小儿双腔右心室的外科治疗（附10例报告）

本文报告了１９９２年收治的１０例双腔右心室病人，男性９例，女性１例。年龄３～１２岁，平均７岁，均合并有其它心内畸形，包括房缺、室缺、肺动脉瓣狭窄等。术前明确诊断双腔右心室者８例，２例误诊为法鲁四联症及单纯室间隔缺损。１０例病人全部经右心室切口切除异常肌束，疏通右室流出道，４例用牛心包补片扩大流出道。术后９例恢复良好，１例死于脑部并发症。作者在文章中描述了双腔右心室的病理解剖学特征，强调术前诊断和术中识别本病的重要性。同时，就手术时机、手术方法及术中应注意的重要问题进行了讨论。     

双腔右心室的超声诊断

目的　总结超声诊断双腔右心室 (DCRV)的经验。方法　回顾分析 2 0例经手术证实为先天性 DCRV的超声特点 ,并与手术结果对照。结果　超声诊断与手术结果相符者 17/2 0例 ,符合率 85 %。 18例合并室间隔缺损 (VSD) ,1例合并右心室流出道狭窄 ,2例合并肺动脉狭窄。超声测得的狭窄程度与手术测量结果无显著差异。结论　超声心动图是目前诊断 DCRV的首选最佳技术     

双腔右心室的超声心动图诊断

本文报告应用超声心动图诊断81例双腔右心室患者，其中手术治疗72例，超声诊断符合率833％。结果表明：室间隔缺损是最常见的并发畸形。通过不同切面可清晰地显示分割右室腔引起流出道狭窄的异常肌束。大动脉短轴、剑突下二尖瓣水平短轴及右室流出道长轴切面可提供双腔右心室的诊断和鉴别诊断非常有价值的信息。多普勒技术也有助于诊断和评价血流动力学，超声心动图是目前诊断双腔右心室最为实用的方法。     

彩色多普勒超声心动图对右心室双腔心的诊断价值

目的回顾探讨彩色多普勒超声心动图在右心室双腔心中的诊断价值。方法比较右心室双腔心手术患者22例的术前彩色多普勒超声心动图诊断和术后结果。结果超声心动图诊断和术后诊断符合率95%(21/22),其中2例为单纯右心室双腔心,20例右心室双腔心合并室间隔缺损,2例右心室双腔心合并肺动脉瓣狭窄。结论彩色多普勒超声心动图诊断右心室双腔心及其合并症的主要手段,具有安全、准确、直接的优点。     

小儿双腔右心室的外科治疗

目的:探讨双腔右心室外科治疗方法。方法:外科手术治疗患者26例,平均年龄7.6岁,平均体质量25.4 kg,全组均伴有室间隔缺损,其中伴发房间隔缺损(ASD)15例,主动脉瓣下纤维嵴(SAS)6例,动脉导管未闭(PDA)3例,肺动脉狭窄(PS)1例。结果:所有患儿在体外循环下行手术治疗,手术顺利,全组无死亡,术后恢复良好。3年远期随访效果良好。结论:DCRV手术治疗关键在适当切除右心室内异常肌束和严密修补室间隔缺损,右心室流出道切口更有利于切除肥厚肌束,疏通右心室梗阻。     

冠状动脉横跨漏斗部的混合型肺动脉狭窄疏通术三例

冠状动脉或其粗大分支横跨右心室流出道常造成右心室流出道疏通的困难。我院手术纠治成功３例，现报道如下：１临床资料例１男，８岁。术前诊断：左旋心、右心室双出口，大血管转位，心室间隔缺损、肺动脉发育差。术中见右冠状动脉一粗大分支横跨右心室流出道，手术于异位...     

双腔右心室的术前与术中诊断对比分析

对１７ 例双腔右心室（ＤＣＲＶ） 患者于术前行经彩色多普勒血流显像（ＣＤＦＩ） 检查, 诊断为单纯ＤＣＲＶ４ 例, ＤＣＲＶ 合并室间隔缺损 （ＶＳＤ） ８ 例、肺动脉瓣狭窄 （ＰＳ） １ 例、房间隔缺损（ＡＳＤ） １ 例, 单纯ＶＳＤ２例, 法乐氏四联症１ 例。均经手术治疗, 术中确诊为单纯ＤＣＲＶ４ 例, ＤＣＲＶ合并ＶＳＤ１１ 例、ＡＳＤ１例、ＰＳ１ 例。认为ＣＤＦＩ对ＤＣＲＶ的诊断有较高的准确性, 但对不典型ＤＣＲＶ的诊断仍有一定困难。     

