目的 探讨冠状动脉旁路移植术后新发心房颤动(房颤)的临床特征及影响因素.方法 回顾性分析2012年1月至2019年1月在我院行冠状动脉旁路移植术的339例患者的临床资料,其中男267例、女72例,年龄37～83(58.03±8.90)岁.分析术后新发房颤的临床特征及影响因素.结果 不停跳冠状动脉旁路移植(off-pump coronary artery bypass grafting,OPCABG)患者共234例,术后新发房颤36例(15.4％),其中男性房颤发生率为16.1％,女性为12.5％.停跳冠状动脉旁路移植(coronary artery bypass grafting,CABG)患者共105例,术后出现新发房颤39例(37.1％),其中男性房颤发生率为40.7％,女性为25.0％.CABG术后新发房颤发生率明显高于OPCABG(37.1％vs.15.4％,P＜0.05),但两组不同性别之间差异无统计学意义(P＞0.05).两种术式术后新发房颤发生率随着年龄增加而上升,最高年龄段为≥60岁(18.9％和45.8％),明显高于＜45岁患者(P＜0.05).两种术式术后新发房颤的高发时间均为术后第2d(即术后24～48h),发作后持续1 d(24 h)的比例最高(P＜0.05).单因素和多因素logistic回归分析显示,高血压(OR=4.983,P=0.036)、频发房性期前收缩或房性心动过速(OR=17.682,P=0.002)、术后肌酸激酶同工酶MB(CKMB)(OR=0.152,P=0.042)、左房前后径(OR=17.614,P＜0.001)和术前射血分数(OR=7.094,P=0.011)是OPCABG术后新发房颤的影响因素;而糖尿病(OR=11.631,P=0.020)、合并其它心脏畸形(OR=29.023,P=0.002)、频发室性期前收缩或室性心动过速(OR=0.047,P=0.001)和术后CKMB(OR=3.672,P=0.040)是CABG术后新发房颤的影响因素.结论 CABG术后新发房颤发生率高于OPCABG,且都随着年龄的增加而逐渐升高,但这两种术式的新发房颤在不同性别之间差异无统计学意义.两种术式术后新发房颤的影响因素不同.

Objective:To analyze clinical outcomes of myocardial incision and tearing for the treatment of myocardial bridge.Methods:A retrospective cohort study was conduct to review the clinical date of 29 patients who underwent surgical myotomy from January 2014 to January 2018 in the Second Hospital of Lanzhou University. A total of 11 patients(incision group) were experienced traditional myotomy on myocardial bridge that the myocardium was longitudinally incised along the direction of the coronary artery, while 18 patients(tearing group) were treated by myocardial incision combined with tearing that longitudinally incised myocardium and deeply tissue tearing. The operation time of surgical myotomy, the amount of bleeding, the number of branches of vascular injury and the number of ventricular ruptures during operation were compared between the two groups. After followed up half a year to one year, the clinical symptoms of angina pectoris, myocardial ischemia by electrocardiogram suggested, and coronary stenosis by coronary CT suggested were collected.Results:The operation time of surgical myotomy, the amount of bleeding patients and the number of branches of vascular injury during operation in the incision group were higher than those in the tearing group( P<0.05). There was no significant difference for the number of ventricular ruptures during operation( P>0.05). After followed up half a year to one year, there was no significant difference in the clinical symptoms of angina pectoris, myocardial ischemia by electrocardiogram suggested, and coronary stenosis by coronary CT suggested( P>0.05). Conclusion:Myocardial incision combined with tearing is a surgical procedure with short operation time and low bleeding risk, which is more beneficial than the traditional longitudinally incised for the myocardial bridge.

