Coronary angiography (CAG) as a typical imaging modality for the diagnosis of coronary diseases hasbeen widely employed in clinical practices. For CAG-based computer-aided diagnosis systems, accurate vessel segmentation plays a fundamental role. However, patients with bradycardia usually have a pacemaker which frequently interferes the vessel segmentation. In this case, the segmentation of vessels will be hard. To mitigate interferences of pacemakers and then extract main vessels more effectively in CAG images, we propose an approach. At first, a pseudo CAG (pCAG) image is generated through a part of a CAG sequence, in which the pacemaker exists. Then, a local feature descriptor is employed to register the relative location of pacemaker between the pCAG image and the target CAG image. Finally, combining the registration result and segmentation results of main vessels and pacemaker, interferences of pacemaker are removed and the segmentation of main vessels is improved. The proposed method is evaluated based on 11 CAG images with pacemakers acquired in clinical practices. An optimization ratio of the Dice coefficient is 12.04%, which demonstrates that our method can remove overlapping pacemakers and achieve the improvement of main vessel segmentation in CAG images.Our method can further become a helpful component in a CAG-based computer-aided diagnosis system, improving its diagnosis accuracy and efficiency.
目的 探讨心脏外科体外循环术后留置心外膜临时起搏导线的康复经验。 方法 选取 2015 年 9 月至 2016 年 4 月 69 例体外循环术后留置心外膜临时起搏导线患者，其中男 26 例、女 43 例，平均年龄（50.2±11.5）岁。予术前及术后干预措施、出院指导和随访，评价康复效果。 结果 患者术后平均住院时间（9.8±2.6）d，69 例患者均顺利出院，其中 57 例患者顺利拔除心外膜临时起搏器导线，1 例患者因Ⅲ度房室传导阻滞继续留置临时起搏器电极，11 例患者残留临时起搏导线出院，出院后两周随访发现 2 例患者的临时起搏导线体内残端露出体表。 结论 心外膜临时起搏电极是心脏外科术后常见的风险防范手段之一，掌握临时起搏器导线的管理及临时起搏器应用的相关知识，合理管理能有效地降低术后并发症的发生，可促进患者术后康复。做好患者宣教，避免因沟通不畅导致的医患纠纷发生。
ObjectiveTo compare the X-ray projection doses during leadless pacemaker implantation and conventional single chamber ventricular pacemaker (VVI) implantation. MethodsThis study included all patients who underwent leadless pacemaker implantation and VVI pacemaker implantation performed by the same principal investigator team using the same digital subtraction angiography (DSA) machine in the West China Hospital of Sichuan University from August 3rd, 2018 to February 18th, 2020. Among the enrolled patients, 27 who underwent leadless pacemaker implantation were included in the case group, whereas 38 who underwent conventional VVI implantation were included in the control group. Data regarding the intraoperative dose area product (DAP), air kerma (AK), duration of X-ray fluoroscopy, number of exposed sequences on the film, total number of frames on the film, operation time, and BMI were collected to investigate the causes of the differences. ResultsThe case group received a higher X-ray projection dose than the control group, and there were statistically significant differences between the two groups in terms of DAP, AK, duration of X-ray fluoroscopy, the number of exposed sequences on the film, the total number of frames on the film, and operation time (P<0.05). ConclusionPatients who underwent leadless pacemaker implantation are exposed to more radiation than those who underwent conventional VVI implantation.
Objective To analyze the long-term outcome of modified Morrow surgery (interventricular septal cardiomyectomy) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM) in children. Methods The clinical data of the children with HOCM (aged≤14 years) who underwent modified Morrow surgery from January 2010 to August 2022 in Guangdong Provincial People's Hospital were retrospectively analyzed, including changes in hospitalization status, perioperative period, and long-term 15-lead electrocardiogram and echocardiography. Results A total of 29 patients were collected, including 22 males and 7 females, aged 10.00 (5.00, 12.00) years. Five (17.9%) patients had New York Heart Association (NYHA) heart function grade Ⅲ or Ⅳ. Ventricular septal cardiomyectomy was performed in all patients. All 29 patients survived and their cardiac function recovered after operation. Before discharge, right bundle branch block was observed in 2 patients and left bundle branch block in 6 patients. After surgery, in the left ventricular septal cardiomyectomy, the left atrial diameter decreased (P＜0.001), left ventricular end-systolic diameter increased (P=0.009), the peak pressure gradient of left ventricular outflow tract decreased (P＜0.001), and the thickness of ventricular septum decreased (P＜0.001). The systolic anterior motion of mitral valve disappeared and mitral regurgitent jet area decreased (P＜0.001). The flow velocity and peak pressure gradient of right ventricular outflow tract also decreased in the patients who underwent right ventricular septal cardiomyectomy. The average follow-up of the patients was 69.03±10.60 months. All the patients survived with their NYHA cardiac function grading Ⅰ or Ⅱ. No new-onset arrythmia event was found. Echocardiography indicated that the peak pressure gradient of the left ventricular outflow tract remained low (P<0.001). Moderate mitral regurgitation occurred in 2 patients, and left ventricular outflow tract obstruction with moderate mitral regurgitation occurred in 1 patient after simple right ventricular septal cardiomyectomy. Conclusion Right ventricular or biventricular obstruction is frequent in the children with HOCM and they usually have more symptoms before surgery. Modified Morrow surgery can effectively relieve outflow tract obstruction and improve their cardiac function. The long-term outcome is satisfactory. However, the posterior wall of the left ventricle remains hypertrophic. Also, there is an increased risk of a conduction block.
