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同种异体带瓣管道在复杂先天性心脏病中的应用

摘要： 目的 探讨同种异体带瓣管道在复杂先天性心脏病中的临床应用价值。 方法 2004年10月至2007年5月济宁医学院附属医院共收治7例复杂先天性心脏病患者，男4例，女3例；年龄5~18岁，平均年龄13岁；体重13~57 kg，平均体重35 kg。所有患者均行同种异体主动脉带瓣管道右心室流出道重建术，同期行动脉导管结扎加法洛四联症(TOF)根治术2例，动脉导管结扎、TOF根治、主动脉瓣成形术1例，TOF根治、左右肺动脉吻合术1例，右心室双出口根治术2例，矫正型大动脉转位、室间隔缺损修补术1例。 结果 手术死亡1例（14.29%），因手术后发生严重低心排血量综合征，术中停机困难死亡。1例患者术后7d出现阵发性室上性心动过速，给予甲基强的松龙和胺碘酮口服后好转。随访6例，随访时间6个月~4年，随访期间有1例术后6个月因持续发热经抗感染治疗无效，最终死于脑出血。5例生存患者紫绀消失，心功能Ⅰ~Ⅱ级，生长发育良好，已恢复正常学习。 结论 同种异体带瓣管道在一些复杂先天性心脏病治疗中有良好的临床应用价值。

先天性心脏病合并气管性支气管伴支气管狭窄一例

A comparative study of mitral valve replacement by right 3rd intercostal small incision and traditional median thoracotomy

ObjectiveTo compare the safety and efficacy of simple mitral valve replacement with the third intercostal incision on the right side and the conventional midsternum incision.MethodsFrom February 2017 to February 2019, heart surgery in the Affiliated Hospital of Jining Medical College completed the first simple mitral valve replacement (MVR) operation in 103 patients, of whom 39 patients were received minimally invasive right third intercostal small incision (a minimally invasive surgery group). There were 10 males, 29 females at average age of 59.51 years. There were 64 patients with MVR via the middle section of the common sternum (a conventional surgery group), 22 males and 42 females, with an average age of 60.22 years. Types of lesions: 65 patients were with mitral stenosis, 22 patients with incomplete closure, 16 patients with incomplete closure.ResultsThere was no significant difference in preoperative clinical data between the two groups (P>0.05). The entire group of patients successfully completed the operation. Surgical replacement of mitral valve mechanical valve in 74 patients and biological valve in 29 patients. There was no significant difference between the two groups in the extracardiopulmonary cycle time, aortic blockade time and total hospitalization time. In the early stage of operation, 3 patients were examined for secondary hemostasis, 1 patient was minimally invasive surgery, and the remaining 2 patients were with routine surgery. The infection of incision occurred in 3 patients, all of them were in the routine operation group. All three patients died early after operation in the routine operation group: two were postoperative low cardiac volumetric syndrome leading to multiple organ failure, and the other was sternum infection accompanied by artificial valve endocarditis.ConclusionThere is no significant difference between MVR through the third rib of the right chest and traditional MVR in the safety. However, it has the advantages of small trauma, beauty, low incidence of incision infection and reduced postoperative pain.

先天性主动脉-肺动脉间隔缺损伴右冠状动脉异常起源于肺动脉一例

Efficacy of aortic valve replacement through the right third intercostal small incision versus median sternal incision: A retrospective cohort study

ObjectiveTo analyze the safety and effectiveness of minimally invasive small incision through the right third intercostal and standard aortic valve replacement.MethodsThe clinical data of 123 patients with the first simple aortic valve replacement in our hospital from June 2013 to May 2020 were retrospectively analyzed. The patients receiving aortic valve replacement through the right third intercostal small incision were allocated to a minimally invasive group, and patients receiving aortic valve replacement through the median sternal incision were allocated to a common group. The clinical outcomes of the two groups were compared.ResultsThere were 40 patients in the minimally invasive group, including 11 (27.5%) females and 29 (72.5%) males, aged 54.60±9.98 years with the body mass index (BMI) of 23.16±2.48 kg/m2. There were 83 patients in the common group, including 27 (32.5%) females, 56 (67.5%) males, aged 58.77±9.71 years, with the BMI of 24.13±3.13 kg/m2. Compared with the common group, the aortic cross-clamping time, cardiopulmonary bypass time, and operation time were longer (P<0.05), the ventilator support time was shorter (P<0.05), and the blood loss, postoperative 24 h chest drainage volume and total expense were less (P<0.05) in the minimally invasive group. The ICU stay, postoperative hospital stay, and total hospital stay were not statistically different between the two groups (P>0.05).ConclusionThe aortic valve replacement through the right third intercostal small incision is safe and effective, with less blood loss, 24 h chest drainage volume and invasiveness.

