Introduction: The aim of the study was to investigate the clinical characteristics, surgical treatment, and long-term efficacy of primary right heart tumors. Methods: This study is retrospective analysis of the clinical data of 70 patients with primary right heart tumors admitted to our department between 1980 and 2022 (observation group) and 70 patients with left heart tumors during the same period (control group). The surgical treatment was performed under cardiopulmonary bypass after differential diagnosis by echocardiography, cardiac CTA, and PET-CT before the surgery. The perioperative characteristics, recurrence rate, and long-term survival rates of right heart tumor versus left heart tumor were compared. Results: The most common pathological types of right heart tumors were myxoma (60%), lipoma (8.57%), and papillary elastofibroma (7.14%). During the perioperative period, there were 1 case of systemic embolism in the observation group, compared with 6 in the control group (p = 0.026), 13 cases of malignant tumor in the observation group versus 1 in the control group (p = 0.01). During the follow-up period, there were 15 cases of tumor recurrence and 17 cases of death in the observation group versus 4 (p = 0.002) and 7 in the control group (p = 0.006), comparatively. Conclusion: Compared with left heart tumors, primary right heart tumors had a higher incidence of malignant tumors and a lower risk of systemic embolism during perioperative period. During the follow-up period, primary right heart tumors had a higher rate of tumor recurrence and a lower long-term survival rate.

Objective To investigate the early changes of left ventricular end-diastolic diameter (LVEDD) in patients with severe aortic valve stenosis (AS) after transcatheter aortic valve replacement (TAVR) and the effect of the changes on the prognosis of TAVR. Methods A single-center retrospective cohort study was performed on 113 severe AS patients undergoing TAVR treatment in our hospital from December 2017 to December 2021.When the improvement of postoperative to preoperative LVEDD ≥1.8 mm was defined as early LVEDD improvement by echocardiography, the patients were divided into improvement group and non-improvement group.After the patients were followed up in 1 year after TAVR through clinic or telephone visits, their clinical data on cardiac ultrasound, electrocardiogram, and surgery-related complications were collected.The endpoints were major adverse cardiovascular events (MACE), including 1-year all-cause mortality, myocardial infarction or angina, and heart failure-related hospitalization. Results The average age of the patients was 71.2±6.5 years, and 59(52.2%) of them were female.The postoperative (4 d after TAVR on average) LVEDD was 48.9±6.5 mm, significantly shorter than that preoperatively (50.7±7.3 mm, P < 0.001).There were 53 patients obtaining early improvement of LVEDD before discharge, accounting for 46.9% of the discharged patients.Univariate Cox regression analysis found that preoperative diabetes (HR: 2.635, 95%CI: 1.013~6.858, P=0.047) and postoperative pacemaker implantation (HR: 3.518, 95%CI: 1.336~9.263, P=0.011) were risk factors for MACE at 1 year, and early improvement of LVEDD was a protective factor (HR: 0.176, 95%CI: 0.052~0.601, P=0.006).Multivariate Cox analysis indicated that early LVEDD improvement was still an independent protective factor for MACE at 1 year (HR: 0.231, 95%CI: 0.062~0.857, P=0.029). Conclusion LVEDD can be improved to various degrees in the early stage after TAVR, and the cumulative risk of developing MACE at 1 year in patients with early improvement of LVEDD is lower than that of patients without improvement.

Suppressor of cytokine signaling 3 (SOCS3) plays a significant role in the process of myocardial adaptation to chronic hypoxia. SOCS3 finely regulates cell signaling cross-talk that occurs between NF-κB and STAT3 during the compensatory protective response. However, the role and mechanism of SOCS3 in hypoxic cardiomyocytes are not fully understood. In the study, we investigated the effect of SOCS3 on the p65 and STAT3 signaling pathways and further examined the potential molecular mechanism involved in regulating apoptosis. Our data showed that SOCS3 silencing could upregulate Ac-p65, p-p65, and p-STAT3 expression in nuclear extracts of H9c2 cells that received hypoxic treatment for 24, 48, and 72 h. SOCS3 silencing also remarkably increased the DNA-binding activity of the p65 motif in hypoxic cultivated H9c2 cells. We also found that SOCS3 knockdown increased cleaved-caspase-3, Bax, and PUMA expression and decreased cleaved PARP and Bcl-2 in expression in hypoxic H9c2 cells. Silencing of SOCS3 caused an increase in LDH leakage from injured cardiomyocytes and reduced cell viability under conditions of hypoxic stress. Furthermore, SOCS3 silencing enhanced the apoptosis of H9c2 cells at 72 h of hypoxia. These findings suggest that knockdown of SOCS3 leads to excessive activation of the NF-κB pathway, which, in turn, might promote apoptosis under conditions of chronic hypoxia. Diagram showing the mechanism of SOCS3 in hypoxic cardiomyocytes. Silencing SOCS3 could induce the apoptosis of H9c2 cells by regulating the apoptosis-associated gene expression, which may be accomplished by activation of the p-STAT3/NF-κB signaling pathway and rely on hypoxia condition.

