Improved Surgical Approach to Left Atrial Appendage Aneurysm

Left atrial appendage aneurysm is a rare anomaly, which usually presents with arrhythmia or cerebral embolism. Diagnostic evaluation traditionally required cardiac catheterization, and surgical resection required cardiopulmonary bypass. Utilizing intraoperative transesophageal echocardiography and surgical stapling devices, we have streamlined our operative technique, allowing resection of a left atrial appendage aneurysm without cardiopulmonary bypass. This report of two cases treated over the past decade demonstrates the evolution of our surgical technique.     

Torn Ascending Aorta Missed by Transesophageal Echocardiography

Transesophageal echocardiography has become a commonly used screening tool for traumatic tears of the descending aorta. The role of transesophageal echocardiography for ascending aortic tears is not yet well-defined. We report an ascending aortic tear imaged by aortography but missed on transesophageal echocardiography.     

Atrial Defibrillation:A New Aspect

A previously described method, using two square-shaped pulses for ventricular defibrillation, is tested on atrial conversion. Two main problems are studied experimentally: (1) Synchronization in the ECG cycle, in order to avoid induction of ventricular fibrillation. (2) The atrial defibrillating capacity of the method. The experiments were made in dogs and the method was also tested in man. The results were encouraging.     

左房粘液瘤的外科治疗

目的：总结左房粘液瘤的临床表现，诊断手段及外科手术治疗时机的把握，方法：本组30例术前均由超声心动图诊断，共接受32例次手术治疗，体外循环下平均阻断主动脉23．7（11－40）min。结果：本组患中24例心功能恢复良好，痊愈出院，随访无复发；6例术后早期死亡，死亡原因为心律失常，低心排综合征和多系统器官衰竭，结论：左房粘液瘤为心脏良性肿瘤中常见的类型，把握手术时机，避免肿瘤脱落引起栓塞等并发症的发生是手术成功的重要因素。     

二尖瓣置换术后左心室破裂的预防及治疗

目的分析二尖瓣置换术后左心室破裂发生的基本情况、转归及经验教训,探讨进一步提高诊治技术的方法及目前面临的困难。方法复习上海长海医院1990年1月~2008年12月期间4 489例接受二尖瓣置换及二尖瓣、主动脉瓣联合置换手术患者的临床资料,共有14例（0.3%）发生术后左心室破裂。其中早期破裂6例,延迟性破裂8例,Ⅰ型破裂1例,Ⅱ型破裂5例,Ⅲ型破裂8例。早期破裂6例,均在体外循环心脏停跳下进行修补,3例采用单纯心外缝合修补,3例采用心内及心外联合修补方法。延迟性破裂8例,均在监护室紧急开胸探查证实诊断,6例在床边缝合修补,2例暂时控制出血后回手术室修补,修补方式均为单纯心外修补。7例（50.0%）1次修补成功,因修复难度较大导致4例（28.6%）进行了2次修补,3例（21.4%）进行了3次及以上修补。结果 12例死亡,2例存活,存活者均为早期破裂患者,且均为采用心内及心外联合修补法的患者。结论对于左心室破裂的防治目前仍以预防为主,早期性破裂患者可综合应用多种方法提高治疗成功率,延迟性破裂者生存率极低,是目前治疗上面临的主要难题,尽早控制出血并恢复重要器官的血流灌注为改善预后的关键。