉闭塞后的第4分钟开始迅速观察到显着变化，分别在去极化的11至22分钟和重新极化的9至12分钟之间达到最大值。随后，在咬合的后期，这些最大变化开始减少。与QRS波复杂度的后半部分相关的去极化变化与闪烁显像图像估计的危险心肌（MaR）呈显着但呈负相关。在咬合期间观察到的两个更相关的峰处评估的MaR与QRS络合物的向下斜率变化之间的相关性为[r = -0.75，p <0.01和r = -0.79，p分别在[公式：参见文本]，时间演变中观察到的正挠度和负挠度<0.01。通过在主要观察到的正峰值处评估ST段抬高来分析的复极变化也显示为负，但与MaR的相关性不显着：r = -0.34，p = 0.28。我们的结果表明，在去极化后期评估的变化（如[公式：请参见文本]所述）受R波幅度，QRS宽度和ST水平变化的同时影响，与缺血量的相关性更好。比在去极化早期或ST段评估的其他指数要高。

BACKGROUND & AIMS: :A 57-year-old woman showed frequent premature ventricular complexes (PVCs) originating from the right ventricular outflow tract (RVOT), and some of the PVCs triggered polymorphic ventricular tachycardia (PVT). Structural heart diseases were ruled out by conventional cardiac examinations. Radiofrequency catheter ablation was successful in eliminating the PVCs and subsequent PVT. However, epinephrine infusion unmasked her prolonged QT interval, and a genetic analysis revealed a KCNH2 mutation (R694H) as the cause of latent type-2 long QT syndrome (LQTS). This case suggests that latent LQTS may work as an arrhythmogenic substrate of PVT triggered by a benign form of RVOT-PVCs in patients with a structurally normal heart.

背景与目标： ：一名57岁的妇女表现出频繁的早产于右室流出道（RVOT）的心室复合物（PVC），并且其中一些PVC触发了多形性室性心动过速（PVT）。通过常规心脏检查排除了结构性心脏病。射频导管消融成功地消除了PVC和随后的PVT。然而，肾上腺素的注入掩盖了她延长的QT间隔，遗传分析显示KCNH2突变（R694H）是潜在的2型长QT综合征（LQTS）的病因。这种情况表明，在心脏结构正常的患者中，潜在的LQTS可能是由良性形式的RVOT-PVC触发的PVT的一种致心律失常底物。

BACKGROUND & AIMS: :Purpose. To evaluate whether 3T clinical MRI with a small-animal coil and gradient-echo (GE) sequence could be used to characterize long-term left ventricular remodelling (LVR) following nonreperfused myocardial infarction (MI) using semi-automatic segmentation software (SASS) in a rat model. Materials and Methods. 5 healthy rats were used to validate left ventricular mass (LVM) measured by MRI with postmortem values. 5 sham and 7 infarcted rats were scanned at 2 and 4 weeks after surgery to allow for functional and structural analysis of the heart. Measurements included ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and LVM. Changes in different regions of the heart were quantified using wall thickness analyses. Results. LVM validation in healthy rats demonstrated high correlation between MR and postmortem values. Functional assessment at 4 weeks after MI revealed considerable reduction in EF, increases in ESV, EDV, and LVM, and contractile dysfunction in infarcted and noninfarcted regions. Conclusion. Clinical 3T MRI with a small animal coil and GE sequence generated images in a rat heart with adequate signal-to-noise ratio (SNR) for successful semiautomatic segmentation to accurately and rapidly evaluate long-term LVR after MI.

背景与目标： ：目的。使用半自动分割软件（SASS）评估具有小动物线圈和梯度回波（GE）序列的3T临床MRI是否可用于表征非再灌注心肌梗死（MI）后的长期左心室重构（LVR）在大鼠模型中。材料和方法。使用5只健康大鼠通过验尸值验证通过MRI测量的左心室质量（LVM）。在手术后第2和第4周对5只假大鼠和7只梗塞的大鼠进行了扫描，以便对心脏进行功能和结构分析。测量包括射血分数（EF），舒张末期容积（EDV），收缩末期容积（ESV）和LVM。使用壁厚分析对心脏不同区域的变化进行定量。结果。在健康大鼠中的LVM验证表明MR和验尸值之间存在高度相关性。 MI后4周的功能评估显示，梗塞区和非梗塞区的EF明显降低，ESV，EDV和LVM升高，以及收缩功能障碍。结论。具有小动物线圈和GE序列的临床3T MRI在大鼠心脏中生成具有足够信噪比（SNR）的图像，可成功进行半自动分割，从而准确快速地评估MI后的长期LVR。

