Anomalous origin of the right coronary artery associated with congenital bicuspid aortic valve.

Anomalous origin of the right coronary artery is an infrequent anomaly. A case with anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Valsalva is described. This patient was also found to have a bicuspid aortic valve. The aortic valve was markedly calcified and stenotic. The aortic valve was replaced with a St. Jude Medical prosthesis.     

肺癌侵犯大血管的外科处理

目的探讨大血管成形术在肺癌外科中的应用价值.方法回顾性分析136例肺癌手术中涉及大血管成形术患者的病例资料.TNM分期Ⅱb 29例;Ⅲa 45例;Ⅲb 62例.鳞状细胞癌98例,腺癌31例,小细胞肺癌7例.结果 136例中上腔静脉置换或部分切除术18例,血管旁路分流术4例;肺动脉成形术92例,其中右上叶肺动脉袖状切除2例,部分切除12例,左上叶袖状切除14例,部分切除64例;左心房部分切除22例.无手术死亡者,随访结果满意.结论应用大血管成形术可以提高手术切除率及手术的安全性,可以最大限度地保留患者的肺功能,并有助于提高患者的术后生存率及生活质量.     

外侧裂血管解剖研究

目的观察外侧裂池的结构特点及池内血管分布,了解侧裂池及内血管与周边结构的关系。方法取12具成年人新鲜尸头,在显微镜下解剖外侧裂池并观察其血管分布。结果M1段分叉夹角度数左侧为（94.5±34.2）°,右侧（94.8±31.64）°。M2段上下干直径;左上干为（2.13±0.3）mm,左下干为（2.16±0.48）mm。右上干为（1.97±0.32）mm,右下干为（2.12±0.4）mm。脑岛表面动脉分支数左侧为（9.58±1.3）支,右侧为（9.58±1.2）支。盖段的血管分布支数左额顶盖上界为（5.8±0.9）支,下界为（3.8±0.7）支;右额顶盖上界为（6.25±0.9）支,下界为（3.75±0.7）支。结论脑岛皮质表面上的动脉成“扇形”运行,盖段动脉基本上是脑岛回环段的直接延续。熟悉大脑中动脉在脑岛分布,认清真正的分叉对手术时有重要意义。     

气管隆嵴、支气管及肺动脉成形肺切除术治疗肺癌

采用气管隆嵴、支气管及肺动脉成形肺切除术治疗肺癌１２例。手术包括右全肺加半隆嵴切除成形术１例：左上支气管袖状肺叶切除术２例；右上支气管袖状肺叶切除术６例：右肺动脉成形加右上肺叶切除术１例：右上肺叶支气管楔形切除术２例。全组无手术死亡。术后随访５～８８个月，重点讨论了手术适应证及围术期处理。     

经右上肢同次完成冠状动脉造影及右心导管检查的可行性

目的探讨经右前臂同次行冠状动脉造影及右心导管检查的可行性.方法对40例在我科就诊经右桡动脉行冠状动脉造影及左室造影后疑诊肺动脉高压患者,随机分为两组,治疗组经右上肢静脉行标准右心导管检查,对照组经股静脉行标准右心导管检查,其中治疗组20例经上肢静脉穿刺失败改为股静脉穿刺.结果两组穿刺成功率、进鞘管及导管成功率、静脉闭塞率及右心导管的数值等均无统计差异(P>0.05),治疗组消毒-穿刺时间(5.3±2.6)min、止血时间(5.5±3.2)min、术后卧床休息时间(1.0±1.6)h、并发症、术后住院时间(1.2±2.7)d及患者满意度均优于对照组(P<0.01).结论经右上肢同次完成冠状动脉造影及右心导管简便、安全可行,可作为冠脉造影后行右心导管的检查路径.     

