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下腔静脉异位连接左心房一例

动脉导管未闭合并感染性心内膜炎一例

法洛四联症术后发生多种并发症救治成功一例

房间隔缺损修补术后残余漏外科治疗七例

心脏肿瘤的外科治疗

目的总结心脏肿瘤的发生部位、肿瘤性质、诊断和外科治疗方法。方法1979年1月至2003年6月对195例心脏肿瘤患者行手术治疗,其中良性肿瘤186例(95.38%)、恶性肿瘤9例(4.62%);完整切除肿瘤188例,大部分或部分切除肿瘤7例。结果手术死亡5例,死亡率2.56%(5/195);手术成功190例(97.44%),术后随访3个月至15年,随访率96.84%(184/190),6例粘液瘤患者于术后4个月～2年内复发,4例恶性肿瘤分别于术后5个月～2年内死亡。结论心脏肿瘤以粘液瘤多见,彻底切除肿瘤是防止心脏肿瘤复发的关键,心脏恶性肿瘤手术近远期效果差;近10年心脏肿瘤呈逐年增加的趋势。

Therapeutic efficacy of extracardiac conduit total cavopulmonary connection

Objective To summary the experience of extracardiac conduit total cavopulmonary connection (TCPC) and study the operative indication, design, method, and therapeutic efficacy. Methods 29 patients of extracardiac conduit TCPC were reviewed:the average age was 10 years. Of them, there were 9 cases of tricuspid atresia, 9 double inlet ventricle with left ventricular type, 3 mitral atresia, 3 corrected transposition of the great arteries with anatomically right ventricular hypoplasia and 5 double outlet of right ventricle with left ventricular hypoplasia. All patients underwent cardiopulmonary bypass, 12 cases with heart arrested, and 17 without heart arrested. In them, 20 cases’ superior vena cava were anastomosed directly to the upper margin of right pulmonary artery, 9 cases deviated to the left side of right pulmonary artery to enlarge the stoma. For the inferior vena cava stoma, 22 cases’ anterior walls of right atrium were partially incised, and sutured to the posterior wall, then anastomosed with Gore-Tex blood vessel prostheses and connected to pulmonary trunk, and the other 7 cases’ bottom of right atrium was totally incised, the proximal was closed, and the distal was anastomosised with Gore-Tex blood vessel prostheses and connected to the lower margin of right pulmonary artery, deviated to the right sidedness. Results 5 died in the first 22 cases, and the next 7 cases all survive. All patients were followed up for 3 months to 10 years with no late death. Of them, 12 cases had low cardiac output syndrome, and 11 cases of chylothorax. Conclusions Compared with other types of Fontan operation, the extracardiac conduit TCPC has better long-term effects in older or grown-up children. Nevertheless, strict operative adoption, reasonable operative design, refined procedures, carefully observation and treatment are the key points of improving therapeutic efficacy.

室间隔缺损伴肺动脉高压患者血浆内皮素、一氧化氮与肺细小动脉形态变化的关系

目的 探讨内皮素(ET-1)、一氧化氮(NO)在肺动脉高压(PH)发生、发展过程中的作用. 方法 60例室间隔缺损患者分为两组,无PH组:20例,不合并PH,平均肺动脉压(MPAP)lt;20mmHg(1kPa＝7.5 mmHg);PH组:40例,合并PH,MPAPgt;20mmHg.测定两组血浆ET-1和NO含量,作肺组织活检,观察肺血管的病理改变及测定肺细小动脉显微形态指标. 结果 全部肺标本按阮英茆的Ⅳ级分类进行病理分级:无PH组患者肺血管无明显病理改变,PH组患者Ⅰ级7例、Ⅱ级13例、Ⅲ级20例,未见Ⅳ级病理改变.随着肺血管病理改变分级的增加,血浆ET-1、NO、血流动力学指标及肺细小动脉显微形态指标测定均呈阶梯样变化,除NO、血管腔面积/血管总面积(EA/TA)逐渐减小,其它指标均逐渐增高,ET-1、NO、MPAP、肺血管阻力(PVR)、肺细小动脉中膜厚度(mMTPA)、血管壁面积/血管总面积(WA/TA)、EA/TA和肌型肺细小动脉/微动脉总数的比值(TWPV),无PH组与PH组Ⅰ级、PH组Ⅰ级与Ⅱ级、Ⅱ级与Ⅲ级之间差别均有显著性意义(Plt;0.05,0.01);血浆ET-1与MPAP、PVR、mMTPA、WA/TA和TWPV均呈显著正相关,血浆NO均呈显著负相关;血浆ET-1与EA/TA呈显著负相关,血浆NO呈显著正相关(Plt;0.01);血浆ET-1浓度与血浆NO浓度呈显著负相关(r=-0.3452,P=0.0069). 结论 ET-1增高,NO减少,ET-1/NO动态平衡的破坏,参与了PH的发生、发展过程.

冠状动脉瘘27例

主动脉窦瘤破裂的外科治疗

摘要 目的　总结1973～1999年85例主动脉窦瘤破裂的外科治疗经验。　方法　主动脉窦瘤破裂85例，合并室间隔缺损40例(47.1%)，主动脉瓣关闭不全15例(17.6%)，均以补片行主动脉窦瘤修补，其中40例以同一补片修补主动脉窦瘤和室间隔缺损，5例同期行主动脉瓣置换术，3例行主动脉瓣成形术。　结果　全组死亡3例，死亡率3.5%，无残余分流等并发症，71例随访2个月～24年，心功能恢复良好。　结论　主动脉窦瘤破裂一经确诊，应尽早手术，采用补片修补主动脉窦瘤及用同一乒乓球拍形补片修补窦瘤和室间隔缺损，效果较好。对于严重的主动脉瓣关闭不全，应同期行主动脉瓣置换术，而轻度主动脉瓣关闭不全可不用特殊处理。

全腔静脉-肺动脉连接术后肺循环无搏动血流对内皮素分泌的长期影响