BACKGROUND & AIMS: :Premature closure of the ductus arteriosus (PCDA) and transposition of the great arteries (TGA) cause persistent pulmonary hypertension of the newborn (PPHN). We present a case of a newborn who demonstrated d-TGA with ventricular septal defect (VSD) and pulmonary stenosis (PS) complicated by PCDA. The neonate showed severe cyanosis resistant to resuscitation soon after birth, and was diagnosed with d-TGA with VSD by echocardiography. PPHN was also suspected based on physical symptoms and results of echocardiography. The neonate was given inhaled nitric oxide, prostaglandin E1, and catecholamines under sedation, and underwent a balloon atrial septostomy (BAS). His condition gradually improved, and he was extubated on day 7, but his pulmonary subvalvular stenosis gradually worsened and pulmonary blood flow was markedly decreased. A second BAS was performed on day 27 and he showed no improvement. Blalock-Taussig shunt surgery was performed on day 34, which markedly improved his condition. The co-existence of d-TGA and PCDA is generally a lethal state. In our patient, an increase in pulmonary blood flow during the fetal period was restricted because of PS and outlet flow from the left ventricle to the right ventricle via the VSD. This restricted blood flow through the ductus arteriosus, which led to narrowing of the DA. At the same time, damage to and constrictive changes of the pulmonary vessels were prevented. The ductus arteriosus should be carefully evaluated to exclude PCDA in cases of d-TGA. The presence of both VSD and PS may be a prognostic factor in such cases.

背景与目标： ：动脉导管过早闭合（PCDA）和大动脉移位（TGA）会引起新生儿持续性肺动脉高压（PPHN）。我们介绍了一个新生儿，该病例表现出伴有PCDA的d-TGA伴有室间隔缺损（VSD）和肺动脉狭窄（PS）。新生儿出生后不久就表现出严重的紫osis病，对复苏无抵抗力，并通过超声心动图诊断为带有VSD的d-TGA。根据身体症状和超声心动图检查结果也怀疑是PPHN。新生儿在镇静下吸入一氧化氮，前列腺素E1和儿茶酚胺，并进行球囊房间隔造口术（BAS）。他的病情逐渐好转，并在第7天拔管，但他的肺动脉瓣下狭窄逐渐加重，肺血流量明显减少。第27天进行了第二次BAS，他没有表现出任何改善。第34天进行了Blalock-Taussig分流手术，明显改善了他的病情。 d-TGA和PCDA的共存通常是致命状态。在我们的患者中，由于PS和通过VSD从左心室到右心室的出口血流，胎儿期肺血流量的增加受到了限制。这限制了通过动脉导管的血液流动，从而导致DA变窄。同时，防止了对肺血管的损害和收缩。对于d-TGA，应仔细评估动脉导管，以排除PCDA。在这种情况下，VSD和PS的存在可能是预后因素。

BACKGROUND & AIMS: BACKGROUND:Ebstein anomaly is a rare and heterogeneous congenital heart defect affecting the tricuspid valve and right ventricular (RV) myocardium. Few studies have analysed the electrocardiographic features of Ebstein anomaly and none has addressed correlations with disease severity. METHODS:Patients with Ebstein anomaly who had undergone electrocardiography and cardiac magnetic resonance (CMR) within 6 weeks between 2001 and 2009 were included. Exclusion criteria were: associated congenital cardiac defect, previous RV myoplasty and/or reduction surgery, class I anti-arrhythmic drug therapy, and paced/pre-excited QRS. Standard electrocardiogram (ECG) findings were correlated with CMR-based RV measures and clinical profile. RESULTS:The mean age of the 63 study patients was 22 ± 13 years. An RV conduction delay (rsR' pattern in right precordial leads) was present in 45 patients (71%). The QRS duration correlated with anatomic RV diastolic volume (r = +0.56, P < 0.0001) and inversely with RV ejection fraction (EF; r = -0.62, P < 0.0001). The presence of QRS fractionation predicted greater atrialized RV volume (80 ± 31 vs. 45 ± 37 mL/m(2), P < 0.001). Normal QRS duration was associated with smaller anatomic RV diastolic volume (150 ± 57 vs. 256 ± 100 mL/m(2); P < 0.0001), higher RV EF (48 ± 6 vs. 34 ± 14%; P < 0.0001), higher oxygen consumption (VO(2)) at cardiopulmonary exercise (25.8 vs. 21.8 mL/kg/min, P = 0.05) and lower incidence of oxygen desaturation with exercise (25 vs. 65%, P = 0.02). CONCLUSION:Delayed and prolonged depolarization of the RV is common in patients with Ebstein anomaly. The QRS duration is a marker of RV enlargement and dysfunction. QRS fractionation is associated with a greater atrialized RV volume. A preserved surface ECG identifies a subset of patients with Ebstein anomaly with mild morphological and functional abnormalities and better clinical profile.

