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风湿性心脏瓣膜病合并不典型无顶冠状静脉窦综合征一例

改进微创技术治疗大龄鸡胸患者的近期疗效

目的　探讨改进微创技术治疗大龄鸡胸患者的可行性及近期结果。 方法　回顾性分析自2009年7月至2011年7月北京军区总医院采用改进微创技术治疗16例大龄鸡胸患者的临床资料，男12例，女4例；年龄（19.8±4.7）岁。鸡胸指数（HI） 2.00±0.23。前胸壁凸起型10例，鸡胸漏斗胸混合型6例。患者仰卧位，在全身麻醉下施行手术。（1）胸骨沉降法：适宜前胸壁凸起型。取胸壁最凸点水平两侧腋中线做小切口，创出横行于前胸壁的胸肌下隧道，将已制备好的矫形板穿过肌下隧道，施压整形后矫形板两端用钢缆与肋骨固定； （2）胸骨抬举及沉降联合法：适宜混合型。用Nuss方法将矫形板置于胸骨最凹陷部位抬举；胸骨角处小切口胸骨截骨和畸形肋软骨切除成形沉降胸骨。 结果　无围术期死亡，16例均顺利完成手术，手术时间（65.0±7.8） min，失血量（20.0±4.2） ml，住院时间（5.0±1.8） d。术后胸廓外形恢复正常，HI 2.8±0.4。胸廓外形和胸部CT影像形状满意。随访 16例，随访时间12～30个月，平均随访18个月。其中1例已取出矫形板。疗效优秀13例（81.2%），良好3例（18.8%）。 结论　采用改进微创技术矫治大龄鸡胸患者，需要选择恰当的手术术式，可获得良好的近期效果。

Clinical Significance of Cardiac Structure and Function Evaluation by Cardiac Magnetic Resonance Imaging for Patients with Pectus Excavatum at Preoperation

ObjectiveTo investigate the changes and clinical significance of cardiac structure and function evaluation by cardiac magnetic resonance imaging (CMR) for patients with pectus excavatum deformity at preoperation. MethodsWe retrospectively analyzed 54 patients (24 children and 30 adults) who underwent pectus excavatum surgery from June 2012 to June 2014. There were 48 males and 6 females at age of 7-33 (19.08±5.17) years. All the patients underwent CMR using 1.5 Tesla scanner for evaluation of compressing and displacement of the heart. The major and minor dimensions of right ventricle were measured. The right ventricle end-diastole volume (RVEDV), right ventricle end-systolic volume (RVESV), and right ventricle ejection fraction (RVEF) were also recorded and analyzed. ResultsThe heart compression and displacement occurred in 83.3% of the children group and 90.0% of the adults group. The extent of heart displacement in the adults was more serious than that in the children (76.86%±13.30% vs. 67.99%±8.15%, P<0.05). The structure of right ventricle were striking distorted because right atrum or right ventricule below valve ring was compressed locally, with the major dimension of right ventricle obviously increased, and the minor dimension of right ventricle obviously decreased. The indices of right ventricle major dimension and right ventricle minor dimension were 61.14±0.44 mm/m2 and 14.82±2.52 mm/m2 in the children, 49.54±15.40 mm/m2 and 18.90 ±3.14 mm/m2 in the adults. The RVEDV and RVESV were significantly higher in the adults than those in the children (139.09±29.08 ml vs. 121.50±31.27 ml; 73.61±16.05 ml vs. 64.92±19.28 ml; P<0.05). RVEF was similar between the children and the adults (45.29%±4.14% vs. 46.30±6.09%). The patients' symptoms disappeared after correction of pectus excavatum. ConclusionCMR is an useful method for evaluating right ventricular structure and functions in patients with cardiac compression and distortion by pectus excavatum before operation, which can bring strong indications for pectus excavatum repair surgery.