经胸超声心动图在小儿冠状动脉瘘诊疗中的应用

目的探讨经胸超声心动图(TTE)在小儿冠状动脉瘘(CAF)诊疗中的价值。方法回顾性分析27例小儿CAF患者,分析其临床症状、TTE检查结果、其他影像学检查结果、治疗方案及随访情况。结果27例CAF患者中,74.07%(20/27)有心脏杂音,14.81%(4/27)有临床症状。7.41%(2/27)出现左心室射血分数减低。55.56%(15/27)的CAF为单纯型;62.96%(17/27)的CAF起源于右冠状动脉,33.33%(9/27)起源于左冠状动脉,而3.70%(1/27)起源于双侧冠状动脉。CAF的瘘道出口可能出现在右心室(13/27,48.15%),肺动脉(6/27,22.22%),右心房(5/27,18.52%),左心室(2/27,7.41%)或冠状静脉窦(1/27,3.70%)。17例患者接受外科手术治疗,1例患者接受介入封堵治疗。TTE精准诊断19例CAF。对于9例接受保守治疗的患者,于诊断后1、3、5年进行随访,未发现自发性闭合、心力衰竭、感染性心内膜炎或死亡病例。结论 TTE安全、有效,可用于筛查、诊断CAF,及评价治疗效果和并发症。     

18例先天性冠状动脉瘘手术治疗体会

目的 总结先天性冠状动脉瘘(coronary artery fistula,CAF)的手术治疗方法及预后。方法 回顾分析2011-01-2015-01间手术治疗的18例先天性冠状动脉瘘患者的临床资料、手术方法及预后。结果 15例在体外循环下行经心腔瘘口关闭术,2例在非体外循环下行冠状动脉下切线褥式缝合,1例在体外循环下行冠状动脉切开修补术。术后随访6个月~3 a,效果良好。所有患者在随访期间症状消失,心功能恢复Ⅰ级,心胸比例趋于正常,心电图改善,能正常工作、生活。结论 冠状动脉瘘手术治疗安全有效,远期效果好。     

Spontaneous coronary artery rupture treated on a beating heart

Primary spontaneous coronary artery rupture (SCAR) without any underlying condition is a rare disorder. The acute and often dramatic nature of hemopericardium with cardiac tamponade advocates immediate pericardial drainage or surgical intervention with timely recognition of coronary artery rupture. This is the first case report of primary SCAR successfully treated on a beating heart without cardiopulmonary bypass.     

Spontaneous right coronary artery pseudoaneurysm

A 67-year-old man who had no history of coronary artery disease was found to have electrocardiographic abnormalities. Coronary angiography showed a proximal coronary artery aneurysm and total occlusion of the distal right coronary artery. He underwent coronary artery bypass grafting and repair of the right coronary artery aneurysm. The pathology of the resected aneurysm wall was compatible with a diagnosis of coronary pseudoaneurysm. Spontaneous coronary artery pseudoaneurysm is a rare condition that has the potential risk of rupture or ischemia. Surgical repair and adequate coronary revascularization are reasonable for a possible coronary artery pseudoaneurysm.     

Congenital left circumflex artery fistula drainage into left ventricle

Congenital communication between left coronary artery to left ventricle is a rare anomaly. A 52-year-old male patient visited our institution complaining of paroxysmal palpitation and echocardiography revealed a large fistula draining into the left ventricle. Coronary angiography and computed tomography (CT) scanning confirmed the fistula located between the left circumflex coronary artery (LCX) and left ventricle (LV). A simple fistula ligation was performed, and postoperative three-dimensional coronary CT scanning confirmed the patient got a complete cure.     

