Idiopathic bilateral occlusion of the foramen of Monro: An unusual entity with varied clinical presentations

We review our experience with four patients who presented to our Medical Center from 2005–2015 with adult idiopathic occlusion of the foramen of Monro (FM). All patients underwent CT scanning and MRI. Standard MRI was performed in each patient to rule out a secondary cause of obstruction (T1-weighted without- and with gadolinium, T2-weighted, fluid-attenuated inversion recovery [FLAIR] and diffusion-weighted imaging [DWI] protocols). When occlusion of the FM appeared to be idiopathic, further high-resolution MRI with multiplanar reconstructions for evaluation of stenosis or an occluding membrane at the level of the FM was performed (T1-weighted without- and with gadolinium, T2-weighted 3D turbo spin-echo). Occlusion of the FM was due to unilateral stenosis and septum pellucidum deviation in two patients, to an occluding membrane in one, and to bilateral stenosis in one patient. Urgent surgical intervention is mandatory when there are signs of increased intracranial pressure while asymptomatic patients may be managed conservatively. In this patient series, truly bilateral stenotic obstruction of the FM was best managed with ventriculoperitoneal shunt and patients with membranous obstruction or unilateral stenosis with septum deviation were treated endoscopically.     

介入治疗颅内前循环动脉粥样硬化性狭窄的临床疗效

目的探讨介入治疗与药物治疗颅内前循环动脉狭窄的临床疗效。方法回顾性分析重度前循环颅内动脉粥样硬化性狭窄而导致的脑梗死或短暂性脑缺血发作患者166例的临床资料,根据患者治疗方法分为介入组（81例）和药物组（85例）。比较两组患者随访期间累积主要终点事件和次要终点事件发生率。结果两组主要终点事件累积发生率比较差异无统计学意义（P〉0.05）。不考虑围手术期并发症,以30 d后责任血管同侧缺血性脑血管事件作为次要终点事件,随访3年时两组累积发生率比较,差异有统计学意义（P〈0.01）。结论介入治疗重度颅内前循环动脉狭窄对30 d后责任血管同侧缺血性脑卒中的预防作用更优于单纯药物治疗,介入治疗的围手术期并发症仍然是限制其临床推广的主要因素。     

Studies on percutaneous transvenous mitral commissurotomy using a modified transseptal approach

Summary A modified version of Brockenbrough's trans-septal catheterization technique was carried out in 11 patients indicated for percutaneous transvenous mitral commissurotomy (PTMC). In 8/11 (72.7%), a coiled guide-wire was successfully inserted through theforamen ovale without atrial septal puncture. The Brockenbrough needle was used merely to maintain stiffness and the orientation of the dilator. PTMC was performed with an Inoue single balloon without incident.Patent foramen ovale was found by transesophageal echocardiography prior to the operation in only 1/11 patients (9.0%); nonetheless, it proved not to be a critical factor for the success of the procedure. This procedure seems to have much potential to enable the treatment of mitral stenosis with a lowered risk to the patient, as long as it is performed with precision and caution.     

部分或全部保留瓣下结构的二尖瓣置换术对巨大左室几何学的影响

目的 动态观察二尖瓣置换术(Mitral valve replacement,MVR)后巨大左心室的几何学变化，对比3种不同术式对左心室形态学逆转的影响。方法 回顾性分析1992年1月至2002年1月间48例巨大左心室病人施行二尖瓣置换术后的超声心动图随访资料。结果 保留二尖瓣装置对巨大左心室形态的逆转有效，其中保留全部瓣下结构术后左窒缩小最显，部分保留其次，无保留术后早期缩小晚期再扩大。结论 对于二尖瓣关闭不全为主合并巨大左室。应尽量采用保留瓣下结构的术式，有利于术后晚期左心室形态的逆转。     

Radiofrequency catheter ablation within the coronary sinus eliminates a macro-reentrant atrial tachycardia: Importance of mapping in the coronary sinus

We describe a patient who underwent radiofrequency (RF) catheter ablation of symptomatic atrial fibrillation. After left atrial (LA) catheter ablation and pulmonary vein isolation, a macro-reentrant atrial tachycardia (AT) with a critical isthmus at the mitral isthmus was induced by incremental atrial pacing from the coronary sinus. Extensive RF energy applications from endocardial sites using ablation catheters with 4 mm- and 8 mm- tips resulted in no discrete potentials being recorded from the endocardial sites of the isthmus, but the tachycardia could not be terminated. However, discrete potentials were recorded within the CS, and epicardial RF energy applications from the CS eliminated the tachycardia. Thus, mapping in the CS is useful for detecting residual conduction at epicardial sites along the mitral isthmus. RF catheter ablation within the CS should be considered when no distinct electrograms are recorded after extensive ablation from the endocardial sites and when distinct electrograms are recorded within the CS.