复杂先心病并冠状动脉畸形重建右室流出道方法的临床分析

目的总结分析23例复杂先心病合并畸形冠状动脉横跨右心室流出道重建右室流出道的方法。方法回顾性分析1999年10月～2011年10月期间合并冠状动脉畸形的法洛四联症（18例）和右室双出口（5例）患者的临床资料,其中6例右冠状动脉起源于左冠状动脉或前降支,13例左前降支起源于右冠状动脉,4例有异常粗大的圆锥动脉,均横跨右室流出道（近肺动脉瓣环处）。11例采用畸形冠状动脉上下右心室流出道双切口,5例采用畸形冠状动脉下右心室流出道切口,3例采用心外管道,4例采用肺动脉干与右心室直接吻合术。结果手术死亡3例,死亡率为13%,无远期死亡,手术死亡原因主要为低心排综合征。随访1～30个月,患者右室-肺动脉压差为（27.2±15.3）mm Hg（1 mm Hg=0.133 kPa）。结论应仔细探查畸形冠状动脉的走行;根据右心室流出道狭窄程度和畸形冠状动脉走行特点选择手术方式。     

COMBINED BILATERAL FREE LATISSIMUS D()RSI SKIN FLAP TRANSPLANTATION

The authors creatively performed a combined bilateral free latissimus dorsi myocutaneous flap transplantation for an eight-year-old girl to repair a skin defect measuring 26X18 cm encircling the entire left leg between the knee and foot. Two free latissimus dorsi myocutaneous flaps were joined to form a single flap with only one common vascular pedicle - the right subscapular artery and vein. The left subscapular artery is anastomosed to the right circumflex scapular artery and the left subscapular vein connected with the right circumflex scapular vein. The left circumflex scapular artery and vein being redundant, are ligated. Cross-bridge vascular anastomosis was employed due to the absence of blood vessels available for anastomosis at the reci pient site. The flaps survived and the patient can bear weight and walk with the affected leg. There has been no functional impairement of the upper limbs after the removal of both latissimus dorsi myocutaneous flaps.     

CASE REPORT OF A 6-WEEK-OLD BOY WITH BLAND- WHITE-GARLAND SYNDROME

Bland-White-Garland syndrome is a rare syndrome with anomalous origin of the left coronary artery （ LCA ） arising from the pulmonary artery, resulting in left ventricular failure. It could occur shortly after birth. We here reported the case of a 6-week-old boy with aortostenosis. Coronary angiography revealed an anomalous LCA arising from the pulmonary artery. Representation of a prominent right coronary artery （ RCA ） delivered numerous collateral vessels to the LCA area, The patient underwent a correction operation with translocation of the LCA and re-implantation into the ascending aorta. One month after operation, clear decrease in the expanded ventricle was noted with an increase in the contractibility.     

Myocardial infarction due to isolated left circumflex or right coronary artery occlusion.

The electrocardiographic (ECG) patterns related to clinical spectrum and angiographic features were assessed in 41 patients with first myocardial infarction due to isolated left circumflex coronary artery (LCX) occlusion, and compared to those in 45 patients with right coronary artery (RCA)-related infarction. The occurrence of inferior Q waves was similar in patients with LCX and RCA occlusion, but lateral Q waves and an abnormal R wave in lead V1 were more frequently seen in patients with LCX-related infarction (46% vs 7% and 51% vs 4%, respectively). Compared with patients with LCX-related infarction without an abnormal R wave in lead V1 and those with RCA occlusion, patients with LCX-related infarction and an abnormal R wave in lead V1 associated with inferior and/or lateral Q waves had larger left ventricular end-diastolic and end-systolic volumes, lower ejection fraction, higher incidence of total occlusion of a dominant LCX without collaterals, and more cardiac events during follow-up. The study suggests that the presence of lateral Q waves and an abnormal R wave in lead V1 after myocardial infarction may be a useful marker of LCX occlusion, and that patients with LCX-related infarction may have different status of left ventricular function depending on the size of circulation and the status of residual flow to the infarct region during LCX occlusion.

     

Unusual case of left iliac vein compression secondary to May-Thurner syndrome and crossed fused renal ectopia

External compression of the left iliac vein against the fifth lumbar vertebra by the right iliac artery May and Thurner syndrome is a well-known anatomic variant. We identified a rare case of May-Thurner syndrome associated with crossed fused renal ectopia on the left side. The patient presented with complete thrombosis of the left common iliac vein down to the popliteal vein. He was treated with catheter directed thrombolysis followed by anticoagulant therapy.     

A case report of right ventricular mass

Primary Cardiac tumors are uncommon during infancy and childhood. Myxomas originating in the right ventricles are even less common in paediatric patient. Our patient baby Rani, 3 months of age presented with shortness of breath and chest indrawing. Antenatal history and delivery was uneventful. The baby was under weight and also malnourished but there was no cyanosis and clubbing. Her respiratory rate was 25/minute. On precordium examination, first heart sound (S1) was normal but pulmonary component of second heart sound (P2) was soft. There was an ejection systolic murmur (Grade-3/6) in the left upper para-sternal area. Chest X-ray revealed cardiomegaly. Echocardiogram revealed a large mass (11x10mm) in the right ventricle, dynamically obstructing the right ventricular out-flow tract and compressing the left ventricle. There was a Tricuspid regurgitation (Grade-2) and moderate pulmonary hypertension (PASP-50 mmHg).     