背景与目标： 背景：Ebstein异常是一种罕见的异质先天性心脏缺陷，会影响三尖瓣和右心室（RV）心肌。很少有研究分析Ebstein异常的心电图特征，没有研究解决疾病严重程度的相关性。
方法：纳入2001年至2009年之间6周内经历过心电图和心脏磁共振（CMR）检查的Ebstein异常患者。排除标准为：相关的先天性心脏缺陷，先前的RV肌成形术和/或复位手术，I类抗心律不齐药物治疗以及起搏/预激QRS。标准心电图（ECG）发现与基于CMR的RV测量和临床特征相关。
结果：63名研究患者的平均年龄为22±13岁。 RV传导延迟（右心前导联中的rsR'模式）存在于45例患者中（71％）。 QRS持续时间与解剖型RV舒张容积相关（r = 0.56，P <0.0001），与RV射血分数成反比（EF; r = -0.62，P <0.0001）。 QRS分馏的存在预示着较大的房颤RV量（80±31 vs. 45±37 mL / m（2），P <0.001）。正常QRS持续时间与较小的RV解剖解剖容积相关（150±57 vs. 256±100 mL / m（2）; P <0.0001），较高的RV EF（48±6 vs. 34±14％; P <0.0001） ，心肺运动时较高的耗氧量（VO（2））（25.8 vs. 21.8 mL / kg / min，P = 0.05）和较低的运动性氧脱饱和发生率（25 vs. 65％，P = 0.02）。
结论：Ebstein异常患者右室延迟和延长去极化是常见的。 QRS持续时间是RV增大和功能障碍的标志。 QRS分馏与较大的房颤RV量相关。保留的表面心电图可识别出具有轻度形态和功能异常以及更好的临床特征的一部分埃伯斯坦异常患者。

BACKGROUND & AIMS: :Intra-ventricular hemorrhage (IVH) is a critical condition with high rate of morbidity and mortality due to acute hydrocephalus and secondary brain injury. Mechanisms underlying the clinical deterioration are not only related to the appearance of an acute hydrocephalus but also to blood-clot mass effect and the inflammatory effects of blood break-down products which impede local blood flow and exert a direct toxic effect on the peri-ventricular structures leading to chronic hydrocephalus. An effective treatment strategy should aim at IVH fast removal and reduction of blood-clot mass effect. Although external ventricular drainage placement is an intuitive treatment for obstructive hydrocephalus this treatment does not address in total the aforementioned pathophysiological mechanisms underlying secondary brain damage. Intra-ventricular fibrinolysis, with tissue plasminogen activator or urokinase, is a level of evidence B, class IIB treatment which has proved to be beneficial in lowering the mortality rates. Its effectiveness on functional outcome has been assessed on three large meta-analysis and a recent large randomized control trial (CLEAR III). Results from the CLEAR III multicenter trial suggest that a routine extra-ventricular drain, irrigation with alteplase reduced mortality but did not substantially improve functional outcomes compared with irrigation with saline. Protocol-based use of alteplase with extra-ventricular drain seemed safe, therefore such approach may be a potential option in individual cases. Currently no consensus has been reached and extrapolation of data from the literature does not permit to identify a uniform therapeutic approach but merely to outline some rational procedural modalities. Further research and studies are needed to compare the efficacy of the different fibrinolytic agents and protocols on functional outcome.

