Abstract： Objective To investigate the clinicopathological characteristics, improve the accuracy of clinical diagnosis， and reduce postoperative complications of thoracic hemangioma. Methods Clinical records of 9 patients with thoracic hemangioma who underwent surgical resection in West China Hospital of Sichuan University from January 2006 to August 2012 were retrospectively analyzed. There were 2 males and 7 females with their average age of 47.9±19.3 （18-71）years. Six patients underwent thoracotomy， 1 patient underwent complete video-assisted thoracoscopic surgery （VATS）， 1 patient underwent video-assisted mini-thoracotomy， and 1 patient underwent staged operations which were performed by neurological surgeons and thoracic surgeons separately. Imaging characteristics, intraoperative gross tumor features, and pathological characteristics of resected hemangioma specimens were analyzed. Clinical outcomes of different surgical strategies for the treatment of hemangioma were compared. Results Nine patients with thoracic hemangioma were included in this study. Imaging studies showed the tumor as a round-shaped mass in 66.7% （6/9） of these patients and a lobulated mass in the remaining 33.3% （3/9） patients. Magnetic resonance imaging （MRI） assessment was helpful for preoperative diagnosis of hemangioma， with T2 weighted imaging tumor enhancement as the main MRI feature. Thoracic operation time was 106.3±60.1 （60-192） min， and intraoperative blood loss was 91.1±43.7 （30-150） ml. All the patients were followed up for 3-6 years except 1 patient who was followed up for 1 month. None of the patients had hemangioma-related death， recurrence or metastasis during follow-up. Conclusions Thoracic hemangiomas are usually benign entities and often locate in the mediastinum. Surgical strategies should be determined by the size and location of the tumor as well as the surgeon’s technique level. VATS has the advantages of being minimal invasive, causing less intraoperative blood loss and shorter length of hospital stay for the treatment of hemangioma. Resection of a dumbbell-type hemangioma may need cooperation between neurological and thoracic surgeons.
Abstract： Objective To summarize our surgical experience of tetralogy of Fallot（TOF） with anomalous coronary artery（ACA）， explore diagnostic method of ACA， and evaluate surgical strategy choices and clinical outcomes of right ventricular outflow tract（RVOT） reconstruction. Methods From January 2004 to January 2010， 29 patients with TOF and ACA underwent total correction in Wuhan Asia Heart Hospital. There were 18 male patients and 11 female patients with their median age of 7 years （5 months to 33 years）and median body weight of 18 （5 to 51） kg at operation. Their preoperative arterial oxygen saturation was 65%-91%. One patient underwent RVOT enlargement and repair of ventricular septal defect via right atrial approach. Three patients underwent RVOT enlargement， repair of ventricular septal defect and main pulmonary artery enlargement using autologous pericardium patch via right atrial approach. Three patients received pulmonary artery translocation （REV） technique. Five patients received double outlet technique. Eleven patients underwent RVOT enlargement via incisions above， below or beside coronary arteries （single patch or two patch technique）. Six patients underwent RVOT reconstruction using trans-annular patch after coronary artery bypass grafting. Results The median cardiopulmonary bypass time was 78 （65-102） min， median aortic crossclamp time was 50（40-82） min， and median operation time was 150 （126-178） min. There was no early death or severe coronary artery injury. Two patients underwent reexploration because of postoperative bleeding. Two patients had low cardiac output and were both cured with inotropic support. The median follow-up period was 51 （21-83）months and there was no late death during follow-up. All the patients were in New York Heart Association （NYHA） classⅠduring follow-up， their left ventricular ejection fraction was normal， there was no sign of myocardial ischemia in electrocardiogram， and their arterial oxygen saturation was 96%-99%.Mean early RVOT gradient （△P） was 19 （8-38） mm Hg， and the RVOT gradient （△P） did not increase during follow-up. Conclusion Preoperative diagnosis of ACA in TOF patients can be made by 64-slice multislice compute tomography （64-MSCT）. Proper surgical strategy for RVOT reconstruction should be chosen according to the distribution of coronary arteries to achieve satisfactory surgical outcomes.