Compression of the common bile duct by the posterosuperior pancreaticoduodenal artery: case report

We describe a unique case of a patient who presented with a linear, transverse filling defect in the common bile duct, detected by cholangiography, that was caused by the posterosuperior pancreaticoduodenal artery compressing the common bile duct associated with gallstones. We believe this case to be the first of its kind reported in the literature.     

Anomalous origin of the left coronary artery from the pulmonary artery: mid-term results after surgical correction

Objectives Children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) are at risk for myocardial infarction and death. This retrospective study shows the mid-term follow-up after the use of aortic implantation and alternative methods to achieve coronary transfer. Methods Since 1990 seven consecutive children underwent primary repair of ALCAPA. Age at operation ranged from 2 to 71 months (median 11 months). Operative techniques included ligation (n = 1), intrapulmonary tunnel (n = 1), and aortic implantation (n = 5). One patient with severe mitral valve incompetence underwent additional mitral valve replacement. A 4-month-old patient was successfully treated after the operation with a left heart assist device. Results One death in the series occurred at 2 weeks after intrapulmonary tunneling. The mid-term results were evaluated in the six survivors with a follow-up mean of 98 months (ranged 58–168). In all surviving patients with two-vessel coronary blood supply, left ventricular end-diastolic volume and left ventricular ejection fraction returned to near normal values 2–12 months postoperatively. The mitral valve incompetence decreased in all patients with a native mitral valve. One patient with coronary ligation showed severe mitral valve regurgitation and received additional mitral valve replacement concomitantly. Six years after primary valve replacement of a 21 mm SJM (Saint Jude Medical) a change of the mechanical valve to a 27 mm valve was necessary because of development of severe stenosis due to growth. Conclusions It is always preferable to establish an antegrade flow of oxygenated blood through the coronary arteries and to create a two-coronary artery system. Mitral valve annuloplasty or replacement may be necessary for patients with severe mitral valve incompetence.     

冠状动脉搭桥手术24例临床分析

目的总结冠状动脉搭桥手术的临床经验及远期疗效.方法施行冠状动脉搭桥术24例,在中度低温体外循环下手术, 游离左乳内动脉和大隐静脉,胸骨正中切口建立体外循环,在并行循环下分离出冠状动脉吻合部位,行冠状动脉搭桥术.急症手术2例,常温不停跳非体外循环冠状动脉搭桥术4例,其中用左前外侧小切口乳内动脉-左前降支搭桥2例.结果全组搭1支桥3例、2支桥6例、3支桥15例,平均搭桥2.5支.LIMA桥20支,桡动脉桥3支,RIMA桥1支.用静脉桥作Y型桥吻合并序贯搭桥6例, 全静脉桥4例,全动脉桥3例,包括1例双侧乳内动脉搭桥,左桡动脉搭桥3例,全动脉化搭桥均应用了乳内动脉和左桡动脉3例, 部分年龄大于75岁者用全静脉桥.20例主动脉阻断时间31～124分钟,平均67分钟,转流时间45～321分钟,平均96分钟.术后因呼吸衰竭带呼吸机大于1周、气管切开并肺部感染、胸骨裂开前纵隔感染5例;行再次清创缝合固定胸骨治愈3例,其中1例肺部严重感染、大量痰液经气管造瘘口窜入胸骨后导致严重感染,监护室监护1个月治愈出院;上消化道出血3例,其中大出血死亡1例;其余病人无心绞痛症状,心功能恢复到I～II级,顺利出院,无远期死亡.结论:冠状动脉搭桥手术比较安全,并发症发生率不高,文献报道手术死亡率1.7%～3.3%, 本组死亡率4%.     

经皮冠状动脉介入治疗冠状动脉复杂病变的临床研究

目的 探讨经皮冠状动脉介入治疗用于冠状动脉复杂病变(CAD-CL)的临床疗效.方法 回顾性分析2002年8月至2008年9月我院对252例CAD-CL患者进行介入治疗的成功率、并发症及预后方面的临床资料.结果 244例CAD-CL(包括慢性闭塞、分叉病变、长病变和再狭窄)患者成功置入支架(244/252,96.83%),无残余狭窄或残余狭窄<20%.32例患者放置支架后出现侧支血管阻塞,48例出现动脉夹层,15例支架内形成再狭窄,未见其他严重并发症.1例急性前壁心肌梗死并发心源性休克患者,前降支置入2枚支架后仍处于低血压状态,经临时起搏器置入等积极抢救无效死亡,1例于术后第3天发生支架内亚急性血栓形成后经急诊PCI治疗闭塞血管再通,痊愈出院.结论 经皮冠状动脉介入治疗对冠状动脉复杂病变是安全有效的.     

