Transcatheter aortic valve replacement (TAVR) has become a common theraputic option for aortic stenosis, but the evidence for precise anatomy for TAVR is accumulating. This paper presents the case of an 71-year-old female patient who had an extremely high risk of coronary obstruction due to both coronary ostia lying too low. The patient underwent TAVR with the help of coronary protection successfully. During the procedure, the patient was protected with wires only for both coronaries. After deployment, angiofluoroscopy suggested that chimney stenting should be applied for left coronary. The whole procedure was unenventful and both coronaries were seen.
目的：本文观察了三只做了泪道激光手术的狗泪小管组织，目的是为了解激光术后是否泪道会遗留瘢痕或狭窄。方法：三只成年狗用激光分别点击了泪小点，泪小管，泪囊。30天内取材。结果：泪道上皮及管道未见损害。结论：泪道YAG激光只要掌握能量和点击次数，术后不会遗留瘢痕。
目的：为了进一步了解YAG激光在临床对泪道病的治疗情况,预后的观察随访的结果,我们对所做的患者进行分析、总结。材料和方法:我院4月中做了96例泪道激光成形术,本文从临床,随访等方面,通过写信,电话,回诊等进行随访、总结。结果:86例中单一部位的堵塞占67%，术后随访58%通畅。结论:泪道YAG激光对泪小管、泪总管堵塞治疗有一定疗效,能解决部分病人的流泪问题。
This article presented the clinical diagnosis and management of a patient with severe aortic regurgitation and moderate aortic stenosis who underwent transcatheter aortic valve replacement complicated with coronary obstruction and retroperitoneal hematoma. The hemodynamics collapsed during the procedure, and transcatheter aortic valve replacement was performed under support of extracorporeal membrane oxygenation and coronary protection. After a negative coronary angiography, the wire was extracted, but a repeated angiography showed left coronary obstruction, so a coronary stent was implanted to the ostium of left coronary artery through the grid of the valve stent. Abdominal CT showed a giant retroperitoneal hematoma 2 weeks after transcatheter aortic valve replacement, and the emergent angiography indicated contrast leakage from left external iliac artery, so a balloon compression was performed followed by a covered stent implantation. This article also provided the clinical characteristics, risk factors and management of coronary obstruction and vascular complication for clinical reference.
In order to solve the problem of the micro flow cell clogging, and to improve the reliability of the flow cytometry system, a new method was proposed for hydrodynamic self-cleaning system. By analyzing the flow cell focus principle, we considered that to obtain stable single cell flow, the stable pressure in the flow chamber must be ensured. Therefore, we established a diagnosis method of clogging by the pressure detecting, and designed a self-cleaning system. Then we built up corresponding experimental systems. Experiments and testing showed that the self-cleaning system could improve the flow and resolve the clogging problem.
Peripherally inserted central catheter (PICC) is widely used as an intravenous therapy pathway, and catheter occlusion is one of the most common complications during the use of PICC. Catheter occlusion may lead to extubation or re-catheterization, which may generate prolonged hospital stay and increased medical costs, thus affecting the implementation of treatment and patient prognosis. The prevention and treatment of occlusion are of great significance. Daily maintenance and nursing operations should be complete, standardized and implemented in place. Evidence-based standard procedures should be established to meet the needs of clinical work. This consensus follows the methods and principles provided in the WHO guidelines formulation manual, and forms a systematic and standardized clinical practice process, including PICC patency assessment, catheter occlusion degree and type assessment, risk factor prevention, blockage management, etc. The purpose of this consensus is to reduce catheter-related complications, ensure the longevity of PICC and the safety of patient treatment.
This case was a 78-year-old woman characterized exertional dyspnea and diagnosed with severe aortic stenosis. Preoperative evaluation revealed that the patient had a very high surgical risk, so transcatheter aortic valve replacement (TAVR) was proposed. But this patient was at high risk of coronary obstruction. After weighing advantages and disadvantages, the heart team decided to choose TAVR under the protection of guide wire and balloon at last. Left coronary ostia obstruction happened after self-expanding valve released during TAVR. Then, emergency “chimney” stent implantation was performed. Finally, TAVR and coronary revascularization was successfully completed. The patient’s condition was improved after TAVR and being good in follow-up. Based on this case, risk factors of coronary obstruction during TAVR and effectiveness and safety of “chimney” stent technique was discussed.