动静脉内瘘对维持性血液透析患者左心室结构及功能的影响

目的：探讨动静脉内瘘对维持性血液透析（血透）患者左心室结构及功能的影响。方法：观察44例血透患者治疗前及治疗后12个月、24个月时的血红蛋白水平、透析间期体重增长量、血压、内瘘吻合口直径、血流量、左心室结构及功能等指标。第24个月根据患者内瘘血流量的大小分为低血流量组（A组＜900ml/min)及高血流量组（B组≥900ml/min)。结论：随血透时间的延长，左心室舒张末内径（LVDd)、室间隔厚度（IVST）及左心室心肌重量指数（LVMI）逐渐增大，心胸比例提高，以血透治疗后24个月高血流量组（B组）显著，左心收缩及舒张功能以射血分数（EF）及舒张早期及晚期最大血流速度比（E／A）变化明显。A、B两组重度水钠潴留者的心胸比例、LVDd及LVMI高于同组的轻度水钠潴留者，E／A低于轻度水钠潴留者。相关分析提示，内瘘血流量与LVDd、LVMI呈明显正相关（均P＜0．05），与EF及E／A呈负相关（P＜0．05），而在左心室收缩末内径（LVDs)、短轴缩短率（FS）及等容舒张时间（IRF）无显著相关性。结论：较高的内瘘血流量与左心室结构及功能的变化有关，水钠潴留有协同作用。     

Congenital right coronary artery aneurysm with fistula to right ventricle associated with isolated pulmonary valvular stenosis

Congenital aneurysmal dilatation of coronary artery with coronary cameral fistula is rare in childhood. We report an even rarer association of congenital right coronary artery aneurysm and right coronary artery to right ventricle fistula with bicuspid pulmonary valve stenosis and an intact ventricular septum in a 3-year-old child.     

Surgical management of a gigantic circumflex coronary artery aneurysm with fistulous connection to the coronary sinus

We report the successful management of a gigantic circumflex coronary artery aneurysm with fistulisation into the coronary sinus. Transoesophageal echocardiography allowed continuous visualisation of ventricular wall motion during dissection and closure of the aneurysm whilst operating on cardiopulmonary bypass on the beating heart.     

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.     

Congenital atresia of the left main coronary artery: management of a 5-year-old child in extremis

Atresia of the left main coronary artery is a rare coronary anomaly. We describe the case of a 5-year-old child presenting in emergency in extremis. Clinical findings of haemodynamic collapse, malignant ventricular tachyarrhythmias and severe mitral regurgitation were indicative of a possible ischaemic aetiology. Surgical revascularization of the atretic left main coronary artery segment using an interposition autologous saphenous vein graft was successfully performed.     

Coronary artery fistula into a persistent left superior vena cava: Report of a case

We herein report the rare case of a patient with coronary artery fistula (CAF) between the left circumflex coronary artery and persistent left superior vena cava (PLSVC) with a complete absence of the right superior vena cava (SVC).     

Congenital fistula of the right coronary artery-left ventricle

While the incidence of right coronary artery-left ventricle fistulae is low, cardiac catheterization, ascending aortogram and selective coronary angiogram led us to suspect the presence of such a fistula in a 10-year old female patient. Arteriorrhaphy with additional ligation was performed and the patient is in good health more than one year after surgery.     

Congenital left atrial appendage aneurysm with unexpected course of left anterior descending coronary artery

The left atrial appendage (LAA) aneurysm is a rare condition that can produce local compressive effects and complications including supraventricular tachyarrhythmias, thromboembolic events and myocardial ischaemia. We present a rare case of a neonate with a congenital LAA aneurysm which resulted in local compressive effects on the left ventricle, severe mitral regurgitation and malposition of the left anterior descending (LAD) coronary artery. Intraoperatively, the LAD was found to be within the aneurysmal wall exterior to the left ventricular epicardium and was inadvertently injured during LAA aneurysm resection. Retrospective review of the preoperative computed tomography and echocardiography scans demonstrated the LAD lying within the wall of the LAA aneurysm, although this had not been well appreciated at that time. This highlights the importance of thorough multimodal preoperative imaging and intraoperative assessment for recognition of this rare association between the LAA aneurysm and LAD malposition, and prevention of inadvertent LAD injury during aneurysm resection.     

Congenital coronary artery fistulas: clinical considerations and surgical treatment

BACKGROUND: Coronary artery fistulas are uncommon abnormalities that can cause significant cardiac morbidity. Indications for operation vary, particularly, for asymptomatic patients. Early surgical correction is indicated because of the high incidence of late symptoms and complications. METHODS: From January 1981 to December 2001, all 15 patients who underwent surgical management of congenital coronary artery fistulas at the Tri-Service General Hospital, Taipei, Taiwan, China were included in the present retrospective study. RESULTS: Twelve patients were symptomatic at the time of the diagnosis. Coronary artery fistulas involved the right coronary artery in five patients, left coronary artery in nine, and both the right and the left coronary arteries in one. Coronary artery fistula drained into the right ventricle in seven patients, right atrium in three, pulmonary artery in two, left ventricle in one, left atrium in two, and coronary venous sinus in one. The value of pulmonary blood flow/systemic blood flow ranged from 0.98 to 2.1. Six patients had associated cardiac anomalies. All patients received surgical correction. Nine patients received cardiopulmonary bypass during operation. There was zero operative mortality and operative morbidity was low. All patients had a stable condition and were asymptomatic during a mean postoperative follow-up of 13.3 years. CONCLUSIONS: Early surgical treatment for coronary artery fistulas is safe and effective. The risk of operative correction appears to be considerably less than the potential for development of serious and potentially fatal complications, even in asymptomatic patients.     