Cerebral embolism and hyperthyroidism

Three different cases of cerebral embolism occurring in combination with hyperthyroidism are reported. Case 1; a healthy 37-year-old woman presented with sudden onset of left hemiparesis and left sided hypoesthesia of all modalities. Embolism in area of the right middle cerebral artery was confirmed by angiography and CT scan. Laboratory examination revealed hyperthyroidism and anemia. Antithyroid treatment brought about euthyroid function while slight hemiparesis remained present. Case 2; a 79-year-old woman who suffered from hypertension for one year had sudden onset of disorientation and left hemiparesis. Electrocardiogram showed atrial fibrillation. The CT scan indicated infarction in the right anterior and middle cerebral artery. The patient was diagnosed as having masked hyperthyroidism. Although antithyroid medication reduced it to euthyroid condition, the patient is now bedridden with hemiparesis. Case 3; a 45-year-old man who had partial thyroidectomy for Basedow's disease and had been treated with antithyroid and antiarrhythmic therapy for 10 years. Suddenly, he was in coma with dilated right pupil and left hemiplegia. Atrial fibrillation and hypothyroid function were observed. CT scan indicated hemorrhagic infarction in the territory of the middle cerebral artery with transtentorial herniation. He died on the 59th day of hospitalization following an episode of bronchopneumonia. On the basis of the cases presented here as well as on the basis of those described in the literature it appears that thyrotoxic patients with atrial fibrillation exhibit high incidence of cerebral embolism, and prophylactic anticoagulant therapy may be recommended.     

Combined coronary surgery and aortic valve replacement after previous right pneumonectomy

Cardiac surgery in patients with previous pneumonectomy is infrequently reported. We report a case of combined coronary artery bypass grafting and aortic valve replacement in a patient with left ventricular ejection fraction less then 35% and a previous right pneumonectomy. All steps in operative management of this rare condition are discussed.     

大学生左右上臂血压的对比研究

目的 :了解大学生左右臂肱动脉血压有无差异及左右臂血压与左右臂围的相关性 ,并探讨影响左右臂血压的因素。方法 :随机抽取武汉大学第二临床学院在校本科生 2 0 2名 ,其中男生 110名 ,女生 92名。用汞柱台式血压计按标准方法测量左右臂肱动脉血压。结果 :左右臂肱动脉收缩压有显著的统计学差异 ,且右臂高于左臂 (男生P <0 0 1,女生P <0 0 5 ) ,而左右臂舒张压无统计学差异 (男生P >0 0 5 ,女生P >0 0 5 ) ;男生左右上臂臂围与肱动脉SBP分别呈显著正相关 (P <0 0 1) ,女生右臂臂围与右臂肱动脉SBP、DBP分别呈显著正相关 (P <0 0 5 ) ;左右臂围差与左右上臂血压差异无明显相关性 (P >0 0 5 )。结论 :临床测量血压应同时测量左右臂的血压以兹比较     

A rare case of isolated non-compaction right ventricular myocardium

Isolated right ventricular noncompaction （IRNC） is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis. The clinical syndrome includes systolic and diastolic dysfunction： some cases may have ventricular arrhythmias. We report a case of a female with the diagnosis of right ventricular non-compaction myocardium （RVNC） with normal left ventricular systolic function. To the best of our knowledge, there have been no reports of isolated ventricular non-compaction involving only the right ventricular before 2008. and there have only been described in very few cases of newborns and adult patients.     

