malities should be alerted in TOF.

患儿男,6个月,主因"查体发现心脏畸形半年"入院.查体:心界大,胸骨左缘3、4肋间可闻及收缩期Ⅲ/6级喷射性杂音.超声心动检查:心房正位,心室右袢,右心房室增大,房间隔近冠状静脉窦口处缺失6 mm,室间隔膜周至室上嵴回声缺失13 mm,主动脉增宽骑跨于室间隔上,骑跨率约40%,右室前壁至室上嵴处可见粗大异常肌束;肺动脉瓣增厚粘连,回声增强,开放受限,连续多普勒测最大前向血流速度为3.1 m/s,压差39 mm Hg(1 mm Hg=0.133 kPa);主肺动脉及左右肺动脉发育良好;三尖瓣前叶轻度脱垂,彩色多普勒显示三尖瓣轻度反流;胸骨上凹主动脉横切面可见永存左上腔静脉入左心房,左心房后下与冠状静脉窦处回声缺失16 mm,彩色多普勒示蓝色血流信号自左心房→冠状静脉窦→右心房.

Objective To study the value of echoeardiography for diagnosis of juxtaposition of atrial appendage(JAA) and to discuss its features. Methods Eehocardiographic characteristics of JAA in nine cases were compared with results of cardiac catheterization and operation. The diagnostic features of echocardiography were summarized. Results Seven cases had juxtaposition of left atrial appendage and two had juxtaposition of right atrial appendage. The nine cases were all associated with severe congenital heart disease and the most frequent malformations observed with JAA were double outlet right ventricle, transposition of great artery, single ventricle and so on. Direct visualization of the JAA in the parasternal short-axis view at the base of the heart and visualization of an unusual transverse orientation of the atrial septum were the most features of JAA. Echocardiographie characteristics of JAA cases were correspondent to the results of cardiac catheterization and operation. Conclusions There is high accuracy by echocardiography to diagnosis JAA. JAA should be alerted in severe congenital heart disease.

患者 1女性,1岁9个月,体重6.5 kg,主因哭闹后口唇青紫伴心脏杂音1年9个月于2006年3月15日入院,伴生长发育迟缓,有反复肺炎病史.

Purpose: To study the value and the features of echocardiography in the diagnosis of Tetralogy of Fallot(TOF) with absence of left pulmonary artery. Materials and Methods: The echocardiographic characteristics of TOF with absence of the left pulmonary artery in five cases were compared with the results of cardiac catheterization and open heart surgery. The diagnostic features of echocardiography were summarized. Results: In addition to the common features like intracardiac malformations in TOF, the cases with absence of left pulmonary artery showed stenosis in their main pulmonary arteries. A circular shaped bifurcation of pulmonary arteries were noticed in 4 cases, and an absence of left pulmonary artery in 1. The echocardiographic diagnosis in all cases were in accordance to that of cardiac catheterization and operation. Conclusion: Echocardiography is an accurate diagnosis for TOF with absence of the left pulmonary artery, especially when a circular shaped bifurcation of pulmonary artery noted in children with TOF.

Objective To summarize the experience of perioperative management of coronary artery bypass graft(CABG) in high-risk patients with coronary heart disease.Methods The clinical data of 164 patients underwent CABG from March 2004 to November 2005 were analyzed.Of 164 patients,151(92.05%) cases had severe coronary heart disease.Results Totally 144 artery-vessels and 353 venous-vessels were transplanted to patients.Combined operative procedures included 11 cases of ventricular aneurysm resect,5 cases of valve replacement,5 cases of valve repair,and 1 case of surgical repair of perforation of ventricular septum.Post-operative complications included 2 cases of low cardiac output,1 case of respiratory failure,1 case of renal failure,and 1 case of cerbral infarction.Two patients died and the operative mortality was 1.22%.Conclusion CABG procedure is safe in the treatment of high-risk patients with coronary heart disease.Proper preoperative and perioperative treatment can improve the curative effects significantly.

左冠状动脉起源于肺动脉(anomalous origin of the left coronary artery from the pulmonary artery, ALCAPA)是一种少见的先天性冠状动脉异常性疾病.因婴幼儿期临床发病一般表现为心力衰竭(简称心衰)症状且影像学显示心脏扩大、心内膜增厚而极易被误诊为原发性心内膜弹力纤维增生症(简称心弹).我们对我院收治的6例经手术证实的婴儿型ALCAPA和44例临床诊断为心弹的年龄<4岁的病例进行回顾性调查,对比分析两组病例的心电图特征,以评价心电图在诊断婴儿型ALCAPA和鉴别诊断中的价值.