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find Author "张昌伟" 4 results
  • Surgical treatment of adult patients with anomalous left coronary artery from the pulmonary artery

    Objective To review the experience of the surgical treatment of adult patients with anomalous left coronary artery from the pulmonary artery (ALCAPA). Methods A retrospective, single institution review was conducted on thirty-six adult patients with ALCAPA surgical treatment from November 1991 to November 2017 in Fuwai Hospital. Of these patients, nine were males and twenty-seven were females. The mean age was 36.6±13.3 years. The mean weight was 60.0±9.4 kg. The preoperative echocardiography showed the mean left ventricular ejection fraction (LVEF) was 57%±6% and the mean left ventricular end-diastolic dimension (LVEDD) was 52.3±6.3 mm. Severe mitral regurgitation (MR) was seen in one patient, moderate in five patients. The operative procedures included coronary artery re-implantation in seventeen patients, Takeuchi operation in sixteen patients, ligation of left coronary artery plus coronary artery bypass graft in three patients. In addition, six patients underwent mitral valve repair. Results There was no in-hospital mortality. The mean cardiopulmonary bypass time was 152.5±72.9 min and aortic cross clamp time was 101.9±43.6 min, respectively. The mean mechanical ventilation time and ICU time was 17.3±16.3 h and 43.1±30.7 h, respectively. The mean postoperative LVEF was 59%±6%, which did not significantly improve compared with preoperative LVEF. However, the mean postoperative LVEDD of 46.9±5.9 mm had significant reduction compared with the preoperative LVEDD. Of the six patients with mitral valve repair, one was mild and the other five were trivial. Thirty-five patients (97.2%) completed the follow-up with a mean time of 5.5 years. All the patients survived with New York Heart Association class Ⅰor Ⅱ. Two patients needed interventional occlusion or re-operation due to the fistula of internal tunnel within the pulmonary artery. At the latest echocardiography, the mean LVEF of 69%±7% improved significantly compared with the preoperative LVEF. Mild MR was detected in ten patients, moderate in two patients during the follow-up period. Conclusion The surgical treatment of adult patients with ALCAPA has satisfactory short- and long-term results. The patients who underwent Takeuchi procedure may need re-operation due to fistula of internal tunnel within the pulmonary artery during the long-term follow-up.

    Release date:2019-05-28 09:28 Export PDF Favorites Scan
  • 介入栓塞治疗一例医源性椎动脉损伤致假性动脉瘤

    Release date:2017-06-15 10:04 Export PDF Favorites Scan
  • 支气管动脉介入治疗中的严重并发症分析

    目的:探讨支气管动脉介入治疗中的严重并发症及相关因素。方法:回顾性分析共135例行介入治疗患者,其中115例为原发性肺癌,20例为内科治疗无效的非肿瘤咯血患者。肺癌患者行支气管动脉灌注化疗104例,支气管动脉化疗栓塞11例。20例内科治疗无效的非肿瘤咯血患者,包括支气管扩张(15例)、肺结核(3例)、血管畸形(2例)。栓塞材料为明胶海绵颗粒或/和条。结果:共7例(5.2%)发生并发症,包括脊髓缺血/损伤2例(1.5%)、肋间动脉缺血5例(3.7%)。经治疗后肋间动脉缺血均于1~3周内缓解。1例脊髓缺血于7d后缓解,4周后死于多器官功能衰竭;另1例于4周后逐渐恢复。2例脊髓缺血/损伤均发生在支气管动脉灌注化疗术者,5例肋间动脉缺血均发生在支气管动脉主干栓塞者。结论:支气管动脉介入治疗需谨慎地进行,合理选择灌注方案及选择明胶海绵作栓塞剂是比较安全的。

    Release date:2016-09-08 10:01 Export PDF Favorites Scan
  • Surgical treatment of patients with anomalous left coronary artery from the pulmonary artery and intramural left coronary artery

    ObjectiveTo summarize the surgical experience of patients with anomalous left coronary artery from the pulmonary artery (ALCAPA) and intramural left coronary artery and analyze the early and mid-term clinical outcomes. Methods The infants with ALCAPA and intramural left coronary artery who underwent surgical treatment in Fuwai Hospital from January 2014 to September 2020 were retrospectively enrolled, and the clinical data of the patients were analyzed. Results A total of 10 patients were included. There were 8 males and 2 females, with a median age of 7.5 (3-46) months at surgery. The surgical techniques included coronary unroofing in 7 patients, coronary unroofing with coronary reimplantation in 2 patients, and coronary unroofing with ligation of left coronary artery ostium in 1 patient. Seven infants received additional procedures, including 5 mitral valve repair. Delayed chest closure was required in 2 infants, and no operative death or major complications occurred in the whole group. Postoperative chest radiograph showed that the mean cardiothoracic ratio was lower than that before surgery (0.62±0.05 vs. 0.67±0.06, P=0.006). Postoperative echocardiography indicated that the mean left ventricular ejection fraction was increased than that before surgery, but there was no statistical difference (38.7%±15.9% vs. 30.0%±16.1%, P=0.066). The follow-up was available for all 10 survivors, with an average follow-up time of 13-92 (46.6±25.0) months. During the follow-up period, the patients had no obvious symptoms, death, coronary complications or other major complications. The chest radiograph at last follow-up showed that the mean cardiothoracic ratio was further decreased (0.60±0.07 vs. 0.62±0.05, P=0.024). The echocardiography at last follow-up showed that the mean left ventricular ejection fraction was further improved (60.1%±9.3% vs. 38.7%±15.9%, P=0.002). Conclusion ALCAPA with intramural left coronary artery is a rare malformation. It can be treated with different surgical techniques with satisfactory early and mid-term outcomes.

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