Mycotic aneurysm of the inferior pancreaticoduodenal artery: successful nonoperative management

Although mycotic aneurysms of small visceral arteries are rare, they have a high morbidity and mortality due to rupture and sepsis. Any patient with abdominal pain and bacterial endocarditis should be suspected of having a mycotic aneurysm. Selective arteriography confirms the diagnosis. In the case we have reported, diagnosis of a mycotic aneurysm of the inferior pancreaticoduodenal artery was established by angiography, and the patient was treated by percutaneous transcatheter embolization. This case demonstrates that mycotic aneurysms of small visceral arteries may be managed nonoperatively with antibiotics and percutaneous transcatheter embolization therapy.     

非体外循环下冠状动脉搭桥术在高危老年冠心病患者中的应用

目的总结非体外循环下冠状动脉搭桥术(OPCABG)在高危老年冠心病患者中的应用经验。方法 2005年1月至2009年12月对23例高危老年冠心病患者行OPCABG治疗。手术在常温全麻下进行,采用前胸正中切口显露心脏。2例直接采用大隐静脉(SV)行SV-左前降支(LAD)搭桥;9例取乳内动脉(IMA)和SV,行IMA-LAD、升主动脉-SV序贯搭桥;12例取IMA和SV,行IMA-LAD、升主动脉-IMA搭桥。结果全组手术均顺利完成,无转体外循环完成手术者;总共搭桥74条,平均每例搭桥3.1条;早期死亡1例,出现呼吸衰竭1例,急性左心衰1例,术后出血二次开胸手术2例,胸骨感染1例;术后心绞痛完全缓解20例,明显缓解2例。结论高危老年患者行OPCABG是一种安全、有效的方法 ,特别对一些不能耐受体外循环的患者是一种可行的方法 。     

Surgical repair of a coronary artery aneurysm associated with coronary artery fistula – a case report

Coronary artery aneurysm is a relatively rare disorder that is usually discovered as a secondary finding in patients undergoing coronary artery angiography. Coronary artery fistulas are relatively more frequent than rare aneurysms and are often associated with other cardiac abnormalities. The etiology of aneurysms is mostly atherosclerotic, and they are less frequently associated with other acquired or congenital diseases, such as Kawasaki disease, connective tissue diseases, septic emboli, arteritis, and iatrogenic disease. We report a 70-year-old woman with a rare combination of a coronary artery aneurysm associated with a coronary artery fistula, which drained into the pulmonary artery. The diagnosis of our patient was made by selective coronary angiography and confirmed by computed tomography angiography. The patient was treated surgically because of the symptomatic course of the disease.     

颅内外动脉多支架置入术后并发症观察及护理

目的探讨颅内外动脉多支架置入与单支架置入术,术后并发症及其护理是否存在差异。方法58例颅内外动脉狭窄支架置入术后患者,根据支架置入枚数分组,进行并发症发生率比较。结果58例患者术后并发症发生率包括穿刺点渗血及淤斑8.6%、穿刺部位局部血肿17.2%、假性动脉瘤8.6%、短暂性脑缺血发作8.6%、脑梗死6.9%、脑出血1.7%、静脉血栓形成1.7%。置入不同数目的颅内外动脉支架各组并发症发生率差异无统计学意义（P〉0.05）。结论颅内外动脉多支架置入术后并发症与支架植入数目多少无关。正确认识并及时处理并发症是颅内外动脉多支架置入术后护理的重要内容。     

破裂和未破裂椎动脉瘤的血管内治疗

目的分析破裂与未破裂椎动脉瘤的成功血管内治疗。方法以在新乡市中心医院接受治疗的63例患者（共有65个椎动脉瘤,包括急性夹层和慢性大型动脉瘤）为分析对象,运用改良Rankin量表对临床结果进行评分。其中对44例患者进行了血管造影随访,为期3～16个月（平均8个月）。结果依据Hunt和Hess分级标准,未破裂动脉瘤34例,1级动脉瘤28例,2级动脉瘤1例。其中小脑后下动脉（PICA）远端动脉瘤25例,PICA近端动脉瘤22例,椎动脉-小脑后下动脉（VA-PICA）动脉瘤18例。63例患者中女12例,男51例。平均年龄为41.7岁（6～77岁）。63例患者中44例进行了血管造影随访。其中39例可以依据早期治疗后的血管造影片来确诊完全或基本完全的血栓形成。3例患者观察到了病灶轻微减小,而2例患者存在显著的残留病灶。临床随访表明90.5%的患者为mRS为0～2,4.8%的患者为mRS〉2,以及4.8%的患者死亡（mRS为6）。1例患者死于再次出血,2例患者死于或进展性占位效应/脑干局部缺血。结论使用血管内技术可以很好地治疗破裂与未破裂的椎动脉动脉瘤,90.5%的患者长期治疗效果良好。     

