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右心房横纹肌肉瘤手术治疗一例

“一鞘两伞” Hybrid 技术封堵室间隔缺损残余漏及左心室右心房通道一例

联合右心房-肺动脉切口手术一期根治婴幼儿法洛四联症

目的　探讨联合右心房-肺动脉切口径路手术一期根治婴幼儿法洛四联症（TOF） 的疗效，总结其临床经验。 方法 回顾性分析 2006年1月至2012年1月解放军第91中心医院采用联合右心房-肺动脉切口径路行一期根治术治疗69例婴幼儿TOF的临床经验，其中男47例，女22例；年龄5个月至2岁7个月；体重5～16 kg。心脏超声心动图提示：左心室舒张期末容积指数（LVEDVI） 24.5～36.9 ml/m2，Nakata指数＞120 mm2/m2，McGoon比值1.15～2.20。 结果 围术期死亡2例，死亡率2.9%，其中术后死于肺部感染1例，渗漏综合征1例。术后患者血流动力学平稳，不需使用大剂量的血管活性药物。呼吸机辅助呼吸时间（11.7±9.3） h，住ICU时间（38.2±20.7） h。生存的67例患者均顺利出院，动脉血氧饱和度由术前平均85%上升至99%，临床症状改善，活动耐量增加，心功能（NYHA分级）恢复至Ⅰ～Ⅱ级。随访67例，随访率100%，随访时间11～70个月。随访期间无死亡，1例于术后3个月因大量心包积液行心包穿刺引流，1例于术后8个月因肺动脉瓣狭窄再次行手术矫治，其余患者恢复良好，心功能（NYHA分级）Ⅰ～Ⅱ级。 结论 联合右心房-肺动脉切口径路手术一期根治婴幼儿TOF安全、可行，较常规手术缩短了体外循环时间，减少了右心室创伤，避免患者远期右心室功能衰竭、室性心律失常导致的猝死，有利于患者远期生存，效果满意。

经右心房切口行右心室流出道疏通术

目的　总结右心室流出道梗阻经右心房切口、三尖瓣口行右心室流出道疏通术的经验。　方法　自2007年6月至2010年12月，安徽医科大学第一附属医院对21例右室双腔心、单纯右心室流出道狭窄及法洛四联症患者［（14例右室双腔心、4例单纯右心室流出道狭窄和3例法洛四联症，流出道压差为（52.56±17.31） mm Hg］，经右心房切口、三尖瓣口行右心室流出道疏通术，切除异常纤维环和增生肥厚肌束，疏通右心室流出道，对并发肺动脉瓣或瓣下狭窄的患者，再经肺动脉根部切口协助显露，同时矫正其他并发畸形。　结果　所有患者手术顺利，术后心功能均恢复满意，术后超声心动图复查提示：右心室流出道疏通效果满意，压差＜20 mm Hg，7例术后有轻度收缩期杂音。术后随访至6个月，随访期间所有患者体力活动完全恢复；复查心脏彩色超声心动图提示:无明显右心室流出道室壁肥厚增生和再梗阻，右心室流出道压差进一步缩小或消失。　结论　经右心房切口行右心室流出道疏通术适用于右室双腔心、单纯右心室流出道狭窄及部分法洛四联症患者，可避免直接切开右室壁引起的心肌、冠状动脉损伤，减轻了术后瘢痕纤维增生，有利于术后心功能恢复。

延伸入右心房内肿瘤的外科治疗

目的　总结膈下肿瘤蔓延至右心房的外科治疗经验。　方法　自 1991年 5月～ 2 0 0 2年 11月外科治疗膈下肿瘤蔓延至右心房 6例 ,病变来源于子宫平滑肌瘤 3例 ,子宫间质肉瘤 1例 ,下腔静脉粘液肉瘤 1例 ,肾平滑肌肉瘤 1例。 5例完整切除右心房和下腔静脉内肿瘤 ,1例部分切除。　结果　无手术死亡 ,1例粘液肉瘤患者部分切除肿瘤术后 5个月死亡 ,其余患者随诊 5个月～ 3年 ,下腔静脉内无肿瘤复发 ,无明显症状。　结论　膈下肿瘤蔓延至右心房应积极手术治疗 ,手术尽量完整切除肿瘤 ,中期疗效良好。

The Study on the Relationship between Daily Activity and Patent Foramen Ovale

ObjectiveTo study the relation between daily activity that can make right atrium pressure rise (such as abdominal belt, sighs, weight lifting) and patent foramen ovale (PFO). MethodsA total of 122 cases of positive patients by the routine transcranial Doppler (TCD) foaming test between 2014 and 2015 were collected. Forty-one patients underwent TCD foaming test in the case of abdominal belt, 41 in the case of sighs, and 40 in the case of weight lifting. We recorded the right to left shunting of the above three cases, and compared them with the normal TCD foam test. ResultsThere was a significant difference in the positive rate between the sigh group and abdominal belt group, and between the sigh group and weight lifting group (χ2=10.5, 7.40; P<0.01). The positive rate in the abdominal belt group was not significantly different from that of the weight lifting group (χ2=0.314, P>0.05). In the sigh group, the sigh shunting volume was significantly higher than that when the patients were at rest. The shunting volume was the biggest when the patients had Valsalva movement, followed by sighing and resting. ConclusionThe daily activity that can make right atrium pressure rise (such as abdominal belt, sighs, weight lifting) can increase the shunting flow from the right to the left. The highest positive rate occurs when patients sigh. This study can provide a certain theoretical basis for the pathogenesis of patent foramen ovale and cryptogenic stroke.

经食管超声心动图引导右心房巨大粘液瘤切除一例

Continuous Half-thickness Suture Outside of the Pectinate Muscles in the Right Atrium Incision in Adult Patients Undergoing Cardiac Surgery

ObjectiveTo evaluate the continuous half-thickness suture outside of the pectinate muscles in the right atrium incision in adult patients undergoing cardiac surgery. MethodsA total of 1 040 consecutive adult patients undergoing cardiac surgery by the right atrium incision with cardiopulmonary bypass (CPB) were randomly divided into a control group (n=518 with 236 males and 282 females at mean age of 44.55 years) and a trial group (n=522 with 242 males and 280 females at mean age 45.75 years) between January 2010 and June 2014. The right atrium incision was sutured by continuous full-thickness suture in the control group and sutured by continuous half-thickness suture in the trial group. After the suture, the bleeding in the right atrium incision was recorded. ResultsAll patients underwent the open-heart operation. Seven patients died of postoperative low cardiac syndrome including four patients in the control group and 3 patients in the trial group. The heart incision was inspected before suturing the pericardium. A total of 203 patients of local active bleeding were stitched again in the right atrium incision in the control group. Only 26 patients were stitched again in the trial group (P<0.001). In the cases of re-exploration for bleeding or tamponade after cardiac operation, 3 patients of bleeding due to the right atrium incision were confirmed in the control group, and no one was confirmed in the trial group. ConclusionThe continuous half-thickness suture in the right atrium incision can prevent the incision bleeding, and avoid locally stitching again in adult patients undergoing cardiac surgery.

经皮椎体成形术后右心和下腔静脉骨水泥占位一例