完全性肺静脉异位引流病理谱及个体化手术治疗

Objective To delineate the morphological spectrum of total anomalous pulmonary venous connection (TAPVC) by building the "road map" and the " variation chart" of pulmonary veins,and to advance individualized surgical treatment Methods Between April,2006 to June,2009, 139 consecutive patients with TAPVC underwent operations. There were 61 supracardiac,55 intracardiac,6 infracardiac and 17 mixed types. Pathological diagnosis was made by echocardiogram,magnetic resonance imaging, computerized tomography,or the cardiac catheterization and operative findings during operation. The option of procedure was determined by findings. Results (1) Pathological spectrum:①" the road map"of the pulmonary veins: the patients with supracardiac type were divided into 4 subtypes according to the course of vertical veins:left course (47 cases),right course (9 cases),posterior course(2 cases) and double courses (3 cases). The patients with intracardiac type were divided into 3 subtypes according to the draining site of pulmonary veins: to coronary sinus (49 cases) ,to right atrium (5 cases) or to coronary sinus and right atrium (1 case),and the openings of pulmonary veins may be 4,2 or 1 in each subtype. The patients with infracardiac type were divided into 4 subtypes according to the draining site of vertical vein:to portal vein (1 case),to hepatic vein(3 cases),to portal vein and hepatic vein (1 case) and to inferior vena cava (1 cases). The patients with mixed type were divided into 3 subtypes: bilateral and symmetrical connections "2 + 2" pulmonary venous drainage pattern; bilateral and asymmetrical connections"3 +1" pulmonary venous drainage pattern and bizarre anatomic variants. ② The morphological "variation chart" of pulmonary veins individual pulmonary vein stenosis or excessive tributary veins (11 cases) showed: hypoplastic confluence veins (4 cases) and vertical veins distortion or elongation or forming hemodynamic vise or common pulmonary vein that drained to coronary sinus or right atrium through a narrowed short vertical vein or a small window(9cases).(2)Surgical results：early death was encountered in 6 cases(4.3％).The causes included 10W cardiac output syndrome in 1 case,and pulmonary veins stenosis and associated complications in the other 5 patients.Six patients with pulmonary restenosis underwent reoperation.All survived.Two patients had mild residual obstruction during Intermediate-term follow-up.Conclusions The patients with TAPVC had a wide spectrum of pulmonary veins with high inter-individual variation.It was useful to delineate the anatomy of pulmonary veins and to plan personalized procedures during operations according to the"road map"and"variation chart"of pulmonary veins.     

心脏术后心肌代谢支持

心脏手术创伤性应激反应和缺血、再灌注损伤使术后心肌能量代谢出现异常,严重影响术后心脏功能的恢复。本文综述了术后心肌代谢的特征及术后心肌代谢支持的办法、原理和适应证。     

心脏术后心肌代谢支持

心脏手术创伤性应激反应和缺血，再灌注损伤使术后心肌能量代谢出现异常，严重影响术后心脏功能的恢复。本文综述了术后心肌代谢的特征及术后心肌代谢支持的方法，原理和适应证。     

Lecompt手术

完全性大动脉错位、右 (左 )室双出口和永存动脉干等心室 -大动脉连接异常 (anomalyofventriculoarterialconnection ,AVAC)的先天性心脏病常常合并肺动脉流出道梗阻 (pul monaryoutlettractobstruction ,POTO)和室间隔缺损 (VSD) 〔1〕。Rastelli手术是治疗此类疾病最常选择的手术方法〔2〕。由于Rastelli手术本身存在一些潜在的缺点 ,如在某些心内解剖异常 (如小VSD等 )时不适用、人工管道的应用导致根治手术时间的推迟和因人工管道狭窄而需要再手术〔3〕。为了克服Rastelli手术的缺陷 ,1982年法国学者Lecompt等〔4〕介绍了一种不…     