冠状动脉瘤的外科治疗

目的 介绍冠状动脉瘤的临床表现及治疗经验。方法 1996年10月－2000年5月,对6例患者行冠状动脉瘤手术,3例为川崎病,3例为冠状动脉瘘;均行冠状动脉旁路移植术,3例冠状动脉瘘患者同时切除冠状动脉瘤,修补冠状动脉瘘口,1例行主动脉瓣置换术。结果 6例患者无住院死亡和严重并发症。随访无异常。结论 冠状动脉瘤是一较为罕见的心脏病,预后差,应尽早手术治疗。手术原则是切除冠状动脉瘤,行冠状动脉旁路移植术并处理好合并病变。     

Double right coronary artery; fistula and atherosclerosis

Combination of the primary congenital coronary artery anomalies, fistula and atherosclerosis rarely occur. We report a 50-year-old male who presented with severe chest pain, for which he underwent a coronary angiography. Injection into the right coronary artery (RCA) demonstrated a double RCA running very closely together in the atrioventricular groove. The superior one gave rise to a coronary fistula leading to the right ventricle and the inferior one was atherosclerotic. Both of them terminated as a posterior descending artery. The left system showed occlusion of the left anterior descending and major obtuse marginal. Both were corrected surgically.     

Development of a fistula between an internal mammary artery graft and the pulmonary vasculature following coronary artery bypass grafting: Report of a case

We report herein the rare case of a 56-year-old man who gradually developed congestive cardiac failure 6 months after undergoing coronary artery bypass grafting and was found to have a fistula between the internal mammary artery and the pulmonary artery of the upper lobe diagnosed by selective left internal mammary arteriogram. A second sternotomy was performed and demonstrated dense adhesion between the fissure surrounding the internal mammary artery and the upper lobe, and the fistula was resected. We believe that the patient's increasing cardiac failure was almost certainly caused by coronary steal.     

Surgical repair of coronary artery to pulmonary artery fistula with aneurysms

A 58-year-old female was referred to our hospital with an abnormal shadow on her chest X-ray. Further examination revealed the left anterior descending coronary artery to pulmonary artery fistula with aneurysms. The patient was successfully repaired with operation and had no residual fistulas and aneurysms.     

Post-coronary artery bypass grafting left internal mammary artery to pulmonary artery fistula: a 6 year follow-up following successful surgical division

We report a case of young male patient who developed left internal mammary artery to pulmonary artery fistula 9 years following the coronary artery bypass grafting operation. The clinical signs and symptoms were very subtle including recurrence of angina and heart murmur. Surgical division of the fistula and re-grafting of blocked coronary arteries resulted in satisfactory long term outcome.     

巨大冠状动脉瘤的外科治疗

目的探讨巨大冠状动脉瘤的临床特点和外科治疗要点。方法1996年7月至2004年10月,共手术治疗6例巨大冠状动脉瘤。外科治疗方法采用冠状动脉瘤切除术3例,同期冠状动脉旁路移植术2例、冠状动脉瘤成形术3例。巨大冠状动脉瘤常合并其他心血管疾病,同期行冠状动脉瘘修补手术4例,主动脉瓣置换术3例,主动脉成形术2例,冠状动脉瘤血栓清除术1例。结果所有患者均康复出院,平均体外循环时间(144±26)min(67～207min)。主动脉阻断时间(104±21)min(56～172min)。患者随访8～87个月(平均48个月)。随访中患者症状均消失,无死亡和冠状动脉瘤复发病例。结论巨大冠状动脉瘤是一种严重的心血管疾病,应及时手术治疗。     