MicroRNA-663 (miRNA-663) regulates the expression of transforming growth factor β1 (TGF-β1), which participates in the pathogenesis of myocardial fibrosis. Therefore, microRNA-663 may also serve a role in myocardial fibrosis. The present study aimed to determine whether miRNA-663 participates in myocardial fibrosis via interaction with TGF-β1. In the present study, the expression of miRNA-663 was significantly downregulated, whereas that of TGF-β1 was significantly upregulated in the endomyocardial biopsies of patients with myocardial fibrosis compared with those in control necropsies. Pearson's correlation analysis revealed that the expression levels of miRNA-663 were negatively correlated with those of TGF-β1 in patients with myocardial fibrosis, but not in the controls. Receiver operating characteristic curve analysis demonstrated that the downregulation of miRNA-663 distinguished patients with myocardial fibrosis from controls. In the AC16 human cardiomyocyte cell line, miRNA-663 overexpression resulted in downregulated TGF-β1 expression, whereas exogenous TGF-β1 treatment exhibited no significant effects on miRNA-663 expression. These results indicate that miRNA-663 may participate in myocardial fibrosis, possibly through interaction with TGF-β1.

Objective This study was performed to evaluate the clinical efficacy and safety of a novel surgical procedure in treating tracheal or bronchial compression related to severe congenital heart disease. Methods The clinical data of 28 patients with tracheal or bronchial compression related to severe congenital heart disease were retrospectively analyzed. In the control group, 12 patients underwent surgery for congenital cardiac malformations. In the treatment group, 16 patients underwent surgery for congenital cardiac malformations combined with partial resection of the pulmonary artery wall. The cardiothoracic ratio, pulmonary arterial pressure, left ventricular end-diastolic dimension, diameter of the pulmonary artery, and diameter of the trachea in the stenotic segment were quantitatively measured before and 9 days after the operation. Results The diameter of the pulmonary artery and diameter of the trachea in the stenotic segment were almost restored to the normal range in the treatment group. Patients in the treatment group recovered more rapidly and effectively than those in the control group. Conclusion Partial resection of the pulmonary artery wall is an efficacious and safe technique in the treatment of tracheal or bronchial compression related to severe congenital heart disease.

患者男,56岁,3个月前因脑梗死就诊,经颅彩色多普勒发泡实验阳性,TTE明确卵圆孔未闭.拟行TEE引导下卵圆孔封堵术,术中TEE示卵圆孔未闭,直径3 mm;左心房内探及隔膜,一端连接于卵圆窝上缘(图1A),另一端连接于左心耳上方(图1B),中间连接左心房前后壁,将左心房分为副房和真房,副房接受4条肺静脉血流,真房连接卵圆孔未闭、左心耳和二尖瓣口,隔膜孔(真、副房交通口)最大径约28 mm,血流速度150 cm/s;提示:三房心,临床分类为A2型(Lams改良分型).

目的 探讨非体外循环冠状动脉旁路移植(off-pump coronary artery bypass grafting,OPCAB)术后新发心房颤动(房颤)的预后因素.方法 回顾性分析2012年1月～2018年12月我院234例OPCAB临床资料,术后出现新发房颤36例(房颤组),未出现房颤198例(非房颤组),通过单因素和多因素logistic回归分析术后新发房颤的预后因素.结果 单因素分析结果 显示,术后新发房颤可能的预后因素有年龄、高血压、频发房性期前收缩(房早)或房性心动过速(房速)、合并心脏其他畸形、收缩压,术前肌酐、尿酸、射血分数(EF)、左房前后径和肺动脉压力,术后血钾和肌酸激酶同工酶(CK-MB)(P<0.05).多因素logistic回归分析显示术前合并高血压(OR=6.109,P=0.019),频发房早或房速(OR=9.915,P=0.017),肌酐增高(男性>106μmol/L,女性>97μmol/L)(OR=18.798,P=0.019),左房前后径增大(男性>38.7 mm,女性>36.8 mm)(OR=17.894,P=0.000)和EF减低(EF<55％)(OR=11.505,P=0.004)是OPCAB术后新发房颤的预后因素.结论 术前合并高血压、频发房早或房速、肌酐增高、左房增大和EF减低是OPCAB术后新发房颤的预后因素.

