Objective:To evaluate the mid-term results of surgery-assisted in-situ needle fenestration technique in complicated aortic arch lesion.Methods:The clinical data of 13 patients(11 males and 2 females) with complicated aortic dissection (AD) treated with surgery-assisted in-situ needle fenestration technique from October 2017 to September 2019 were retrospectively analyzed. There were type A AD in 5 cases and type B in 8 cases.Results:In-situ fenestration with c-TAG aortic covered stent was performed on all the 13 patients, among which three supra-arch branches were reconstructed in 8 cases and two supra-arch branches were reconstructed in 5 cases. The technical success rate was 100% (13/13). One patient died of a sudden cerebral hemorrhage 4 months after surgery while the remaining 12 patients were followed up for (23.3±0.7) months. The incidence rate of recurrent postoperative AD was 15.4% (2/13). One patient received ascending aortic replacement due to retrograde AD at 6-month postoperatively. Another patient suffering from cervical artery dissection at the first postoperative month did not receive special treatment because of no discomfort.Conclusion:For complicated aortic arch lesion requiring reconstruction of multiple branches, surgery-assisted in-situ needle fenestration technique showed promising mid-term results.

目的 回顾性总结分析阜外医院45例小儿体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持治疗心脏术后急性心肺功能衰竭的临床结果和经验.方法 2004-12～2009-12对45例小儿先天性心脏病术后急性心肺功能衰竭实施ECMO,所有患儿均行静脉-动脉ECMO(V-A ECMO)辅助方式,激活凝血时间(ACT)维持140～200 s,肝素用量4～20 U/(kg*h).辅助期间流量40～150 mL/(kg*min).结果 22例患儿成功撤离ECMO,撤机率48.9%;20例患者出院,出院率44.4%.2例成功撤离ECMO后死亡,23例不能撤离ECMO,终止治疗,院内死亡.出院患儿ECMO支持时间(64.21±14.36)h(16～268 h),死亡患儿ECMO支持时间(109.88±21.98)h(25～308 h),差异有统计学意义(P=0.05);出院组年龄、体质量与死亡组比较差异有统计学意义(P=0.000);肾功能不全、感染及氧合器渗漏的患儿死亡率显著上升.至2010-03-31出院患儿通过电话随访到18例,随访率90.0%;1例出院后1 d死亡,1例出院后57 d死亡;余16例患儿存活,生长发育正常,学龄儿童与同龄正常儿童学习成绩比较差异无统计学意义.结论 ECMO支持治疗在小儿先天性心脏病术后急性心肺功能衰竭的治疗中是一种有效的机械辅助方法,手术畸形矫正满意.尽早对心肺衰竭患儿采用ECMO支持治疗,避免重要脏器的不可逆损伤是ECMO成功的关键.低龄、低体重、长时间ECMO支持是死亡的危险因素.

目的探讨经胸骨正中切口心脏直视手术后发生乳糜胸的可能机制和治疗经验,以减少术后乳糜胸的发生。方法回顾分析1996年10月至2006年1月收治的18例经胸骨正中切口径路行心脏直视手术后发生乳糜胸患者的临床资料,其中男12例,女6例;年龄2个月～79岁,平均年龄14.4岁。所有患者均采用在禁食基础上的保守治疗,包括胸腔闭式引流、静脉高营养、强心、利尿等综合措施。结果住院时间7～130 d,胸腔引流时间4～35 d。全组死亡2例,其中死于心律失常、心搏骤停1例;因肺部感染、再次插管,死于多器官功能衰竭1例。随访14例,随访时间2～10年,失访2例。随访期间无乳糜胸复发或需二次手术者。结论经胸骨正中切口径路行心脏直视手术后发生乳糜胸可能与手术时损伤较小的淋巴侧枝有关,采用禁食、胸腔闭式引流、静脉高营养等保守治疗效果满意。