背景与目标： ：脑室内出血（IVH）是一种由于急性脑积水和继发性脑损伤而导致高发病率和高死亡率的严重疾病。临床恶化的潜在机制不仅与急性脑积水的出现有关，而且与血块质量效应和血液分解产物的炎症作用有关，这些物质阻碍局部血流并直接对脑室周围产生毒性作用导致慢性脑积水的结构。一种有效的治疗策略应以IVH快速清除和减少血块效应为目标。尽管外部脑室引流是阻塞性脑积水的一种直观治疗方法，但这种治疗方法并未完全解决继发性脑损伤背后的上述病理生理机制。带有组织纤溶酶原激活剂或尿激酶的脑室内纤维蛋白溶解是证据水平B，IIB类治疗，已被证明有助于降低死亡率。已通过三项大型荟萃分析和一项近期的大型随机对照试验（CLEAR III）评估了其对功能结局的有效性。 CLEAR III多中心试验的结果表明，常规的心室外引流，阿替普酶冲洗可降低死亡率，但与盐水冲洗相比，并不能显着改善功能结局。基于协议的阿替普酶伴室外引流的使用似乎是安全的，因此，在个别情况下，这种方法可能是一种潜在的选择。当前，尚未达成共识，并且从文献中推断数据还不能确定统一的治疗方法，而仅是概述一些合理的程序方式。需要进行进一步的研究以比较不同纤溶剂和方案对功能结局的功效。

BACKGROUND & AIMS: BACKGROUND:Left atrial enlargement, a sensitive integrator of left ventricular diastolic function, is associated with increased cardiovascular morbidity and mortality. Vitamin D is linked to lower cardiovascular morbidity, possibly modifying cardiac structure and function; however, firm evidence is lacking. We assessed the effect of an activated vitamin D analog on left atrial volume index (LAVi) in a post hoc analysis of the PRIMO trial (clinicaltrials.gov: NCT00497146). METHODS AND RESULTS:One hundred ninety-six patients with chronic kidney disease (estimated glomerular filtration rate 15-60 mL/min per 1.73 m(2)), mild to moderate left ventricular hypertrophy, and preserved ejection fraction were randomly assigned to 2 μg of oral paricalcitol or matching placebo for 48 weeks. Two-dimensional echocardiography was obtained at baseline and at 24 and 48 weeks after initiation of therapy. Over the study period, there was a significant decrease in LAVi (-2.79 mL/m(2), 95% CI -4.00 to -1.59 mL/m(2)) in the paricalcitol group compared with the placebo group (-0.70 mL/m(2) [95% CI -1.93 to 0.53 mL/m(2)], P = .002). Paricalcitol also attenuated the rise in levels of brain natriuretic peptide (10.8% in paricalcitol vs 21.3% in placebo, P = .02). For the entire population, the change in brain natriuretic peptide correlated with change in LAVi (r = 0.17, P = .03). CONCLUSIONS:Forty-eight weeks of therapy with an active vitamin D analog reduces LAVi and attenuates the rise of BNP. In a population where only few therapies alter cardiovascular related morbidity and mortality, these post hoc results warrant further confirmation.

背景与目标： 背景：左心房扩大，左心室舒张功能的敏感积分，与心血管疾病的发病率和死亡率增加有关。维生素D与降低心血管疾病的发病率有关，可能会改变心脏的结构和功能。但是，缺乏确凿的证据。我们在PRIMO试验的事后分析（clinicaltrials.gov：NCT00497146）中评估了活化的维生素D类似物对左心房体积指数（LAVi）的作用。
方法和结果：196例慢性肾脏病患者（估计肾小球滤过率每1.73 m（2）为15-60 mL / min），轻度至中度左心室肥厚和保留射血分数被随机分配为2μg口服paricalcitol或相匹配的安慰剂治疗48周。在治疗开始后的基线以及第24和48周获得了二维超声心动图。在研究期内，与安慰剂组（-0.70 mL）相比，paricalcitol组的LAVi（-2.79 mL / m（2），95％CI -4.00至-1.59 mL / m（2））显着降低。 / m（2）[95％CI -1.93至0.53 mL / m（2）]，P = .002）。 Paricalcitol还可以减轻脑钠肽水平的升高（paricalcitol中10.8％，而安慰剂中21.3％，P = .02）。对于整个人群，脑钠肽的变化与LAVi的变化相关（r = 0.17，P = .03）。
结论：用活性维生素D类似物治疗四十八周可降低LAVi并减轻BNP的升高。在只有少数几种疗法能改变与心血管有关的发病率和死亡率的人群中，这些事后结果值得进一步证实。