右腋下小切口体外循环心内直视手术270例

目的　总结右腋下小切口在常见先天性心脏病手术中的应用经验。　方法　回顾性分析济宁医学院附属医院2009年10月至2011年6月采用右腋下小切口经第4肋间进胸，在体外循环下施行心内畸形矫治手术270例患者的临床资料，其中男132例，女138例；年龄3个月～9岁 （3.0±1.6） 岁，行室间隔缺损（VSD）修补术132例，房间隔缺损（ASD）修补术50例，ASD修补术＋部分型肺静脉异位引流（PAPVC）矫治术12例，部分型房室管畸形（PECD）矫治术15例，VSD＋ASD修补术26例，法洛四联症根治术35例。　结果　全组无手术死亡，无二次开胸止血，平均住院时间9 d，平均住ICU 1.6 d。发生右肺不张3例，右侧气胸2例，阵发性室上性心动过速1例，Ⅱ°房室传导阻滞1例。术后全部患者均获得随访，随访时间1～16个月，随访期间3例VSD术后发生小于2 mm的残余漏，其余患者恢复良好。　结论　对具有该术式适应证的患者经右腋下小切口行心内直视手术，有安全可靠、创伤小、美观等优点。

Cardiac Valvular Surgery for 129 Patients by Small Incision at the Third Intercostal Space via Right Anterolatera

目的总结右胸前第3肋间小切口瓣膜置换/成形术的技术要点。 方法回顾性分析2011年1月至2014年6月我院行右胸前第3肋间小切口心脏瓣膜手术129例的临床资料，其中男57例、女72例，年龄23～65（42±17）岁。瓣膜病变患者股动静脉插管建立体外循环、经右胸前第3肋间小切口行瓣置换/成形术，其中行二尖瓣置换术49例，二尖瓣成形术21例，主动脉瓣置换术33例，二尖瓣+主动脉瓣双瓣膜置换术26例。 结果129例手术均顺利完成，切口长度5～7 cm，无感染及神经系统并发症发生，住院时间10～14 d，均痊愈出院。随访1～30个月，患者心功能改善，无死亡病例。 结论右胸前第3肋间小切口行瓣膜手术安全可靠，创伤小并具有美容效果。

Establishment of a rat model with aortic dissection induced by β-aminopropionitrile combined with angiotensin Ⅱ

ObjectiveTo investigate the optimal administration combination of β-aminopropionitrile (BAPN) and Angiotensin Ⅱ (Ang-Ⅱ) in the establishment of SD rat aortic dissection (AD) model and the related complications. MethodsForty-two three-week-old male SD rats were randomly divided into 7 groups: a group A (0.25% BAPN), a group B (0.40% BAPN), a group C (0.80% BAPN), a group D [1 g/(kg·d) BAPN], a group E [1 g/(kg·d) BAPN+1 μg/(kg·min) saline], a group F [1 g/(kg·d) BAPN+1 μg/(kg·min) Ang-Ⅱ] and a group G (control group). There were 6 rats in each group. The intervention period was 4 weeks (groups E and F were 4 weeks+5 days). Rats were dissected immediately if they died during the experiment. After the intervention, the surviving rats were sacrificed by pentobarbital sodium, and the whole aorta was separated and retained. Hematoxylin-eosin staining was used to observe the changes of aorta from the pathological morphology. ResultsThere was no statistical difference in the survival rate among the groups after 4 weeks of BAPN intervention (P>0.05). After 5 days of mini-osmotic pumps implantation, the survival rate of rats was higher in the group E than that in the group F (P=0.008), and the incidence of AD in the group E was lower than that in the group F (P=0.001). BAPN could affect the food and water intake of rats. After BAPN intervention for 4 weeks, the body weight of rats in the group G was higher than those in the intervention groups (P<0.05). BAPN combined with Ang-Ⅱ could make the aortic intima thick, elastic fiber breakage, arrangement disorder, and inflammatory cell infiltration in rats, which conformed to the pathological and morphological changes of AD. BAPN could also affect mental state and gastrointestinal tract. ConclusionThe combination of BAPN [1 g/(kg·d)] and Ang-Ⅱ [1 μg/(kg·min)] can stably establish AD model in rats, which will provide a stable carrier for further study of the pathogenesis and therapeutic targets of AD. However, the complications in this process are an unstable factor. How to balance the influence of BAPN on other tissues and organs in the process of AD model establishment remains to be further studied.

小儿主动脉缩窄或主动脉离断合并心内畸形的诊断与外科治疗

目的　探讨主动脉缩窄（CoA）或主动脉离断（IAA）合并心内畸形的诊断及手术方式选择。　方法　2003年1月至2010年3月济宁医学院附属医院手术治疗14例小儿CoA（9例）或IAA（5例）合并心内畸形 ［包括室间隔缺损（VSD）、房间隔缺损（ASD）、房室隔缺损（APSD）等畸形，但不包括单纯合并动脉导管未闭（PDA）］ 患者， 其中男10例，女4例；年龄0.7～12.0 （3.2±4.5）岁；体重5.5～25.5 （10.2±5.5） kg。分期手术3例，经胸骨正中切口径路一期手术矫治11例。　结果　手术死亡2例，其中1例为分期手术，二次手术行VSD修补术后死于急性左心衰竭；1例术前诊断为VSD＋PDA合并重度肺动脉高压，术前未发现IAA，术后死于急性肾功能衰竭。随访12例，随访时间6～84 （32±22）个月，患者恢复良好。复查心脏超声心动图提示：胸主动脉轻度狭窄2例，继续随访观察。　结论　多层螺旋CT和核磁共振成像是目前诊断CoA和IAA的首选检查方法。经胸骨正中切口径路一期手术治疗CoA或IAA合并心内畸形婴幼儿，可获较好的显露及疗效。