简介：为了从期刊文献的学科属性实现族性检索，为文章的分类统计创造条件，本刊2005起均对具有文献标识码的文章采用《中国图书馆分类法》（第四版）进行分类后。标识分类号文章一般标识1个分类号，多个主题的文章可标识2个或3个分类号；主分类号排在第一位，多个分类号之间应以分号分隔。希望有条件查询的作者在来稿时自行标明中图分类号。

简介：MitralstenosisduetorheumaticheartdiseaseisnotcommonintheUnitedStatesbutiscommoninthedevelopingworldbecauserheumaticfeverisstilloccurringfrequently.Symptomsusuallygraduallyoccurintheyoungadult(mostcommonlyfemale).Atrialfibrillationisacommonaccompanyingrhythminpatientswithprovenmitralstenosis.Themainphysiologiceventisapressuregradientbetweentheleftatriumandtheleftventricle.DiagnosisisrelativelystraightforwardusingphysicalexamandsimplelaboratorystudiessuchasChestX-Ray(elevatedLeftmainstembronchus,DoubleDensityindicatingenlargedleftatrium)andECG(P-Mitrale).Cardiacultrasoundconfirmstheclinicaldiagnosis(Domingofmitralvalveindiastole,Hockeystickdeformityoftheanteriormitralvalveleaflet,largeleftatrium,Dopplerestimationofvalvegradient).Mitralcommisurotomy(surgicalorBalloon)iswarrantedifthevalveispliableandnotheavilycalcified.

简介：Inclinicalpractice,avarietyofsyndromesareassociatedwithcardiovasculardiseaseandhavecharacteristicfindings.Mostofthemareanautosomaldominantgeneticdisorderandhavedifferenttypesofcardiovascularabnormalities,includingelectrocardiographicconductiondefects,arrhythmias,cardiomyopathy,vascularandvalvulardiseases,cardiacseptaldefects,andpulmonaryproblems.Thereisagrowingneedforphysicianstopaymoreattentiontothesesyndromes.

简介：Cardiovasculardiseaseistheleadingcauseofpregnancy-relateddeathsintheUnitedStates[1].Anestimated4%ofallpregnanciesintheUnitedStatesareaffectedbymaternalcardiovasculardisease,with80%ofthesecasesattributedtocongenitalheartdisease(CHD)[2–4].SecondarytoimproveddiagnosisandmanagementofCHD,morewomenwithCHDarereachingreproductiveage,andmanyofthesewomendesirepregnancy.WhilemanypregnantwomenwithCHDwillhaveanuncomplicatedpregnancyanddelivery,somewithmorecomplexcardiaclesionsorcomorbiditieswillhaveanincreasedriskofmaternalandneonatalmorbidityanddeath.Individualizedpreconception,antepartum,intrapartum.

简介：Infectiveendocarditisisalethalandchallengingmultifaceteddiseasethatcaninvolveanyvascularizedsystem.Webelievethatmultimodalityimagingisinvaluabletoprovideacomprehensivediagnosis.OurmanagementapproachtoinfectiveendocarditisadherestoacombinationoftheAHA,ACC,STS,andESCguidelines.Withtherapidlyincreasingtranscathetervalvepopulation,weexpectanincreasedcaseloadofinfectiveendocarditis.Beyondpatientswithhemorrhagicstrokes,weadvocateforearlysurgeryifmedicalmanagementhasfailed.Furthermore,amultidisciplinaryteamapproachisimperativeininfectiveendocarditis,andclearcommunicationreducesthetimetodiagnosisanddefinitivetreatmentforthispatientpopulation.

简介：Cardiaccatheterizationandpercutaneouscoronaryinterventionplayanimportantroleinthemanagementofcoronaryarterydisease.Althoughthetransfemoralapproachhasbeenthetraditionallydominantmethod,therehasbeenanincreasedutilizationofthetransradialapproach.Multipleobservationalstudiesandrandomizedclinicaltrialshaveshownfewerbleedingcomplications,reducedmorbidityandmortality,improvedqualityoflife,andbettereconomicoutcomeswhenthetransradialapproachisutilizedwhencomparedtothetransfemoralapproach.Despiteitsmanybenefits,utilizationofthisapproachincertaincountriesincludingtheUnitedStateshasbeenlessthanoptimalduetoaloweradoptionratesmostlydrivenbylackoftrainingopportunitiesanddecreasedawarenessofclinicalbenefitsofthetransradialapproach.Inthisreview,thehistory,observationaltrends,efficacy,andtechnicalaspectsoftransradialcardiaccatheterizationandpercutaneouscoronaryinterventionarediscussed.