BACKGROUND & AIMS: We determined functional and morphological changes of the heart by 2-dimensional and pulse Doppler echocardiography in 20 patients with primary aldosteronism and compared the results with those in 50 healthy normotensive subjects, 12 patients with Cushing's syndrome, 9 patients with pheochromocytoma, and 47 patients with essential hypertension. All hypertensive groups had greater left ventricular mass indexes than did the normotensive group (76.9 +/- 17.2 g/m2). Despite similar age distribution, blood pressure during antihypertensive treatment, and duration of hypertension, the primary aldosteronism group had a significantly greater left ventricular mass index (152.5 +/- 42.5 g/m2) than did the Cushing's syndrome (103.4 +/- 37.5 g/m2), pheochromocytoma (122.4 +/- 28.5 g/m2), and essential hypertension (101.4 +/- 32.8 g/m2) groups. The left ventricular posterior wall thickness and interventricular septal wall thickness were significantly greater in the hypertensive groups than in the normotensive group and also significantly greater in the primary aldosteronism group than in any of the other hypertensive groups. By contrast, there were no significant differences among the four hypertensive groups in any variable of systolic or diastolic function of the heart. The results suggest that left ventricular hypertrophy is more pronounced in patients with primary aldosteronism than in patients with other forms of hypertension. It is therefore important to echocardiographically evaluate cardiac hypertrophy as a risk factor of morbidity and mortality in patients with this low renin hypertension.

背景与目标： 我们通过二维和脉冲多普勒超声心动图确定了20例原发性醛固酮增多症患者的心脏功能和形态变化，并将结果与​​50例健康血压正常的受试者，12例库欣综合征，9例嗜铬细胞瘤和47例高血压患者进行了比较。原发性高血压。所有高血压组的左心室质量指数均高于正常血压组（76.9 / 17.2 g / m2）。尽管年龄分布，抗高血压治疗期间的血压以及高血压持续时间相近，但原发性醛固酮增多症组的左心室质量指数（152.5 /-42.5 g / m2）明显高于库欣综合征（103.4 /-37.5 g / m2） ），嗜铬细胞瘤（122.4 /-28.5 g / m2）和原发性高血压（101.4 /-32.8 g / m2）组。高血压组的左心室后壁厚度和室间隔间隔壁厚度显着大于正常血压组，而原发性醛固酮增多症组也显着大于其他任何高血压组。相比之下，在四个高血压组之间，心脏的任何收缩或舒张功能变量均无显着差异。结果表明，原发性醛固酮增多症患者比其他形式的高血压患者左室肥厚更为明显。因此，超声心动图评估心脏肥大是低肾素高血压患者发病和死亡的危险因素，这一点很重要。

BACKGROUND & AIMS: :Detergent-resistant membranes (DRMs) represent specialized membrane domains resistant to detergent extraction, which may serve to segregate proteins in a specific environment in order to improve their function. Segregation of glycosylphosphatidylinositol-anchored proteins (GPI-APs) in DRMs has been shown to be involved in their sorting to the apical membrane in polarized epithelial cells. Nonetheless, we have shown that both apical and basolateral GPI-APs associate with DRMs. In this report we investigated the lipid composition of DRMs associated with an apical and a basolateral GPI-AP. We found that apical and basolateral DRMs contain the same lipid species although in different ratios. This specific lipid ratio is maintained after mixing the cells before lysis indicating that DRMs maintain their identity after Triton extraction.

背景与目标： ：抗洗涤剂膜（DRMs）代表对去污剂萃取有抗性的特殊膜结构域，可用于在特定环境中分离蛋白质以改善其功能。研究表明，DRM中糖基磷脂酰肌醇锚定蛋白（GPI-AP）的分离与其在极化上皮细胞的顶膜中的分选有关。尽管如此，我们已经表明，根尖和基底外侧的GPI-AP均与DRM相关。在本报告中，我们研究了与根尖和基底外侧GPI-AP相关的DRM的脂质成分。我们发现顶端和基底外侧DRM包含相同的脂质种类，尽管比率不同。在裂解之前混合细胞后，该特定脂质比率得以维持，这表明DRM在Triton提取后仍保持其身份。

BACKGROUND & AIMS: OBJECTIVE:To review the findings and discuss the implications of mechanical ventilator weaning protocols in children. DESIGN:A critical appraisal of Randolph et al. Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: A randomized controlled trial. JAMA 2002;288:2561-2568, and literature review. FINDINGS:There was no difference in ventilator weaning times between children randomized to a ventilator weaning protocol (pressure support, volume support, or no protocol). However, the study did show that increased sedative use during the first 24 hrs of weaning (the only time during which these data were collected) was an important predictor of weaning duration (p < .001) and weaning failure (p = .04). CONCLUSIONS:The majority of children are weaned from mechanical ventilation over a short period of time. Weaning protocols may not shorten this brief duration of weaning but may have other advantages such as improved collaboration between healthcare team members. Future research into the effects of sedation on weaning from mechanical ventilation is needed in children.