Replaced or right accessory hepatic artery: Can ultrasound replace angiography?

The accuracy of ultrasonography in detecting the right hepatic artery was prospectively assessed in 128 patients undergoing abdominal angiography. Twenty-five (19%) of the ultrasound studies were technically inadequate mainly because of gas superimposition. Of the remaining 103 cases, 14 had a replaced hepatic artery, which was diagnosed in 10 cases with ultrasound (sensitivity 71%). Eighty-nine did not have a replaced hepatic artery and the ultrasound assessment was falsely positive in four of them (specificity 96%). Two of the four false negative results could be explained by a stenosis of the superior mesenteric artery in front of the origin of the replaced hepatic artery. Two of the four false positive results could be explained by the presence of a stenosis of the celiac trunk with hypertrophy of the pancreaticoduodenal arteries, one of them being misdiagnosed as a replaced hepatic artery.     

经桡动脉途径行冠状动脉介入治疗手部的观察及护理

目的 探讨减少经桡动脉途径行冠状动脉介入治疗术后患者不适及严重并发症的护理方法。方法 对105例患者按常规方法进行桡动脉穿刺及冠状动脉造影及介入治疗。术前、术中、术后进行针对性的心理护理及观察术侧上肢的皮肤颜色、血氧饱合度、腕围变化等方面的护理。结果 所有病例均顺利完成介入诊疗手术,术后1例患者发生术侧上肢肿胀明显,经减压、抬高手臂或上举及拆除包扎后得到改善,无一例手部发生缺血性坏死及其他并发症。结论 有针对性地观察和预防性的护理,对于减少经桡动脉途径进行冠状动脉介入治疗术后患者明显不适及防止严重并发症的发生起到了不可缺少的作用,可以提高护理质量。     

Case of laparoscopic right hemicolectomy for ascending colon cancer after aortic graft replacement and revascularization of the superior mesenteric artery

A 67‐year‐old man who presented with a bloody stool was diagnosed with ascending colon cancer. He had previously experienced thoracic and abdominal aortic dissections, which were treated with thoracic and abdominal aortic grafts and superior mesenteric artery revascularization. We performed a laparoscopic right hemicolectomy with a D3 lymph node dissection. During the laparotomy, we identified the superior mesenteric artery and an enlarged anterior superior pancreaticoduodenal artery. Injury to the latter artery could lead to severe ischemia in multiple organs; therefore, it was crucial to identify the primary feeding artery and vascular anatomy before and during surgery. We chose the laparoscopic right hemicolectomy to avoid injuring the anterior superior pancreaticoduodenal artery and the intra‐abdominal abscess. This case study was the first to describe a laparoscopic hemicolectomy after thoracic and abdominal aortic grafts and superior mesenteric artery revascularization.     

共用型造影导管在经桡动脉行冠状动脉造影的应用

目的探讨使用4F、5F共用型导管经桡动脉径路冠状动脉造影的可行性。方法入选2004年11月至2005年6月，在我院行择期经桡动脉径路冠状动脉造影65例患者，术前给予阿司匹林、波立维等抗血小板药物。并进行Allen试验，穿刺右侧桡动脉。选择Temm04F、5F共用型造影管，当使用共用型造影管难以完成时换用Judkins造影导管。结果64例患者经桡动脉穿刺成功，成功率98．4％，1例改为肱动脉穿刺成功。冠状动脉造影正常18例，冠状动脉造影异常48例，行冠状动脉介入治疗19例。结论经桡动脉行冠状动脉造影，使用共用型导管操作较简单，节省时间，较易进入左冠状动脉口，造影成功率高，本组不论选择4F或5F共用型造影导管均顺利完成左冠状动脉造影，但使用其做右冠状动脉造影需要一定经验和技巧。若难以完成时核用JudkinsR型造影导管，本组未发生桡动脉痉挛现象。1例出现前臂血肿，未经特殊处理，自行吸收，2例加压不当，引起手部浮肿。总之，使用共用型造影管经桡动脉径路冠状动脉造影，操作简便快速，病人痛苦少，安全有效，成功率高，值得临床推广应用。     