旋肩胛动脉升支的解剖学研究

为明了旋肩胛动脉升支的解剖,在20例尸体40侧行旋肩胛动脉血管造影观察,发现旋肩胛动脉浅支的分支升、横、降三支的出现率均为100%。其中升支的出现情况可分为三种类型:Ⅰ型,由旋肩胛动脉主干发出,4例4侧,占10%。Ⅱ型,由旋肩胛动脉浅支分出,20例36侧,占90%。Ⅲ型,升支为两支型,10例12侧,占30%。并发现升支自发出后向内上方斜行,达到或超过肩胛岗,与肩胛上动脉、颈横动脉、胸肩峰动脉的分支形成丰富的岗上血管网,为临床上设计超过肩胛岗以上的肩胛皮瓣提供了解剖学依据。     

冠状动脉旁路移植术患者左心室舒张功能的初步评估

目的 评价冠状动脉旁路移植术（CABG）患者左心室舒张功能（LVDF）.方法 采用经食管超声心动图（TEE）技术观察46例不停跳CABG（OPCABG）患者手术前后LVDF的变化.结果 与术前比较，术后经二尖瓣尖脉冲多普勒血流频谱（TMF）的舒张早期充盈波（E波）和舒张晚期充盈波（A波）流速显著加快（P＜0.01）；E波血流时间积分（VTIE）和A波血流时间积分（VTIA）显著增加（P＜0.05或P＜0.01）；E波减速时间（DT）和加速时间（AT）显著缩短（P＜0.05或P＜0.01）；而E/A、A波间期和舒张早期充盈分数（RFF）值差异无统计学意义.术后经左上肺静脉血流频谱（PVF）的S、D和AR波的流速显著加快（P＜0.01）；而S/D、AR波间期和AR-A（AR波间期与A波间期之差）差异无统计学意义.面积减少分数（FAC）和心排血量（CO）显著增加（P＜0.01）.PCWP与AR波直线回归方程：PCWP=2.6＋0.4 AR.结论 CABG患者普遍存在以左心室松弛功能减低为主的舒张功能不全，术后早期收缩功能迅速改善，但舒张功能不全依然存在.TEE可区分心脏的收缩和舒张功能.     

Images in cardiovascular medicine voluminous left main stem to pulmonary artery fistula: A conservative approach

The presence of a coronary arteriovenous fistula is almost rare in the adult population, even rare when associated with aortic valve insufficiency. Management and treatment options can vary and depend on a single patient. In our case, a large fistula with a rounded origin started from the roof of the left main stem, just attached to the wall of the aortic root, and finished with a very narrowed end in the pulmonary trunk. Due to its anatomical position and to the potential complications related to a proximal surgical closure as well as the incidental discovery in adult age (without signs or symptoms until the operation), we decided to have a conservative approach, leaving untouched the fistula. No intraoperative, perioperative, and follow-up signs of myocardial ischemia were observed.     

旋肩胛动脉升支的解剖学研究

为明了旋肩胛动脉升支的解剖，在２０例尸体４０侧行旋肩胛动脉血管造影观察，发现旋肩胛动脉浅支的分支升、横、降三支的出现率均为１００％。其中升支的出现情况可分为三种类型：Ｉ型，由旋肩胛动脉主干发出，４例４侧，占１０％。Ⅱ型，由旋肩胛动脉浅支分出，２０例３６侧，占９０％。Ⅲ型，升支为两支型，１０例１２侧，占３０％。并发现升支自发出后向内上方斜行，达到或超过肩胛岗，与肩胛上动脉、颈横动脉、胸肩峰动脉的分支形成丰富的岗上血管网，为临床上设计超过肩胛岗以上的肩胛皮瓣提供了解剖学依据。     

Successful surgical management for aneurysms of single coronary artery with a fistulous connection to the right ventricle

While a coronary artery fistula with aneurysmal formation is rare, a fistula/aneurysm combination occurring in single coronary artery is even rarer. Here, we report the successful surgical correction of a right ventricular fistula with a large aneurysm of 30 mm and a daughter aneurysm within a case of single coronary artery.     

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.     

Right coronary artery to left carotid artery collateral in the absence of stenosis

Anomalies as well as variations of vascular structures are widely diagnosed with today's advanced diagnostic tools and healthcare screening programs. Collateral formation is a well known phenomenon in the presence of stenosis or occlusion to provide blood flow to the distal vasculature. In this report, we present the image of a collateral between the left common carotid artery and right coronary artery in the absence of significant stenosis.