背景与目标： 目的：回顾研究结果并讨论机械呼吸机断奶方案对儿童的影响。
设计：Randolph等人的重要评估。机械呼吸机断奶方案对婴幼儿呼吸系统结局的影响：一项随机对照试验。 JAMA 2002； 288：2561-2568，以及文献综述。
结果：随机分配到呼吸机断奶方案（压力支持，容量支持或无协议）的儿童之间的呼吸机断奶时间没有差异。但是，该研究确实表明，在断奶的前24小时（收集这些数据的唯一时间）内镇静剂使用的增加是断奶持续时间（p <.001）和断奶失败（p = .04）的重要预测指标。 。
结论：大多数儿童在短时间内断奶了机械通气。断奶协议可能不会缩短这段短暂的断奶时间，但可能具有其他优势，例如改善医疗团队成员之间的协作。儿童需要镇静剂对机械通气对断奶的影响的未来研究。

BACKGROUND & AIMS: :A 4-year-old child with patent ductus arteriosus, perimembranous ventricular septal defect and ostium secundum atrial septal defect was successfully treated with the use of a simultaneous transcatheter for all of the anomalies present. The patent ductus arteriosus was closed first by using a coil, then the perimembranous ventricular septal defect was closed by using a 10-mm Amplatzer eccentric device. Finally, a 10-mm Amplatzer atrial septal defect device was implanted to treat the atrial septal defect.

背景与目标： ：对于同时存在的所有异常，使用同步经导管成功治疗了患有动脉导管未闭，膜周室间隔缺损和仲孔房间隔缺损的4岁儿童。首先使用线圈闭合动脉导管未闭，然后使用10 mm Amplatzer偏心装置闭合膜周围室间隔缺损。最后，植入10毫米Amplatzer房间隔缺损装置以治疗房间隔缺损。

BACKGROUND & AIMS: OBJECTIVE:Acute pulmonary hypertension may cause right ventricular (RV) contractile failure. While it has been assumed that restoration of normal loading conditions after acute pulmonary hypertension is sufficient for complete recovery of RV function, this has not been rigorously examined. The purpose of this study was to test the hypothesis that acute RV pressure overload produces RV contractile dysfunction that persists following restoration of control loading conditions. METHODS:We subjected 18 autonomically-blocked, chloralose-anesthetized, open-chest pigs to 1 h of pulmonary artery constriction to increase RV systolic pressure from 35 +/- 1 to 55 +/- 1 mmHg, followed by 2 h of measurements after pulmonary artery constriction release. We determined regional RV free wall function from pressure-segment length loops and preload recruitable stroke work relations, and global RV function from stroke work vs. end-diastolic pressure relations. RESULTS:As expected, RV free wall systolic shortening diminished during pulmonary artery constriction, but the endo/epi blood flow ratio, lactate uptake, and coronary venous pH were not significantly changed. Following release of pulmonary artery constriction, RV systolic and diastolic pressure returned to control values. Nonetheless, contractile dysfunction persisted, with depressed RV free wall systolic shortening (70 +/- 22% of control), RV regional external work (59 +/- 11% of control at control end-diastolic length), and global RV stroke work (56 +/- 14% of control at control end-diastolic pressure). Depressed regional work was due to a parallel, rightward shift of the preload recruitable stroke work relation. Five pigs identically instrumented but not subjected to pulmonary artery constriction showed no significant over 3 h. CONCLUSIONS:Acute pulmonary hypertension causes RV contractile dysfunction that persists at least 2 h after restoration of control loading conditions. Contractile dysfunction is not attributable to RV ischemia during pressure overload.

背景与目标： 目的：急性肺动脉高压可能导致右心室（RV）收缩衰竭。尽管已经假定急性肺动脉高压后恢复正常负荷状态足以使RV功能完全恢复，但尚未对此进行严格检查。本研究的目的是检验以下假设：急性RV压力超负荷会导致RV收缩功能障碍，并在控制负荷条件恢复后持续存在。
方法：我们对18头经氯醛糖麻醉的自闭式开胸猪进行了1小时的肺动脉收缩，以将RV收缩压从35 /-1增加到55 /-1 mmHg，然后在肺动脉进行2小时的测量收缩释放。我们从压力段长度环和预负荷可招募的卒中功关系中确定了区域RV无壁功能，并从卒中功与舒张末期压力关系中确定了整体RV功能。
结果：正如预期的那样，在肺动脉收缩期间右室游离壁收缩期缩短减少，但是内/外血流量比，乳酸摄取和冠状静脉pH值没有显着变化。释放肺动脉收缩后，RV收缩压和舒张压恢复至控制值。然而，收缩功能障碍持续存在，右室游离壁收缩期缩短（控制区的70 /-22％），右室局部外部工作（在控制舒张末期的控制区为59 /-11％）和整体右室卒中工作持续存在（56）在对照舒张末期压力下为对照的14％）。较低的区域工作量是由于预载可招募中风工作关系的平行，向右移动。五只相同仪器但未经历肺动脉收缩的猪在3 h内无明显变化。
结论：急性肺动脉高压导致右室收缩功能障碍，在控制负荷恢复后至少持续2 h。压力超负荷期间收缩功能障碍不归因于RV缺血。