简介：Commonpracticedictatestheperformanceofpercutaneouscoronaryinterventionunderconventionalangiographicguidance.Withstudiessuggestingthehighincidenceofintraobservervariability,especiallyinangiographicborderlinelesions,newmodalitiessuchasintravascularultrasound(IVUS)guidanceduringpercutaneouscoronaryinterventionhavesurfaced.MultiplestudieshaveshownimprovedoutcomeswithIVUSguidance,mainlydrivenbyadecreaseinischemia-driventargetlesionrevascularization.Inthepasttwodecades,amultitudeofstudieshaveinvestigatedtheusesandclinicaloutcomesassociatedwiththistechnology.Inthisreview,wehighlighttheutility,advantages,economicimplications,andclinicaloutcomesofIVUSguidanceoverstandardangiographicguidance,withemphasisondataastheypertaintoIVUS-guidedstentimplantation.

简介：Cardiovasculardisease(CVD)anddepressionandanxietycontributesubstantiallytothecurrentdiseaseburdenworldwideaswellasinChina.BothdepressionandanxietyarehighlyprevalentamongpatientswithCVD.WesystematicallyreviewedtheliteraturetodisentangletheroleofdepressionandanxietydisordersintheonsetandprognosisofCVDwithanemphasisoncohortstudiesconductedintheChinesepopulation.Despitethelackoflarge-scaleprospectivestudiesinChina,theavailableevidenceimpliesthatbothdepressionandanxietyarecloselyassociatedwiththeonsetandprognosisofCVD,includingischemicheartdiseaseandstroke,inChineseadults.Putativebehavioralandbiologicalmechanismsareimplicatedinthelinkbetweendepression/anxietyandCVD.TimelyscreeninganddiagnosisfollowedbypropertreatmentshouldbeimplementedfordepressionandanxietyinboththegeneralpopulationandpatientswithCVD.CurrentstandardtreatmentssuchasselectiveserotoninreuptakeinhibitorsandpsychotherapiesarerecommendedforCVDpatientswithdepression,althoughtheirefficacyforreducingCVDmorbidityandmortalityremainsuncertain.Inconclusion,prospectivestudiesonthelinkbetweendepression/anxietyandtheonsetandprognosisofCVDareurgentlyneededintheChinesepopulation,andmoreeffortsarewarrantedtoexaminetheefficacyofdepressionandanxietytreatmentsforCVDpatients,particularlytheintegratedcaremodelofincludingpsychiatristsinamultidisciplinaryclinicalgroup.

简介：Tetralogyoffallot(TOF)occursinapproximately1in5000livebirthsandaccountsfor12%-14%ofcon-genitalheartdisease.Surgicalrepairwasfirstintroducedinthe1950sandthereisnowalargepopulationofadultswithrepairedTOF.

简介：Sinceitsoriginaldescription,theFontanoperationhasbeenwidelyusedforthepalliationofchildrenwithsingleventriclephysiologyandhasresultedinanincreasingnumberofthesepatientssurvivingtoadulthood.TheFontanoperationisauniqueapproachtocreateacirculationinserieswithouttwodistinctpumpingchambers.AlthoughtheFontanoperationincreasedthesurvivalratesofpatientswithsingleventriclephysiology,itcarriesaninevitableriskoflong-termmorbiditiesthatimpactstheoutcomesandqualityoflifeinthesepatients.Inthisreview,wediscussthechallengesresultingfromtheuniquepathophysiologyofFontancirculationandproposemanagementstrategies.