Spontaneous coronary artery dissection causing acute coronary syndrome: an early diagnosis implies a good prognosis

Spontaneous coronary artery dissection is an unusual cause of acute coronary syndrome. We describe a series of cases that with an early diagnosis and aggressive treatment, which includes percutaneous angioplasty with stent implantation and cardiac surgery, had a good outcome. The objective was to study the demographic characteristics, clinical settings, treatments, and inhospital course of patients with spontaneous coronary artery dissection. We studied a retrospective case series in 3 coronary care units in third-level university hospitals. The spontaneous coronary artery dissection diagnosis was made by coronary angiography. Seven cases of spontaneous coronary artery dissections were recorded. They were 5 women and 2 men. The age range was 28 to 64 years. Two of them took oral contraceptives and one case occurred in the postpartum period. An acute anterior wall myocardial infarction was the most frequent clinical presentation, occurring in 4 of the 7 cases. In fact, the left anterior descending artery was involved in 6 cases. An urgent coronary angiogram was performed in all cases. Definitive treatment included percutaneous angioplasty and stent implantation in 3 cases, coronary artery bypass surgery in 2 case, and cardiac transplantation in another case. One patient was treated medically. None of the patients died in the hospital. Spontaneous coronary artery dissection remains an unusual cause of acute coronary syndrome. It should be included in the differential diagnosis of acute myocardial infarction, especially when it affects young, healthy females. An early clinical suspicion and diagnosis with urgent coronary angiography and aggressive treatment that includes percutaneous angioplasty with stent implantation and cardiac surgery could improve the prognosis of these patients.     

超声心动图在冠状动脉瘘封堵术中的应用价值

目的探讨经胸超声心动图(TTE)在指导经心导管介入治疗冠状动脉瘘(CAF)中的临床价值,以提高介入治疗的成功率。方法 TTE筛选符合介入治疗条件的10例CAF患者行经导管封堵术。术中数字减影血管造影结合TTE全程监测,封堵术后TTE复查以判断疗效。结果 9例在超声指导下一次介入封堵成功,均未见残余分流,1例选用10/12 mm动脉导管封堵器后仍有中量残余分流而放弃封堵,择期行二次介入手术,选用12 mm室间隔小腰大边封堵器,封堵成功。结论 TTE对于介入治疗CAF术前病例选择、术中指导监测及术后疗效评价均有较好的应用价值。     

成人肝移植术后肝动脉并发症的介入治疗疗效分析

目的探讨肝移植(LT)术后肝动脉并发症血管内介入治疗的安全性和有效性。方法回顾性分析2010年1月~2015年2月我院12例肝移植术后经影像学证实的肝动脉并发症的临床资料。包括肝动脉血栓形成(HAT)5例,肝动脉狭窄(HAS)3例,HAS合并HAT 2例,肝动脉假性动脉瘤(HAP)合并HAS 2例,对肝动脉血栓形成、肝动脉狭窄程度超过50%及肝动脉假性动脉瘤形成者行介入治疗。结果成功治疗10例,技术包括导管内溶栓(CDT),经皮腔内血管成形术(PTA)及支架植入术(stent placement),技术成功率83%(10/12)。1例在PTA过程中破裂,成功植入覆膜支架,1例在溶栓过程中出现少量出血,经保守治疗后好转。术后两周血清丙氨酸氨基转氨酶(ALT)、天门冬氨酸氨基转氨酶(AST)、总胆红素(TBil)及直接胆红素(DBil)明显降低(P0.01)。随访2~24个月,2例因术后再狭窄和急性血栓形成再次介入治疗,余患者未出现介入相关并发症。结论血管内介入治疗可作为肝移植术后肝动脉并发症的一线治疗方法。     