BACKGROUND & AIMS: :This study attempted to examine the relation of left ventricular filling patterns to hemodynamic status and left atrial function in dilated cardiomyopathy. Transesophageal echocardiography and cardiac catheterization were performed in 41 patients with dilated cardiomyopathy (six with an ischemic origin). Transmitral, left atrial appendage, and pulmonary venous flow velocities were recorded with the pulsed Doppler method. Left atrial systolic function was assessed by the peak velocity of the left atrial appendage emptying wave and pulmonary venous flow reversal during atrial systole. Patients were classified into three groups according to their left ventricular filling patterns. Group 1 showed an abnormal relaxation pattern (E wave/A wave ratio <1, n = 17), group 2 had a normal or pseudonormal pattern (1 < or = E/A < 2, n = 11), and group 3 had a restrictive pattern (E/A > or = 2, n = 13). No differences were found among the groups with regard to age, gender, heart rate, and M-mode echocardiographic indices of left ventricular function. Compared with patients in group 1, those in groups 2 and 3 had more symptoms (New York Heart Association functional class III or IV) and had higher left ventricular filling pressures. The sensitivity of an E/A ratio > or = 1 for predicting a pulmonary capillary wedge pressure > or = 15 mm Hg was 75% and the specificity was 94%. Despite a similar increase of filling pressures, group 3 patients had a lower left atrial appendage emptying velocity, pulmonary venous flow reversal velocity, and mitral A velocity than did group 2 patients. The sensitivity and specificity of an E/A ratio > or = 22 for detecting left atrial dysfunction (left atrial appendage emptying velocity < or = 40 cm/sec) was 85% and 86%, respectively. In conclusion, among patients with dilated cardiomyopathy, those who had a restrictive or pseudonormal filling pattern were in a higher functional class and had higher filling pressures. Further studies are needed to determine the therapeutic and prognostic significance of left atrial dysfunction, which was common in patients with a restrictive pattern.

背景与目标： ：这项研究试图检查扩张型心肌病的左心室充盈模式与血流动力学状态和左心房功能的关系。经食道超声心动图和心脏导管检查术治疗了41例扩张型心肌病（其中6例是缺血性）。用脉冲多普勒法记录经颅，左心耳和肺静脉血流速度。通过心房收缩期间左心耳排空波的峰值速度和肺静脉血流逆转来评估左心收缩功能。根据患者的左心室充盈模式将其分为三组。第1组显示异常的放松模式（E波/ A波比<1，n = 17），第2组显示正常或伪正常模式（1 <或= E / A <2，n = 11），第3组显示限制性模式（E / A>或= 2，n = 13）。在年龄，性别，心率和左心室功能的M型超声心动图指数方面，各组之间未发现差异。与第1组的患者相比，第2和3组的患者出现更多症状（纽约心脏协会功能性III或IV级），并且左心室充盈压更高。 E / A比>或= 1对预测肺毛细血管楔压>或= 15 mm Hg的敏感性为75％，特异性为94％。尽管充盈压增加相似，但第3组患者的左心耳排空速度，肺静脉血流逆转速度和二尖瓣A速度均低于第2组患者。 E / A比率>或= 22对检测左心功能不全（左心耳排空速度<或= 40 cm / sec）的敏感性和特异性分别为85％和86％。总之，在扩张型心肌病患者中，充盈受限或假正常的患者功能类别较高，充盈压力较高。需要进一步的研究来确定左心功能不全的治疗和预后意义，这在有限制性模式的患者中很常见。

BACKGROUND & AIMS: The purpose of this study was to determine if quantitative measurements of regional asynergy add independent prognostic information to global ejection fraction in patients with chronic coronary artery disease. Four hundred eighty-six patients with a history of Q-wave myocardial infarction who underwent gated-equilibrium radionuclide angiography at least 3 months after infarction were monitored for a median duration of 4.7 years. During follow-up there were 95 deaths. Four of five regional asynergy indexes analyzed were associated with overall mortality. The strength of the association between overall mortality and the index that proved to be optimal (univariate chi2 = 26.4, p < 0.001) was stronger than for global ejection fraction (univariate chi2 = 21.5, p < 0.001). For patients with global ejection fraction <40%, 4-year survival was 87% for those with a low asynergy index versus 65% for those with a high asynergy index (p = 0.016). In conclusion, indexes of regional asynergy add independent prognostic information to global left ventricular ejection fraction.