经左右桡动脉行冠状动脉造影术效果分析

目的 探讨经左右桡动脉行冠状动脉造影术的临床疗效以及两者之间的差异.方法 回顾性分析2015年1月至2016年6月期间在我院行冠脉造影术的500例患者的临床资料,按照入路分为左侧桡动脉100例及右侧桡动脉组400例,比较两组患者的手术成功率、手术相关指标、导管到位所需时间、并发症种类及发生率.结果 右侧桡动脉组患者的成功率为96.25%,左侧桡动脉组成功率为95.00%,两组成功率比较差异无统计学意义(P>0.05);两组患者的手术时间、X线暴露时间及对比剂量比较差异均无统计学意义(P>0.05);左侧桡动脉组导管到位时间比右侧组患者明显较短,差异有统计学意义(P<0.05);两组患者术后并发症种类主要为导管打结、血管痉挛、局部血肿等,右侧桡动脉术后并发症的发生率(24.5%)明显高于左侧桡动脉(4.0%),差异有统计学意义(P<0.05).结论 经左侧桡动脉冠脉造影及右侧桡动脉冠脉造影均有很高的成功率,并且两侧入路的手术相关指标不存在明显的差异,但左侧入路导管造影到位时间更短,同时左侧桡动脉冠脉造影术可以有效降低术后并发症,值得临床推广.     

老年及老年前期先天性冠状动脉畸形(附7例临床分析)

目的探讨老年及老年前期先天性冠状动脉畸形的临床特征及诊疗方法。方法7例患者均行选择性冠状动脉造影及逆行升主动脉造影,然后依具体情况进行内科或外科治疗。结果右冠状动脉开口于左冠状动脉前降支(简称左前降支)2例,其中1例左前降支远段闭塞,另1例有左心功能不全;右冠状动脉缺如伴左前降支狭窄1例;左冠状动脉回旋支(简称左回旋支)起源于右冠状动脉开口处并左前降支心肌桥1例;右冠状动脉右房瘘伴左回旋支狭窄1例;右冠状动脉右室瘘伴左前降支狭窄1例;右冠状动脉左房瘘1例。其中5例患者经内科治疗后胸痛消失或明显减轻,2例经介入或外科手术治疗后症状明显改善。结论老年及老年前期先天性冠状动脉畸形患者,多伴有冠心病,心功能不全等疾病,应加强内科治疗,必要时施行外科手术治疗。     

Transvenous pacemaker electrodes placed unintentionally in the left ventricle: three cases

Three patients are described in whom pacemaker electrodes were unintentionally placed within the left ventricle, followed by considerable delay before the error was recognized. In two cases temporary pacemaker wires were inserted into the subclavian artery and passed along a retrograde course. One patient required urgent surgery for acute arterial obstruction on removal of the wire. In the third case, a permanent wire was inserted correctly into a vein but traversed the atrial septum, probably via a patent foramen ovale, to enter the left ventricle. Twelve lead electrocardiograms in all three patients showed paced complexes with right bundle branch block configuration. This appearance should raise suspicion that the pacemaker electrode might be in the left ventricle, in which case its position should be defined by chest radiographs (including a lateral view) and echocardiography.     

家猪右冠状动脉解剖学观测

目的探讨家猪心脏右冠状动脉的解剖结构,丰富动物实验资料。方法取新鲜家猪心脏46例,用过氯乙烯-乙酸乙酯填充剂灌注冠状动脉,其中40例经1.75 mol.L-1甲醛固定,手工剥制显示右冠状动脉,观察和测量右冠状动脉及其分支;6例经酸腐蚀制作动脉血管铸型,观察冠状动脉的吻合情况及血供范围。结果家猪冠状动脉分为左、右冠状动脉,右冠状动脉较左冠状动脉细小且较浅表,分支有心房支、心室支、窦房结支、房室结支及后室间支等。后室间支多止于后室间沟的上1/3。结论猪心右冠状动脉与人心右冠状动脉有一定的相似性。     

手术治疗Marcus-Gunn综合征(附一例报告)

Marcus-Gunn综合征是一种罕见的眼病,又称下颌瞬目综合征。患眼的提上睑肌与咀嚼肌发生异常联合运动。因发病机理不明,故仅能对症治疗。对于轻症者多主张不予处理,重症者可手术治疗。笔者所见国内先后7例报告症状均较轻,无一例手术治疗。报告一例17岁女性患者,右上睑严重下垂,平视时上睑完全遮盖角膜,极似完全性上睑提肌麻痹。张口时下垂的上睑明显抬起,睑缘位置较健侧为高。咀嚼时,下垂的上睑随下颌运动上下启阖。严重影响容貌。患者迫切要求手术治疗,经施行右上睑异体巩膜额肌悬吊术及上直肌缩短、下直肌后退术后,效果较好,容貌明显改观,认为额肌悬吊术是治疗本综合征的安全、有效的方法。