胎羊体外循环研究进展

近年来，国外利用胎羊进行了体外循环研究，本文综述了胎羊体外循环的装置，插管，病理生理及胎羊长期存活的结果。     

婴儿大型室间隔缺损并发肺炎和呼吸衰竭的早期手术治疗

目的 探讨婴儿大型室间隔缺损（VSD）并发肺炎和呼吸衰竭早期手术治疗的可行性、手术时机和适应证以及术中和术后处理。方法 1999年10月～2004年1月，我院收治大型VSD并发肺炎和呼吸衰竭29例婴儿，19例进行带机早期手术治疗，10例行内科保守治疗。结果 手术病例中，18例婴儿手术成功、脱离呼吸机出院，术后主要并发症有肺不张、气胸、气管再插管，无全身感染、肺动脉高压危象以及严重低心排病例；1例婴儿死于气管狭窄，病死率5．3％。内科保守治疗病例中，8例在治疗途中因心肺衰竭死亡，病死率80Uo；2例好转撤离呼吸机出院。结论 把握手术时机和适应证，防治术中和术后肺损伤，带机早期手术治疗可提高和改善大型VSD并发肺炎和呼吸衰竭婴儿治疗效果和预后。     

冷挛缩对幼兔心肌功能和代谢的影响

目的：建立冷挛缩模型，探讨冷挛缩对新西兰幼兔（３～４周）心肌功能和代谢的影响。方法：在改良Ｌａｎｇｅｎｄｏｒｆｆ模型基础上，对照组（ｎ＝１０）和冷挛缩组（ｎ＝１０）离体再灌注复苏，测试缺血前、后心功能：左心室舒张末压、最大心脏指数、最大心搏量指数、最大心搏作功指数；代谢：心肌摄氧量及冠状动脉阻力指数。结果：离体心缺血复苏后，对照组最大心脏指数、最大心搏量指数、最大心搏作功指数始终高于冷挛缩组，对照组复苏后摄取更多的氧，而冷挛缩组左心室舒张末压、冠状动脉阻力指数高于对照组。结论：冷挛缩现象对未成熟心肌缺血后心功能恢复不利，应尽量避免心脏停跳前低温刺激     

谷氨酸,天门冬氨酸与心肌保护

本文综述了谷氨酸、天门冬氨酸解除缺血、再灌注心肌能量代谢障碍的作用机制，以及它们在心肌保护、特别是在未成熟心肌保护中的应用及价值。     

功能性单心室合并肺动脉高压的分期手术结果

目的分析功能性单心室合并肺动脉高压(FSV-PH)的分期手术结果,探讨初期手术时机及相关风险因素与治疗结果的关系。方法回顾性分析2008年4月至2015年12月我院收治功能性单心室合并肺动脉高压129例患者的临床资料,其中男81例、女48例,右心室双出口71例,三尖瓣闭锁17例,大动脉错位7例,单心室33例,完全性房室间隔缺损1例。初期进行肺动脉环缩术(PAB),之后根据肺血管状况,适时分期行Glenn手术和Fontan手术。结果 129例患者共行159例次PAB,术后死亡6例(4.7%),失访9例;87例(67.4%)患者行二期Glenn手术,死亡2例;43例(33.3%)患者行三期Fontan手术,术后死亡3例。32例合并主动脉缩窄、主动脉弓中断、心脾综合征、完全性肺静脉异位引流或房室瓣反流,分别有15例(46.9%)行Glenn手术和6例(18.8%)行Fontan手术。14例患者出现左室流出道狭窄。结论早期PAB有利于FSV-PH进行后期的Glenn和Fontan手术,合并复杂畸形是降低Glenn和Fontan完成率的危险因素。     

主动脉缩窄术后远期高血压的研究进展

远期高血压是主动脉缩窄患者术后常见的并发症。该文介绍主动脉缩窄术后远期高血压的发病机制和防治策略,揭示远期高血压与动脉血管重构、残余狭窄、再狭窄、主动脉弓形态异常、心功能异常、手术时机和术式的关系,介绍远期高血压手术干预、降压药物应用和预防血管重构等治疗策略。