冠状动脉内膜剥脱联合旁路移植治疗弥漫性冠状动脉狭窄病变的近中期效果

目的探讨冠状动脉内膜剥脱术(CE)联合冠状动脉旁路移植术(CABG)治疗弥漫性冠状动脉狭窄病变的近中期效果。方法回顾性分析2010年1月至2019年1月在南京市第一医院心胸血管外科接受CE+CABG的248例弥漫性冠状动脉狭窄病变患者的临床资料。男性201例,女性47例;年龄(65.6±8.5)岁(范围:43~79岁)。体外循环手术156例,非体外循环手术92例。共对269根病变血管完成CE,包括前降支108根,右冠状动脉140根,钝缘支21根。共完成旁路移植872支,包括左胸廓内动脉248支,桡动脉48支,大隐静脉576支,每例患者移植(3.5±0.8)支(范围:2~6支)。CE后平均血流量为(26±8)ml/min(范围:13~59 ml/min),血流指数为3.1±0.8(范围:2.0~6.7)。采用t检验或χ²检验比较体外循环和非体外循环患者的手术结果及术后通畅率。结果全组围手术期病死率为1.2%(3/248),2例死于肾功能衰竭,1例死于术后顽固性低心排血量。9例发生围手术期心肌梗死。随访(41.8±21.4)个月(范围:1~68个月)。旁路血管术后1年通畅率为78.4%(182/232),3年通畅率为69.8%(162/232)。左冠状动脉系统通畅率明显高于右冠状动脉系统(1年:87.4%比73.1%,χ²=6.533,P=0.011;3年:78.2%比64.8%,χ²=4.588,P=0.032)。体外循环组和非体外循环组旁路血管通畅率无差异(1年:80.0%比76.9%,χ²=0.277,P=0.599;3年:71.5%比67.9%,χ²=0.300,P=0.584)。结论CE+CABG治疗弥漫性冠状动脉狭窄病变可以获得较满意的完全再血管化,有较好的早、中期效果和旁路血管通畅率。体外循环和非体外循环手术具有相似的早中期结果。     

冠状动脉病变程度与冠心病危险因素的相关分析

目的探讨冠心病患者冠状动脉病变的严重程度与冠心病危险因素的关系。方法选择冠心病患者116例为冠心病组,选择冠状动脉样硬化狭窄程度〈50%的患者66例为对照组。分析冠状动脉狭窄程度与冠心病危险因素的关系。结果多因素分析结果显示,LVEF、Ccr与冠状动脉粥样硬化程度呈负相关,而hs-CRP与冠状动脉粥样硬化程度呈正相关（P〈0.05或P〈0.01）。结论冠状动脉狭窄程度与LVEF、Ccr呈负相关,与hs-CRP呈正相关。     

Surgical treatment of a left anterior descending artery to the main pulmonary artery fistula

We report a case of surgical treatment of a 58-year-old symptomatic patient with large coronary artery fistula, which drained from the left anterior descending artery into the main pulmonary artery (PA), and concomitant large patent foramen ovale. The surgery was performed through a median sternotomy with aortobicaval total cardiopulmonary bypass. The PA was incised. The fistula was identified 5 mm above the anterior leaflet of the pulmonary valve and was closed off using a prolene suture. Afterward, the atrium septum defect was closed with a Dacron patch via the standard right atrium access. There were no postoperative complications.     

Spontaneous coronary artery dissection in a parturient with Nail–Patella syndrome

Spontaneous coronary artery dissection is an uncommon cause of acute coronary syndrome, occurring predominantly in women during and immediately after pregnancy; it carries a mortality rate of greater than 50%. While the exact etiology is unknown, possible contributing factors include pregnancy-related hormonal, connective tissue and hemodynamic changes. We present a case of a 35-year-old multigravid woman with Nail–Patella syndrome who developed an acute myocardial infarction secondary to spontaneous coronary artery dissection during labor which was not diagnosed until after delivery. We hypothesize that abnormal collagen fiber formation found in Nail–Patella syndrome may have put her at an increased risk of coronary dissection and myocardial infarction. Regardless of etiology, a delay in diagnosis of myocardial ischemia can lead to significant morbidity and mortality. In light of the increasing burden of cardiac disease in the obstetric population, clinicians should remain vigilant for signs of myocardial infarction and prepare for definitive diagnosis and treatment.     

The blue man: an unusual happy end of a spontaneous rupture of a coronary artery

We report the case of spontaneous rupture of a coronary artery. It was that of a 56-year-old man admitted for dyspnoea and anterior thoracic pain. The most striking feature on physical examination was the marked cyanosis of his face, upper part of the thorax and the upper limb. The patient was haemodynamically unstable with tachycardia and hypotension. Cardiac tamponade was confirmed by echocardiography and computed tomography of the thorax. The patient was transferred for surgery. Emergency sternotomy revealed pericardial bloody effusion and a continuous bleeding around the posterior interventricular artery. No other perioperative findings could explain the haemopericardium. Haemostasis was obtained by a suture of the bleeding coronary artery.