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Surgical Treatment of Tetralogy of Fallot with Anomalous Coronary Artery

Abstract: Objective To summarize the experience of surgical treatment of tetralogy of Fallot (TOF) with anomalous coronary artery. Methods From March 1993 to April 2006, 22 patients with TOF and anomalous coronary artery underwent repair. The resection of hypertrophied parietal, septal band and the ventricular septal defect (VSD) repairs were performed by trans-right ventricular outflow tract (RVOT) approach in 5 cases, and by transatrial approach in 17 cases, which consisted of 7 cases required a transannular patch to enlarge a pulmonary annulus, construction of a double barrel outlet in 6 cases, by autologous pericardium conduit (3 cases), homograft (1 case) and reflected anterior wall of the main pulmonary artery in combination with bovine pericardium (2 cases). Results There was one operative death because of the anomalous coronary artery impairment. The accessory left anterior descending artery was severed because it was mistaken for the conal arteryin 1 case, which caused failure to wean from bypass, after the left internal mammary artery was anastomosed to the accessory left anterior descending artery, the cardiopulmonary bypass (CPB) was stopped successfully. Mean early gradient(ΔP) was 23.4mmHg and ΔP＞20mmHg in 9 cases. Eighteen cases were followed up, mean time was 13.2 months. Late ΔP＞20mmHg in 7 cases, and ΔP were less than 20mmHg in 11 cases. Conclusion The repair of TOF with anomalous coronary artery is more safe by using the transatrial approach. The surgical reconstruction of RVOT depends on the anatomic characteristic of anomalous coronary artery.

动脉导管未闭合并其他心脏畸形的临床分析

目的 探讨动脉导管未闭(PDA)合并其他心脏畸形的外科治疗经验. 方法 回顾性分析106例PDA合并其他心脏畸形的临床特点、手术方式与转归. 结果 死亡9例,住院死亡率8.5%,体外循环(CPB)前发现PDA与CPB后发现,住院死亡率差别有显著性意义(χ2＝6.383,Plt;0.05);术后发生并发症40例,术前漏诊与确诊PDA患者并发症的发生率差别有显著性意义(χ2＝5.388,Plt;0.05). 结论 在室间隔缺损、房间隔缺损、主动脉瓣或瓣下病变、主动脉缩窄、法洛四联症等心脏畸形进行手术治疗时,应特别注意是否合并PDA.提高术前及CPB前PDA诊断水平,对降低住院死亡率及并发症发生率具有重要意义.

升主动脉和弓部动脉瘤的外科治疗

目的 总结1990年1月至2001年12月对48例升主动脉和弓部动脉瘤患者行外科治疗的经验. 方法 3例弓部动脉瘤施行全弓置换术,其中2例采用象鼻技术.29例马方综合征(Marfan syndrome)施行Bentall手术,其中2例同时分别施行二尖瓣成形术或二尖瓣置换术,3例合并急性夹层动脉瘤.主动脉夹层动脉瘤16例,急性期手术8例,慢性期手术8例;其中Bentall手术5例,升主动脉置换术5例,升主动脉置换加主动脉瓣成形术4例,Wheat手术2例. 结果 43例生存, 4例手术死亡, 1例术后早期死亡, 住院死亡率为10.4 %. 其中急症手术11例, 死亡4例,死亡率为36.4 % ;择期手术37例,死亡1例,死亡率为2.7%. 结论 按手术紧急程度不同,可分为急症手术、尽早手术和择期手术三类.对真性梭形弓部动脉瘤采用非切断腔内吻合术能明显简化手术,缩短深低温停循环时间.急症手术,动脉瘤破裂和夹层内膜破口侵犯弓部将增加手术风险.

肺转移性绒毛膜上皮癌破裂致血胸二例

A型主动脉夹层动脉瘤的外科治疗

目的 总结1996年1月至2002年8月收治的34例A型主动脉夹层动脉瘤的外科治疗经验. 方法 应用Bentall手术19例,升主动脉人工血管置换术7例,升主动脉人工血管置换加主动脉瓣成形术(Trusler’s法)5例,分别行升主动脉人工血管置换及主动脉瓣置换术(Wheat术)2例,升主动脉、主动脉弓人工血管置换术1例. 结果 手术死亡6例,死亡率17.6%.其中慢性主动脉夹层动脉瘤死亡3例,急性夹层动脉瘤死亡3例.随访20例,随访率71.4%.随访时间2～46个月,平均24.7个月,1例术后3个月猝死(原因不明),1例术后6个月死于心内膜炎.18例存活患者情况良好. 结论 应根据夹层动脉瘤的部位及范围采用不同的手术方式,保留主动脉瓣的升主动脉人工血管置换术治疗该病效果较好,准确可靠的吻合技术、保留瘤壁的完整性,将使手术更为安全.

创伤性室间隔缺损的诊断和治疗

摘要 目的　总结3例创伤性室间隔缺损诊断和治疗的经验。　方法　1992年5月～1997年5月先后收治3例创伤性室间隔缺损，并施行了修补术。　结果　3例患者术后均恢复顺利，无并发症发生。　结论　在心脏开放伤中，应注意创伤性室间隔缺损的诊断，伤后8～12周是进行修补术的最好时机。

体外循环术后并发急性胰腺炎一例