简介：BackgroundAtrialfibrillation(AF)wasusedtobeconsideredasnongeneticsdisorder,butrecentstudieshaverevealedthatgeneticsvariantsconferredsusceptibilitytoAFdevelopment,butmostwithlimitedevidence.Inordertosystematicallyevaluatetheoverallcontributionsofgene-diseaseassociationstudiestocurrentunderstandingsofthegeneticsusceptibilitytoatrialfibrillation,weperformasystematicreviewandmeta-analysisbasedoncomprehensivesearches.MethodAllstudiesontheassociationsofgeneticsvariantswithAFriskwereidentifiedbysearchingthefollowingdatabases:Medline,Embase,BIOSIS,GlobalHealth,LILACSandCBMDisc.Oddsratios(CI)and95%confidenceintervals(CI)werecalculatedunderhomozygotecomparison(HC),dominantmodel(DM)andrecessivemodel(RM),respectively.ResultsAtotalof41studieson32genesand72polymorphismslocationswereidentified.ThesummaryORwasstatisticallysignificantassociationsin23(31.94%)singlenucleotidepolymorphisms(SNPs).Thegenesinrenin-angiotensin-aldosteronesystem(RAAS)andionchannelswerethemostlystudied.FourSNPs(50.00%)inRAASgenesweresignificantlyassociatedwithAFsusceptibility:ACEI/D(HC:OR=1.53,95%CI:1.14-2.0DM:OR=1.47,95%CI:0.86-1.53;RM:OR=0.49,95%CI:0.41-0.59);AGTA-20C(HC:OR=1.56,95%CI:1.41-2.12);AGTM235T(HC:OR=2.37,95%CI:1.21-4.65).StatisticallysignificantassociationswerealsofoundinthefollowinggenesandSNPs:ABCA1G1051A,BCHEG1615A,CETPA1061G,I405V,TaqIB,CRPC1444T,EDN2A985G,eNOST-786C,IL-10T-819C,A-592C,MinKG38S,KCNH2rs1805120,Kir3.4C171T,G810T,MMP2C-1306T,FactorⅡG20210A,SCN5AH58R,SLC26A8I639V,G-proteinβ-subunitC825T,chromatosome4q25rs2200733andrs10033464.ConclusionsNearlyone-thirdofSNPswerestatisticallysignificantassociatedwithAFrisk,withvariantsinRAASgenesmosthighlysignificantassociation.Morestudiesonawiderangeofgenesaremerited.

简介：Invasivefractionalflowreserve(FFR)measurementiscurrentlythegoldstandardforcoronaryintervention.FFRmeasurementbycoronarycomputedtomographyangiography(FFRCT)isanovelandpromisingimagingtechnologythatpermitsnoninvasiveassessmentofphysiologicallysignificantcoronarylesions.FFRCTiscapableofcombiningtheanatomicinformationprovidedbycoronarycomputedtomographyangiographywithcomputationalfluiddynamicstocomputeFFR.Todate,severalstudieshavereportedthediagnosticperformanceofFFRCTcomparedwithinvasiveFFRmeasurementasthereferencestandard.FurtherstudiesarenowbeingimplementedtodeterminetheclinicalfeasibilityandeconomicimplicationsofFFRCTtechniques.ThisarticleprovidesanoverviewanddiscussestheavailableevidenceaswellaspotentialfuturedirectionsofFFRCT.

简介：Thesubcutaneousimplantablecardioverter-defibrillator(ICD)isanoveltechnologyusingasubcutaneous(extrathoracic)systemfortreatmentofpotentiallethalventriculararrhythmias.ItavoidsmanyoftherisksoftransvenousICDimplantation.ItmaybeconsideredinpatientshavinganICDindicationwhodonothaveapacingand/orcardiacresynchronizationtherapyindication,andwhoareunlikelytobenefitfromantitachycardiapacingtherapy.Wereviewpatientselection,systemcomponents,theimplantationtechnique,andscreeningconsiderationsforsubcutaneousICDimplantation.Itsusesinspecificpatientpopulations,includingchildren,patientswithcongenitalheartdisease,hypertrophiccardiomyopathy,orend-stagerenaldisease,andpatientswithpreexistingpacemakers,arehighlighted.Areasoffutureinvestigationarereviewed,includingpotentialusewithleadlesspacingandmagneticresonanceimaging.

简介：摘要目的探讨鱼骨图分析法在护理不良事件管理中的应用。方法通过用鱼骨图分析法分析12例护理案例,讲述鱼骨图的具体实施方法。结论运用鱼骨图分析法进行护理不良事件管理,能有效降低护理不良事件的发生。

简介：小桥流水人家，风景这边独好，欢迎您到天然大“氧吧”疗养院（广州市第十一人民医院）。

简介：Background:Thesafetyandefficacyofcoronaryarterybypassgrafting(CABG)andsecond-generationdrug-elutingstents(DESs)inpatientswithcoronaryarterydisease(CAD)remaincontroversial.ThereforeweaimedtocomparetheoutcomesofCADpatientstreatedwithCABGandsecond-generationDESs.Methods:WesystematicallysearchedthePubMed,CochraneLibrary,Ovid,andElsevierdatabases.Studiescomparingsecond-generationDESswithCABGinCADpatientswereincluded.RevMan5.3wasusedtoextractandpoolthedatafromtheapplicablestudies.Results:Sixtrials(N=6604participants)wereincludedinthismeta-analysis.AmongalloftheCADpatients,second-generationDESswereassociatedwithnodifferencesintherisksofall-causedeath[riskratio(RR)1.18,95%confidenceinterval(CI)0.98–1.43,P=0.09],cardiovasculardeath(RR1.14,95%CI0.81–1.59,P=0.45),myocardialinfarction(RR1.22,95%CI0.98–1.54,P=0.08),andstroke(RR0.83,95%CI0.59–1.17,P=0.29),butincreasedtherisksofrevascularization(RR1.95,95%CI1.66–2.30,P<0.001)andmajoradversecardiacandcerebrovascularevents(RR1.72,95%CI:1.31–2.26,P<0.001)whencomparedwithCABG.Conclusions:InthetreatmentofCADpatients,second-generationDESswasnotassociatedwithincreasedrisksofall-causedeath,cardiovasculardeath,myocardialinfarction,andstroke,butincreasedtherisksofrevascularizationandmajoradversecardiacandcerebrovasculareventswhencomparedwithCABG.