双腔右心室的手术治疗

本文报告5例小儿双腔右心室并存室间隔缺损的手术治疗结果。重点描述由这类异常肥厚肌束形成的心内病变表现。手术矫治须防止损伤室间隔和三尖瓣,避免残余分流。     

主动脉瓣下狭窄合并室间隔缺损、右室异常肌束的诊断和治疗

本文报告4例小儿主动脉瓣下狭窄伴室间隔缺损、右室异常肌束(或双腔右心室)的手术治疗和良好结果,结合文献对该症的病理生理、临床表现、诊断和手术等同题进行了讨论。     

右心室高位室间隔起搏与右心室心尖部起搏的临床对照研究

目的:探讨右心室高位室间隔起搏与右心室心尖部起搏对血流动力学的影响。方法:右心室高位室间隔起搏组20例,右心室心尖部起搏组20例,分别于术前、术后3个月行心电图、超声心动图检查,术中测定起搏参数及曝光时间。结果:2组在起搏阈值、感知、阻抗,电极脱位率方面差异均无统计学意义,右心室高位室间隔起搏组手术曝光时间长于右心室心尖部起搏组。与后者比较,右心室高位室间隔起搏组起搏后QRS波宽度变窄,射血分数、每搏量明显增大,差异有显著性。结论:右心室高位室间隔起搏更接近生理性起搏,血流动力学更好,可能是一个更佳的起搏部位。     

Rupture of a right sinus of valsalva aneurysm into the right ventricle during vaginal delivery: a case report

A case is reported of a right sinus of Valsalva aneurysm rupture into the right ventricle during vaginal delivery in a 34-year-old healthy woman in her third pregnancy. Pregnancy was carried to term and a healthy baby was delivered vaginally. On day 7 following vaginal delivery she was admitted to hospital for dyspnea and cough, with clinical signs of severe heart failure. The diagnosis of the right sinus of Valsalva aneurysm rupture into the right ventricle was established by transthoracic and transesophageal echocardiography. Clinical recognition and early echocardiographic diagnosis followed by immediate surgical repair proved lifesaving in our patient.     

Echocardiographic diagnosis of a rare mechanical complication of biventricular infarction. Rupture of the free wall of the right ventricle

The authors report a case of rupture of the free wall of the right ventricle, diagnosed by two dimensional echocardiography. This examination revealed an intrapericardial clot associated with a fissure of the diaphragmatic wall of the right ventricle. This case emphasises the value of two dimensional echocardiography in the acute phase of myocardial infarction for the diagnosis of complications which require urgent surgical treatment.     

心内膜心肌纤维化病的外科治疗

手术治疗心内膜心肌纤维化右室型及左室型各１例，取得良好疗效。本症较少见，易误诊，应提高对其认识和警惕性。根据临床表现，结合超声心动图及心脏造影检查可以作出诊断。无论左室型或右室型，手术经心房切口为宜，对纤维化内膜行谨慎的锐性剥离并行受累房室瓣膜替换术。术中心肌保护和术后心功能维护是取得良好疗效的重要因素。     

冠状动脉瘘28例诊断及外科治疗

目的 总结冠状动脉瘘的诊断和手术治疗效果。方法 28例不同部位的冠状动脉瘘患者采用超声心动图和选择性冠状动脉造影,明确冠状动脉瘘发生位置,全部采用外科治疗,统计其疗效。结果 单纯冠状动脉瘘20例,合并其他心内畸形8例;右冠状动脉瘘18例,左冠状动脉瘘8例,双冠状动脉瘘2例。瘘入右心室13例,瘘入右心房12例,瘘入左心室1例,瘘入肺动脉2例。心腔内双瘘口及三个瘘口各有1例,余26例为单一瘘口。所有病例行手术治疗,8例合并其他心内畸形同期矫治。全组无死亡及残余瘘,效果满意。结论 心脏直视手术治疗冠状动脉瘘效果肯定,合并其他心内畸形应同期矫治。选择性冠状动脉造影对明确冠状动脉瘘发生位置和（或）瘘人心腔的位置非常必要。     

Right coronary artery fistula to left ventricle complicated with huge coronary artery aneurysm

Congenital coronary artery fistula (CAF) with huge coronary artery aneurysm is a very rare condition. In this paper, we describe a 26-year-old asymptomatic male patient with right coronary artery (RCA) to the left ventricle fistula with a huge coronary artery aneurysm which was diagnosed by multidetector computed tomography and coronary angiography. The patient received surgical treatment for coronary artery after diagnosis. Both RCA and a giant aneurysm were excised; surgical closure of CAF and coronary artery bypass grafting were performed on this patient. Two months after surgery, the enlarged left ventricle returned to normal as evaluated by echocardiography.     