冠状动脉旁路术中不同旁路材料的应用体会

目的 :总结冠状动脉旁路移植术中目前几种常用旁路材料的临床应用。方法 :2 0 0 0年 1月～ 2 0 0 2年 3月连续 5 6例行冠状动脉旁路移植术 ,旁路材料包括左乳内动脉 (5 6根 )、游离右乳内动脉 (2 1根 )、桡动脉 (3 2根 )和大隐静脉(4 3根 )。回顾分析不同旁路材料的手术结果。结果 :桡动脉移植后旁路血管“线样征”1例 ;无胸骨、前臂并发症 ;下肢切口感染 2例 ,均为糖尿病、大体重患者 ,治疗后痊愈 ;死亡 3例 ,与旁路材料无关 (非体外循环手术因循环状态不稳死亡 1例 ,鱼精蛋白过敏 1例 ,顽固性心律失常 1例 )。结论 :注意旁路材料的取制技巧 ,针对不同病变冠脉血管选取应用不同旁路血管 ,以及术后及时监护处理是保证良好手术结果的关键     

Combined surgical and interventional treatment of tandem carotid artery and middle cerebral artery embolus: A case report

BACKGROUND The 2018 American Heart Association/American Stroke Association guidelines for early management of acute ischemic stroke recommend the use of retrievable stents for mechanical thrombectomy in patients with acute internal carotid artery or middle cerebral artery M1 occlusion that can be treated within 6 h from onset.For cases of carotid artery with ipsilateral middle cerebral artery tandem embolization, the operation is more complicated and challenging. We here report a case of a tandem embolism, and the anatomy of the aortic arch was complex.Direct carotid artery incision and thrombectomy can not only prevent the escape of the carotid embolus but also save time during establishment of the thrombectomy access.CASE SUMMARY The patient was a 70-year-old man. He was admitted to hospital due to sudden inability to speak and inability to move his right limb for 3 h. Imaging confirmed a diagnosis of a tandem embolism in the left carotid artery with left M1 occlusion.Carotid artery incision thrombectomy combined with stent thrombectomy was performed. The operation was successful, and 24 h later the patient was conscious and mentally competent but had motor aphasia. His bilateral limb muscle strength level was 5, and his neurologic severity scores score was 2.CONCLUSION Carotid artery incision thrombectomy combined with stenting for carotid artery plus cerebral artery tandem embolization is clinically feasible. For patients with a complicated aortic arch and an extremely tortuous carotid artery, carotid artery incision can be chosen to establish the interventional path.     

Congenital coronary artery fistulas in adults: concomitant pathologies and treatment

Background Coronary artery fistula is a rare congenital malformation. Complications such as intracardiac shunts, endocarditis, myocardial infarction, aneurysm and sudden death can be observed. The purpose of this article is to present our experience with concomitant cardiac pathologies and discuss various therapeutic approaches including surgical and percutaneous intervention. Materials and methods During 18,272 diagnostic cardiac catheterizations, coronary artery fistulas were identified incidentally in 10 patients (0.05%). There were 3 female and 7 male patients. The patients’ ages ranged from 42 to 76 years. All patients with coronary artery fistula were preoperatively in New York Heart Association functional class and Canadian Cardiovascular Society class II or III. Results In addition to coronary artery fistula, coronary artery disease was detected in 4 patients (40%), a ventricular septal defect and an aneurysm of the sinuses of Valsalvae with aortic regurgitation in one patient (10%) and an anomalous origin of the LAD from the pulmonary trunk in one patient (10%) during cardiac catheterization. Four (40%) of the total of 10 patients had only coronary artery fistula. Surgical closure of the coronary artery fistula was performed in 7 patients (70%). An interventional fistula closure with a coil device was confirmed by cardiac catheterization in another 3 patients (30%). One patient of the latter group showed a small residual shunt from the LAD to the pulmonary trunk. No death or long-term morbidities could be observed. Conclusions Coronary artery fistulas are incidentally diagnosed during coronary artery angiographies in adults and should be closed to prevent complications.     

流量介导的肱动脉扩张和颈动脉内中膜厚度对冠心病患者发生心血管事件的预测作用

目的探讨流量介导的肱动脉扩张（FMD）和颈动脉内中膜厚度（IMT）能否预测冠心病患者心血管事件的发生。方法150例经冠状动脉造影明确患有冠心病的患者作为观察对象,分别测量每位患者的肱动脉FMD和颈动脉IMT,随访24个月,观察150例患者心血管事件的发生率,并比较心血管事件发生者与未发生者肱动脉FMD和颈动脉IMT的差别。结果150例患者中有21例在24个月的随访时间内发生心血管事件,未发生心血管事件者的肱动脉FMD较发生心血管事件者低,颈动脉IMT在未发生心血管事件者和发生心血管事件者中相差不显著（P〉0．05）。结论肱动脉FMD可以帮助预测冠心病患者心血管事件的发生。