Objective To evaluate the preliminary surgical experience of ' unifocalization approach' for pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries(PA/VSD/MAPCAs). Methods Between April 1999 and April 2007, 17 consecutive patients underwent 'Unifocalization' and other concomitant procedures for PM/VSD/MAPCAs. There were 7 males and 10 females with a mean age of 6.0 years(range from 0.8 to 18.0 years) and a mesa body weight of 20.0 kg (range from 6.5 to 55.0 kg). The mean native pulmonary artery index(PAI) was 133.7(42.0～366.1 )mm2/m2. Surgical approach through medi-an stemotomieswes in 10 patients (59%), through median sternotomy+ left thoracotomy in 5 patients (29%), and through median sternotomy + right thoracotomy in 2 patients (12%). 12 patients(71% ) underwent primary repair and unifocalization, among them, 1 palliative right ventricular outflow reconstruction and 1 systemic to pulmonary shunt had been performed one year before definitive re-pair of PA/VSD. 5 patients(29%) underwent unifocalization and palliative operation. Totally 44 MAPCAs were identified in this study group, among them 29 MAPCAs(66%) were transplanted, 5 MAPCAs (11%) were ligated, Interventional coil occlusion of 5 MAPCAs were performed in one patient preoperatively and another postoperativdy. Results There were 6 early hospital mortality (35%) .The mean cardiopulmonary bypass time was 174.3( 98.0～430.0) minutes and aortic cross damping time was 88.7(42.0～148.0) minutes. The mean mechanical ventilation time was 7.4(0.2～42.0)days and ICU stay was 11.8(0.2～60.0)days. The mean total neopulmonary arterial index(TNPAI) of 11 survivors was 249(102～496)mm2/m2. The causes of six early deaths were persis-tent low cardiac output syndrtrome or abrupt ventricular dysrhythmia resulting from severe hypoplastic pulmonary arteries in 2 patients whose TNPAI were lees than 200 mm2/m2 .One of the two patients with TNPAI was 341 mm2/m2, died of low cardiac output syndrome, ascertained by autopsy a severe pulmonary artery hypertension had been existing in regional pulmonary segments preoperatively, In the other 3 deaths with TNPAI beyond 4.50 mm2/m2 : one patient had severe pulmonary infection, effusion and acute renal failure, one had difficulty in weaning from mechanical ventilation and repeated airway bleeding and one had a refractory ventricular dysrhyshmia. Other complications included 1 phrenic nerve neurapraxia, 1 cerebral cortex blind ness, 1 bacillus cloacae pneumonia and pulmonary hemor-rhage, respectively. Conclusion The critical treatment of PA/VSD/ MAPCAs is a definitive repair and unifocalization of MAPCAs. This procedure is complicated. As a variety of pulmonary vasculopathy exists, it is common that the hypertensive and hypoplasic MAPCAs coexost in a patient, it needs to master the indication rationally and sophisticate the surgical technique persistently.

OBJECTIVE To evaluate the effectiveness of modified roller pump pulsatile perfusion during conventional extracorporeal circulation(ECC) heart surgery and observe pressure drop caused by different devices in ECC circuit.METHODS 20 pediatric patients diagnosed as tetralogy of Fallot(male 8,female 12) were involved in this clinical pulsatile perfusion study.Mean age was 13.5 months and mean weight was 10.2 kg.Two kinds of oxygenators were used(separate number was 10) in present trial.Jostra HL-20 heart lung machine provided modified roller pump pulsatile perfusion according the inner computer controller.Every patient applied pulsatile perfusion during aorta artery cross-clamping period and roller flat perfusion during cross-clamp off.Three circuit sites(oxygenator inlet,oxygenator outlet and artery cannula connecter site) were arranged pressure detector to measure the pressure during ECC,renal or femoral artery invasive pressure was measured through patient's central monitor system.RESULTS Pulse pressure(ΔP) of renal/femoral artery pressure can be maintained between 15 to 35 mmHg during pulsatile perfusion of ECC.The maximum pressure drop happened at artery cannula site in ECC circuit(pressure drop rate was 72%-73%) while minimum pressure drop occurred at oxygenators(pressure drop rate was 22%-24%).The oxygenator pressure drop(OPP) caused by Capiox RX05 oxygenator was less than that caused by Lilliput 902(P0.05) in different pulsatile perfusion blood flow.CONCLUSION Jostra HL-20 heart lung machine can provide effective pulsatile perfusion during conventional ECC.Artery cannula makes the maximum pressure drop during pulsatile perfusion and the less oxygenator pressure drop will be benefit to the maintenance of pulsatile perfusion energy during ECC.

Objective:To investigate the incidence of cardiac and pericardium tumors and epidemiological characteristics.Method:The data of 250 cases of cardiac and pericardium tumors among all the patients accepted heart operation from 1996 to 2005 were analyzed.Result:Two hundred and forty-two cases of primary and 8 cases of secondary heart and pericardium tumors were discovered,revealing an prevalence of 0.75% in general. The incidence of benign neoplasm (88.0%) was higher than malignant masses (11.2%)( P 0.01). The prevalence rates of cardiac tumors were quite different among age groups with the highest(30%)in age group 40 to 49,followed by(26.8%) in age group 50 to 59.The number of female patients with myxoma was higher than that in male( P 0.01).Conclusions:The incidence of cardiac and tumors was 0.75% among the patients underwent cardiac surgical treatment.The benign neoplasm was much more common than the malignant masses.