简介：ObjectivesWereportacaseinwhichapatientwhosufferedfromanginasecondarytomediastinalirradiationandhavebeentreatedbyoff-pumpcoronaryarterybypass(OPCAB)inourhospitalsince3yearsago.A34-year-oldmanpresentedwithanginafor8yearsafterreceivingradiationtherapyforHodgkin'slymphoma.WeretrospectivelyreviewedallthecasesofOPCABinourhospitalandfollowed-updataforupto3yearspost-operatively.Mediastinalirradiationisprobablythecauseofsignificantostialstenosisofleftmaincoronaryandrightcoronaryartery.OPCABgraftingwasperformedonthispatient3yearsago.Hisanginadisappearedafteroperation,andherecoveredwellduringfollow-up.ConclusionsPatientswithmalignancieswhohavereceivedmediastinalirradiationshouldbecarefullyfollowedupandroutinelyscreenedfortheprematuredevelopmentofcoronaryarterydisease.OPCABmaybeanappropriatetreatmentforcoronaryarterydiseasecausedbymediastinalirradiation.

简介：目的评价床边超声心动图在房间隔缺损（ASD）封堵术中的临床应用。方法25例ASD适合介入封堵的病人,术中床边超声心动图测量ASD最大直径,与测量球囊测量ASD直径比较,指导封堵器封堵、释放等过程,并观察有无残余分流及封堵器是否影响周围结构功能。结果25例患者ASD直径床边超声心动图测量值为（20.52±1.53）mm,球囊导管测量值为（21.41±1.52）mm,二者差异无统计学意义（P〉0.05）。25例患者全部一次堵闭成功,术后即刻超声心动图检查无残余分流,各瓣膜无病理性返流或原有返流加重,上、下腔静脉回流正常。结论床边超声心动图在ASD封堵术中能准确估测ASD直径,指导封堵过程,监测有无并发症发生,在ASD封堵术中具有重要指导作用。

简介：Despitewidespreadawarenessanduseofscientificallyprovenlife-prolongingmedicalanddevice-basedtherapiesoverthelasttwodecades,heartfailureremainsaleadingcauseofmorbidity,mortality,andhealthcareexpenditureintheUnitedStates.Mechanicalcirculatorysupportwithacontinuous-flowleftventricularassistdevice(CF-LVAD),eitherasabridgetohearttransplantationorasdestinationtherapy,isanincreasinglyusedtreatmentmodalityforpatientswithadvancedheartfailuresyndromesthatworsendespitetheirreceivingstandardtherapies.CF-LVADsupportcreatesuniquehemodynamicalterationsthatmustbeunderstoodtoprovideappropriatecareforthesepatientsbeforeandafterimplantation.EchocardiographyisessentialintheevaluationofpatientswhoarebeingconsideredfororaremechanicallysupportedbyCF-LVADs.Hereweprovideafocusedclinicalreviewontheuseofechocardiographyintwomainaspectsoftheevaluationofthesepatients:(a)optimalpatientselectionforCF-LVADsupportand(b)followupassessmentofoptimalpumpfunction.

简介：目的研究6小时内到达医院就诊的急性脑梗死患者未进行溶栓治疗的原因及对策。方法通过回顾性调查,对院内发生的或6小时内到院的急性脑梗死患者未进行溶栓治疗的原因统计,并对原因进行对策分析。结果174例缺血性脑卒中患者在发病6小时内到达医院就诊,42例接受溶栓治疗,占24.41%。溶栓患者平均到院时间（4.00±1.61）小时。发病6小时内就诊的132例脑梗死患者未接受溶栓治疗,其原因有醒后卒中,完成评估后超过时间窗,患方拒绝或犹豫,严重神经功能缺损,年龄不符等。结论加强对醒后卒中的研究,加强公众对脑卒中的了解,优化院内卒中流程,更新我国溶栓指南等有助于提高脑梗死溶栓治疗比例。