ObjectiveTo investigate the new-onset conduction block after transcatheter aortic valve replacement (TAVR) and summarize the relevant experience. Methods The perioperative data of TAVR patients in the Second Hospital of Hebei Medical University from January 2016 to February 2023 were collected, and the new-onset incidence of conduction block after TAVR was analyzed retrospectively. Results Finally 352 patients were included, including 225 males and 127 females, with an average age of (67.2±5.1) years, among whom 256 patients were treated with Venus-A valves, 69 patients with Vita-Flow valves, and 27 patients with J-Valve valves. There were 38 (10.8%) patients of new-onset postoperative block. There were 6 (1.7%) patients of new-onset postoperative grade Ⅲ atrioventricular block, including 5 (2.0%) patients of Venus-A and 1 (1.4%) patient of Vita-Flow. Conduction function was restored in 2 patients within 14 days after surgery, and failed to be restored in 4 patients, who then received permanent pacemaker implantation in the Department of Cardiology. There were 27 (7.7%) patients of new left bundle branch block after surgery, including 22 (8.6%) patients of Venus-A, 4 (5.8%) patients of Vita-Flow and 1 (3.7%) patient of J-Valve; and conduction function was restored within 7 days after surgery in 23 patients, and 5 (1.4%) patients developed new right bundle branch blocks after surgery including 4 (1.5%) patients of Venus-A and 1 (1.4%) patient of Vita-Flow. Conclusion New-onset conduction block is a common complication after TAVR, and the new-onset rate of left bundle branch block is the highest, followed by the grade Ⅲ atrioventricular block. Mastering reasonable methods and applying appropriate strategies can effectively reduce the new-onset rate of postoperative conduction block and improve the overall success rate of TAVR surgery.
目的 调查安置永久性人工心脏起搏器的老年患者术前焦虑状况，为制订护理对策提供依据。 方法 2004年7月-2008年7月收治需安置永久性人工心脏起搏器的心脏病患者78例，术前采用焦虑自评量表（SAS）对其进行问卷调查，并采用自制一般情况问卷调查了解情况。 结果 植入永久性心脏起搏器的老年患者术前SAS得分高于国内常模（Plt;0.05）。根据自制调查问卷结果，差异有统计学意义（Plt;0.05）的项目:老年患者随年龄增长焦虑量表评分降低；丧偶者焦虑评分高于有配偶者；完全公费、部分公费、自费的焦虑量表评分依次增高；老年患者对起搏器知识了解程度越少，焦虑评分越高；无家人陪伴者比有家人陪伴者焦虑评分高。而性别、文化水平差异无统计学意义。 结论 植入永久性起搏器的老年患者术前多数存在焦虑情绪，且焦虑与年龄、婚姻、费用支付方式、有无家人陪伴、相关知识等有一定关系，医护人员应针对性地做好患者术前护理，帮助患者面对现实，以积极的心态接受手术治疗。
Objective To analyze predictive factors, clinical implications and prognosis effects of new-onset conduction block after transcatheter aortic valve implantation (TAVI). Methods The clinical data of 86 patients who underwent TAVI through transfemoral approach from 2019 to 2021 in Fujian Provincial Hospital were retrospectively analyzed, including 59 males and 27 females with an average age of 72.9±8.0 years. The patients were divided into a normal group and a new-onset conduction block group according to whether there was new-onset conduction block after operation, and then the new-onset conduction block group was subdivided into a left bundle branch block (LBBB) group (28 patients) and a complete atrioventricular block (CAVB) group (11 patients). We compared the hemodynamics and TAVI-related complications between the postoperative and early follow-up periods, and used the multivariate logistic regression models to identify risk factors for the new-onset conduction block. Results The median EuroSCORE of all patients were 8 (2) points before the operation. In the postoperative and early follow-up periods, the hemodynamics and TAVI-related complications had no statistical difference between the new-onset conduction block group and the normal group (P>0.05). The incidence of permanent pacemaker implantation (81.8%, 9/11) and mortality due to cardiac causes (18.1%, 2/11) in the CAVB group were significantly higher than those in the normal group and theLBBB group (P<0.05). Female, severe calcification of the aortic valve, too large valve size and deep valve implants were the risk factors for new-onset conduction block after TAVI. ConclusionThe incidence of LBBB and CAVB is high after TAVI, however, both of them do not significantly effect the hemodynamics of the patients. Higher incidence of permanent pacemaker implantation is found in the CAVB group which affects the rate of rehospitalization and mortality. Female patients, severe calcification of the aortic valve, too large valve size and deep valve implants are the risk factors for the new-onset conduction block after TAVI.
In order to improve the reliability of cardiac pacemaker contact-less power supply technology, this paper proposes a novel application of wireless feedback voltage stabilizing technology to adjust heart disease patients with inner power supply filter circuit output voltage and current control method, to keep the output voltage stability, and to ensure that the super capacitor and cardiac pacemaker to get a stable power supply. To implement the real-time accurate voltage control with considering the primary and secondary side inductance coupling coefficient changes, the change of the external power supply voltage and load, it is necessary to test thee real-time and accurate output voltage and current value after rectifying filtering. Therefore, based on the chaotic control theory, we adopted method of phase diagram on the basis of the quick observation after rectifying filtering, so that the method of voltage and current could improve the detection time of the circuit. The phase diagram of proposed control method can be divided into 8 segments, and we got 7 zero-extreme points. When these zero-extreme points are detected, according to extreme points of the zero instantaneous values, the corresponding average values of voltage and current were obtained. Simulation and experimental results showed that using the above method can shorten the response time to less than switch devices 1/2 switching cycles, thus validating the effectiveness and feasibility of the proposed detection algorithm.