目的 探讨心肌桥致主要不良心脏事件(major adverse cardiac events,MACE)发生的危险因素.方法 收集43例前降支冠状动脉心肌桥的患者,记录住院期间的临床资料,根据是否发生MACE分为非MACE组(n=23)和MACE组(n=20),进行回顾性分析(病例对照研究).比较两组的基线资料和心肌桥狭窄程度、长度、厚度情况,结果吸烟、饮酒、餐后2小时血糖、基础心率、心肌桥狭窄程度和厚度在两组间存在着差异(均P ＜0.05).通过Logistic多因素回归分析发现吸烟、饮酒和心肌桥狭窄程度是预测心肌桥并发MACE的危险因素,OR值分别为11.1、10.1和5.4,且上述OR值均具有统计学意义(P＜0.05).结论 心肌桥可引发不良心脏事件,且吸烟、饮酒和心肌桥狭窄程度是心肌桥患者发生MACE的危险因素.

1 病例资料 患者,男,52岁.因“活动后胸闷、气促1个月余,加重3d”入院.查体:双肺查体未见异常,心界扩大,胸骨右缘第二肋间可闻及收缩期喷射样杂音,腹软,无压痛,无肢体偏瘫和肌力减退.患者既往无吸烟史、糖尿病和结蒂组织病史.入院后化验示:血、尿、便常规,凝血及肝肾功能正常;心电图示:左心室肥厚伴ST-T继发性改变,左束支传导阻滞,频发室性期间收缩;X线胸片示:心脏扩大,呈靴型心改变;经胸心脏超声示:主动脉瓣叶多发钙化,瓣膜开放明显受限,呈重度狭窄,二尖瓣、三尖瓣开放尚可,关闭不良,呈轻度返流,主动脉瓣环内径27 mm,窦部内径40 mm,升主动脉内径38 mm,左心增大,左室舒张末期直径55 mm,右室舒张末期直径34 mm,室间隔厚度13 mm,射血分数(EF)50％;心脏多普勒示:主动脉瓣上探及高速窄束血流信号,血流速度366 cm/s;人院后明确诊断为心脏瓣膜病,主动脉瓣狭窄(重度),心功能Ⅱ～Ⅲ级.入院后拟行主动脉瓣膜置换术,术前常规行冠状动脉(冠脉)造影发现右冠脉开口异常,经反复更换及调整造影导管后造影成功,其中左、右冠脉血管未见明显狭窄.

目的 探讨重症先天性心脏病合并与之相关的气管或支气管狭窄患者新的外科治疗方法.方法 回顾性分析我院2010年6月至2014年6月重症肺血增多型先天性心脏合并气管或支气管狭窄患者行外科治疗31例患者的临床资料,其中男18例、女13例,平均年龄(14.6±4.0)个月,体重(8.8±3.0)kg.结果 术前平均住院时间12d,术中体外循环时间(65.0±21.0)min,主动脉阻断时间(42.0±16.0)min,术后呼吸机应用时间平均(25.0±18.0)h,ICU滞留时间(4.0±1.8)d.所有患者生存,术后9d复查胸部X线片示心胸比率较术前降低,但差异无统计学意义(P＞0.05).左心室舒张期末前后径较术前缩小(P＜0.05),肺动脉压降低(P＜0.01),肺动脉血流速度基本正常;术后9d动脉血管造影(CTA)示:所有患者肺动脉直径均较术前缩小(P＜0.01),气管直径恢复正常28例,残留轻度气管狭窄3例,所有术前不张的肺组织重新复张.随访6个月至4(2.5±1.4)年,无死亡,生长发育良好,心脏彩色超声未见异常,CT示所有患者气管狭窄消失.结论 对重症先天性心脏病合并气管或支气管狭窄患者,术中采取解除对气管或支气管的压迫因素的外科措施有必要.这种方法外科操作技术简单、术后恢复快、成活率高、费用低、无远期气管再狭窄,预后良好.

目的：探讨心脏黏液瘤的临床特点和外科诊断及治疗方法。方法回顾性分析行外科手术治疗的32例心脏黏液瘤患者的临床资料。结果32例患者术后均恢复良好，围手术期无严重并发症和死亡发生。随访1个月至5年，未发现复发和远处转移。结论心脏黏液瘤手术治疗效果好，术前应做好充分的准备工作，掌握好手术时机。