简介：BackgroundChordaereconstructionisoneofthekeypointsinrepairofmitralvalveprolapse,especiallyforanteriorleaflets.Hereweintroduceourexperiencesofusingecho-determinednormalchordaellengthtomaketheloopspreoperativelyandrebuildtheelongated/rupturedchordaeintraoperatively.MaterialsandmethodFromJune2011toFebruary2012,19consecutivecaseswithmitralanteriorleafletprolapseunderwentvalverepairprocedures.Echocardiographywasusedtodeterminethelengthofnormalchordaethattheprolapsedleafletsshouldhavefornormalcoaptation.Theartificialchordaewasfabricatedinloopsaccordingtoecho-determinedlength.ResultsAllpatientssurvivedtheoperations.2.8preoperativelypreparedloopswereusedperpatienttorestoretheanteriorleaflets,aswellasposteriorleaflets.Artificialmitralvalveringswereappliedto18patientsformitralannuloplasty.16patientswereunderwentdifferentconcomitantoperations.Echocardiographicresultsatdischargeshowedthatgradeofmitralregurgitation,leftventricularend-diastolic,end-systolicdimensiondecreaseddefinitely,respectivelyfrom3.26±1.10,53.79±15.03mm,33.00±12.05mmpreoperativelyto0.47±0.61(P<0.01),44.74±10.28mm(P<0.01),30.16±10.58mm(P<0.05)postoperatively.AllpatientsimprovedclinicallyandNYHAfunctionalclassdecreasedsignificantlyfrom2.17±0.81to1.12±0.33.ConclusionReconstructionofprolapsedanteriorleafletchordaewithartificialloopsinpreoperativelyecho-determinedlengthissafeandeffective,andinitialclinicaloutcomeissatisfactory.

简介：BackgroundThefactorsinfluencingtheq-wavechangesinV5andV6duringanterioracutemyocardialinfarction(AMI)havenotbeenthoroughlydescribed.MethodsWestudied70patientswithafirstanteriorAMI,inwhomtheelectrocardiogram(ECG)showedeitherdisappearanceofthenormalseptalqwave(n=24)orpresenceofpathologicalQwaveinV5andV6(n=46)duringfollow-up.TheECGandcoronaryangiographyfindingswerecorrelated.ResultsTherewasnodifferencebetweenthe2groupsintheculpritsiteproximaltoS1(46%vs.36%,P=0.405),buttheculpritsitewasmorefrequentlylocatedproximaltoD1inthegroupwithabnormalQwave(21%vs.67%,P=0.001).Patientswithdisappearanceoftheseptalqwavemoreoftenhadalargeobtusemarginalbranch(46%vs.22%,P=0.037)anddisappearanceoftherwaveinV1(88%vs.7%,P=0.001).PatientswithabnormalQ-wavemoreoftenhadalargeLAD(42%vs.71%),smallrwaveortallorwideRwaveinV1(0%vs.89%,P=0.001)andabnormalQwavesintheinferiorleads(33%vs.59%,P=0.044).ConclusionsInpatientswithfirstanteriorAMI,qwavechangesinV5andV6correlatedwiththemorphologyinV1.EmergingabnormalQwaveinV5/V6predictedtheculpritlesioninalargeLADproximaltoD1,butdisappearanceoftheseptalqwavecouldnotpredicttheculpritlesionproximaltoS1.