Bacterial endocarditis with ruptured sinus of valsalva and aorticocardiac fistula

A case is presented of bacterial endocarditis with a ruptured sinus of Valsalva and formation of an aorticocardiac fistula from the right coronary sinus into the right atrium and right ventricle. The pathologic, clinical and surgical aspects of bacterial endocarditis complicated by a ruptured sinus of Valsalva and an aorticocardiac fistula are analyzed. This complication of bacterial endocarditis is still uncommon, but alertness to its diagnosis makes possible early and successful surgical treatment.     

右室双出口超声和右心室造影与手术结果对比分析

对15例经手术证实的右室双出口患者术前超声检查和右心室造影诊断与手术病理结果进行对比分析，超声诊断准确率86．7％（13／15），右心室造影诊断准确率91．7％（11／12）。经统计学分析，两者无显著性差异（P＞0．05）。认为：超声心动图检查与右心定造影结合可在术前诊断右室双出口及合并畸形。     

Double-chambered right ventricle: an uncommon congenital heart disease. Case report and literature review

A double-chambered right ventricle (DCRV) is a rare congenital heart disease and an uncommon cause of congestive cardiac failure. An anomalous muscle band divides the right ventricle into two cavities, causing variable degrees of obstruction. Echocardiography is considered a useful method for the diagnosis of this pathology, especially in children. An eight-year-old patient with a small ventricular septal defect (VSD) and double-chambered right ventricle presented with a history of palpitations, easy fatigability and recurrent fever. On presentation, she had features of congestive cardiac failure. A complete diagnosis was initially missed with transthoracic two-dimensional (2-D) echocardiography but later obtained based on transthoracic 2-D echocardiography with Doppler facility. This was confirmed with cardiac catheterisation. The patient was referred for surgical correction, which was successful. Due to the rarity of this condition and the consequences of missing the diagnosis, we present this case in order to highlight the rarity of this congenital heart disease in childhood.     

Severe tricuspid stenosis presenting as tricuspid atresia. Echocargraphic diagnosis and surgical management.

Two cases of pulmonary atresia with intact ventricular septum and severe tricuspid stenosis are described in which the initial angiographic diagnosis was tricuspid atresia and pulmonary atresia. Two dimensional echocardiography showed the features of an imperforate tricuspid valve because in each case contrast echocardiography failed to show anterograde flow from the right atrium to right ventricle. Successful radical surgical repair was achieved in one patient with performing a tricuspid valvotomy and inserting an external valved conduit between the hypoplastic right ventricle and the main pulmonary artery. In the second case, an infant died four weeks after tricuspid valvotomy and right ventricular outflow tract reconstruction.     

Double-inlet left ventricle with rudimentary right ventricle and ventriculoarterial concordance

Seven hearts were studied that had in common the segmental combination of double-inlet left ventricle, rudimentary right ventricle and ventriculoarterial concordance. The prototype of these hearts has been described as the “Holmes heart” or “single ventricle type A1.” Five of the hearts had 2 atrioventricular valves; in 1 of these the right valve was minimally straddling. The other 2 had a common valve. In 6 of the hearts the rudimentary right ventricle was obliquely situated on the anterior surface of the dominant left ventricle. The trabecular component was anterior and right-sided with the outlet components and pulmonary trunk in left-sided position. In the final case, both trabecular and outlet components of the rudimentary right ventricle were left-sided. Conduction tissue studies were performed in 2 hearts. In 1, the connecting atrioventricular node and bundle were in anomalous anterolateral position, as expected in double-inlet left ventricle. In the other, a ring-like, posterior, nonbranching bundle connected the regular node in the atrial septum to the branching bundle positioned on the anterior interventricular septum. The anatomic findings are related to the likely modes of presentation and differential diagnosis while the conduction tissue findings are discussed in the light of options for surgical repair. Thus, the term “single ventricle” is best avoided when describing hearts that unequivocally possess 2 ventricular chambers.