随着先天性心脏病外科治疗水平的不断提高,一些简单的先天性心脏病得到了治愈.我们采取右腋下小切口手术治疗先心病,取得了良好的效果.现报道如下.

Objective:To analyze early surgical results of double outlet right ventricle (DORV).Methods:Between January 2000 and September 2004,169 patients with DORV underwent surgical treatment,including biventricular repair in 103 (60.9%),single-ventricle repair in 50 (29.6%),and palliative procedures in 16 (9.5%).Results:There were 20 early deaths in the whole series (11.8%).The mortality for biventricular repair,single-ventricle repair and palliative procedures were14.6%,4.0% and 18.8%, respectively.The mortality decreased from 19.5% in 2000 to 7.9% in 2004.Nineteen(95.0%) hospital deaths occurred in patients with pulmonary stenosis.Reoperations were needed in 7 Patients(4.1%) becanse of surgical complications.Conclusion:Early outcomes were satisfactory for patients with DORV.Careful attention to surgical anatomy and pathophysiology and proper timing of surgical procedures will enhance the outcomes.

心肌冷挛缩是指在心内直视手术中低温灌注使正常舒缩心肌产生不规则收缩的现象.临床上多见于婴幼儿手术中,在心脏停跳前转流降温,心肌阻断时出现心肌强直挛缩,坚硬如石.本院在心内直视手术中遇见2例,现将临床治疗及处理体会报道如下.

心肌冷挛缩在婴幼儿心脏手术中时有发生,预后往往不良,总结我院3年来婴幼儿低温体外循环手术,考虑2例病儿发生严重心肌冷挛缩,现报告如下.

Objective To assess pulmonary flow in both lungs qualitatively and quantitatively after pulsatile bidirectional Glenn shunt with radionuclide pulmonary perfusion imaging. Methods 11 patients with complex congenital heart diseases reffered for pulsatile bidirectional Glenn shunt were studied with radionuclide pulmonary perfusion imaging.Radionuclide agent was injected in upper limb preoperatively, and seperately in upper limb and lower limb postoperatively.Imaging was performed in both anteroposterior and posteroanterior positions after balance of radioactive tracers in both lungs was achieved. 5×10 5 radioactive counts were acquired in each position.Imaging of two kidneys was performed if they showed radionuclide uptake.Radioactive counts were calculated preoperatively and postoperatively in both lungs and kidneys. Results There was no marked difference between the one lung counts to the total counts of two lungs ratios of left and right lung, and blood flow was evenly distributed in two lungs after pulsatile bidirectional Glenn shunt. Right to left shunt was decreased markedly after operation. Conclusions Radionuclide pulmonary perfusion imaging is a noninvasive method for evaluating pulmonary flow in both lungs qualitatively and quantitatively after pulsatile bidirectional Glenn shunt and can be used for evaluating the short term effect of this therapeutic procedure.

Objective To introduce the technique of surgical treatment of tetralogy of Fallot with absent pulmonary valve(TOF/APV) Methods From January 1985 to September 2000, 13 patients with TOF/APV underwent surgical correction at our hospital Results The post operative mortality was 7 7% (1/13) with no later death Surgical complications included low cardiac output in 3 cases, pericardial effusion in 1 case Eight patients suffered from pulmonary regurgitation (5 mild, 2 moderate, 1 severe with congestive heart failure) during the follow up of 1-3 years after surgery Conclusions We recommend that older children can be treated electively,while infants should be treated early The technique of partial resecting and plicating of dilated pulmonary artery and pulmonary valve implantation may improve outcome in patients with airway compression

1997年12月至1998年11月,我们抢救心脏术后并发全身毛细血管渗漏综合征病儿12例,均获成功.现报告如下.

心脏横纹肌瘤合并结节硬化综合征国内罕见报道.1998年1月我院收治1例,现报道如下.

新生儿先天性心脏病围术期特点不同于其它年龄段,易出现特殊并发症,并可因忽视而影响预后.本例患儿术后合并毛细血管渗漏综合征,抢救治疗成功.报道如下:

1 临床资料 患儿女,3.5岁.1岁时发现心影增大,心包内肿物,初步诊断为心脏肿物.入院后心电图示:心房扩大,室性早搏;X线胸片示:两肺轻度淤血,左心缘下段显著延长且边缘不规则;超高速计算机断层摄影术(CT)示:左心室增大并明显向上移位,其下方近隔面处可见一占位病变,形态略不规则,左心室左下方见一块状肿物,约6.0 cm×4.0 cm×4.0 cm,密度均匀一致,肿块主要向左下延伸;二维超声心动图检查:心室间隔中下段及心尖部偏向