背景与目标： 这项研究的目的是确定是否定量定量区域性无反应性增加了慢性冠状动脉疾病患者总射血分数的独立预后信息。在梗死后至少3个月接受门控平衡放射性核素血管造影的466名有Q波心肌梗塞病史的患者的中位持续时间为4.7年。在随访期间，有95人死亡。所分析的五个区域非协同指数中有四个与总体死亡率相关。总死亡率和被证明是最佳指标（单变量chi2 = 26.4，p <0.001）之间的关联强度要强于总体射血分数（单变量chi2 = 21.5，p <0.001）。对于总体射血分数<40％的患者，低无反应指数的患者的4年生存率为87％，而无高反应指数的患者的4年生存率为65％（p = 0.016）。综上所述，区域无力指标为整体左心室射血分数增加了独立的预后信息。

BACKGROUND & AIMS: UNLABELLED:In this study, protective effects of adenosine and acetylcholine-induced postconditioning were investigated on the contractile function of the ischemic isolated rat ventricular myocytes. A video-based edge-detection system was used to monitor single ventricular myocytes contraction. Adenosine and acetylcholine were administrated for 6 min before ischemia as preconditioning, or 15 min after ischemia as postconditioning. Adenosine and acetylcholine receptor antagonists and mitoKATP inhibitor were used to analyze pathways underlying the effects on postconditioning. RESULTS:(1) The peak shortening of ischemic heart cells was improved by both adenosine and acetylcholine during preconditioning (84.72+/-5.34% and 68.61+/-8.10% vs. control: 8.43+/-5.35% of the pre-ischemia value), as well as postconditioning (76.47+/-7.87% and 57.48+/-6.97% vs. control: 8.43+/-5.35% of the pre-ischemia value) and the effects of preconditioning and postconditioning were comparable. More datum in the normal text. (2) Observed effects of adenosine and acetylcholine postconditioning were missing in the presence of adenosine A1 receptor and muscarinic M2 receptor antagonists, respectively. (3) Adenosine and acetylcholine-induced postconditioning was also blocked by mitoKATP antagonist. These results suggest that both adenosine and acetylcholine protect the contractile function of ischemic heart cells to a similar extent during preconditioning and postconditioning. The postconditioning of adenosine and acetylcholine is relative to the adenosine A1 and muscarinic M2 receptors, respectively. MitoKATP is implicated in the postconditioning of both acetylcholine and adenosine.

背景与目标： 未标记：在本研究中，研究了腺苷和乙酰胆碱诱导的后处理对缺血性离体大鼠心室肌细胞收缩功能的保护作用。基于视频的边缘检测系统用于监测单个心室肌细胞的收缩。缺血前6分钟给予腺苷和乙酰胆碱作为预处理，缺血后15分钟给予腺苷和乙酰胆碱作为后处理。腺苷和乙酰胆碱受体拮抗剂以及mitoKATP抑制剂被用于分析对后处理的影响的潜在途径。
结果：（1）腺苷和乙酰胆碱在预处理过程中均改善了缺血性心脏细胞的峰缩短（与对照组相比分别为84.72 /-5.34%和68.61 /-8.10%：缺血前值的8.43 /-5.35%），以及后处理（相对于对照组，分别为76.47 /-7.87%和57.48 /-6.97%：缺血前值的8.43 /-5.35%），并且预处理和后处理的效果可比。普通文本中的基准面更多。 （2）在腺苷A1受体和毒蕈碱M2受体拮抗剂的存在下，腺苷和乙酰胆碱后处理的观察到的作用分别消失了。 （3）腺苷和乙酰胆碱引起的后处理也被mitoKATP拮抗剂阻断。这些结果表明，腺苷和乙酰胆碱在预处理和后处理过程中均以相似的程度保护缺血性心脏细胞的收缩功能。腺苷和乙酰胆碱的后处理分别相对于腺苷A1和毒蕈碱M2受体。 MitoKATP与乙酰胆碱和腺苷的后处理有关。