BACKGROUND:A diversity of surgical strategies are used to treat Marfan syndrome patients with aortic disease. We sought to evaluate the long-term efficiency of aortic root replacement (ARR) for patients with Marfan syndrome.METHODS:Data were collected from 131 patients with Marfan syndrome and aortic disease who underwent ARR in our center. We retrospectively analyzed the long-term outcomes of these patients, among whom 68 had been diagnosed with aortic aneurysm (AA) and had undergone ARR. The remaining 63 patients had aortic dissection (AD); of these, 35 underwent ARR for limited ascending AD, while the others underwent ARR and total arch replacement combined with frozen elephant trunk (FET). Risk factors for survival and reoperation were identified.RESULTS:The operative mortality rate was 4.58%. Age >40 years was the sole risk factor for operative mortality. During follow-up, 12 deaths occurred. Patients aged <25 years and female patients were more prone to late death than were other patients. Indications for reoperation were noted in 22 patients, and the risk factors were age <30 years and female sex. At 5 years, the survival rate was 92.96%, and the freedom from reoperation rate was 88.36%. At 10 years, the survival rate was 85.25%, and the freedom from reoperation rate was 71.75%. The survival and freedom from reoperation rates were significantly higher in patients with AD than in those with AA. Specifically, chronic AD was a greater risk factor for late survival than was acute AD in patients with Marfan syndrome.CONCLUSIONS:For patients with Marfan syndrome and aortic disease, ARR can be safely performed and results in low operative mortality and favorable long-term survival. Young and female patients have a higher risk for late death and reoperation. To prevent AD, surgical intervention should be promptly implemented following the diagnosis of aortic sinus dilation.

Objective To investigate the differences and factors influencing the medium-term outcomes of aortic valve replacement (AVR) between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients. Methods A total of 245 patients who underwent AVR in our hospital from January 2014 to June 2019 and met our inclusion criteria were retrospectively recruited in this study, and were divided into TAV group (n=158) and BAV group (n=87), including 15 cases of type 0 Ap, 21 cases of type 0 Lat, 45 cases of type 1, and 6 cases of type 2. The 1:1 propensity score matching method (PSM) was used to screen the matching cohort, and the intraoperative, perioperative and follow-up outcomes were compared. Multivariate Logistic regression analysis was performed to evaluate the factors affecting the continued dilation of the ascending aorta. Results After PSM, 69 pairs of matching cohorts were selected and the baseline data of the 2 groups were basically balanced. Intraoperative and perioperative outcomes did not differ between the 2 groups. During the median follow-up time of 45 months, there were no significant differences in the diameter of the ascending aorta, diameter of the aortic sinus and its changes, incidence of adverse aortic events, functional status of the prosthetic valve, and classification of cardiac function between the 2 groups, while the difference of ascending aorta change, annual change rate, and proportion of continuous dilation of ascending aorta were significantly higher in the BAV group than the TAV group (P=0.016, 0.010, 0.041). Multivariate Logistic regression analysis of PSM cohort showed that BAV types (OR=3.296, 95%CI: 1.473~7.372), aortic regurgitation (OR=6.491, 95%CI: 2.691~15.657) and aortic valve stenosis with regurgitation (OR=8.233, 95%CI: 2.565~26.429) were positively correlated with the continued dilatation of the ascending aorta after AVR. Furthermore, after the BAV cohort was screened out from the PSM cohort, multivariate Logistic regression analysis indicated that type 1 in BAV (OR=10.378, 95%CI: 1.587~67.853), smoking (OR=4.959, 95%CI: 1.158~21.231) and aortic regurgitation (OR=8.070, 95%CI: 1.729~37.674) were positively correlated with the continued dilatation of the ascending aorta after AVR in BAV patients. Conclusion BAV patients are more likely to continue to dilate the ascending aorta after AVR when compared with TAV patients, and type 1 in BAV, smoking and aortic regurgitation are independent risk factors in BAV patients.

Objective To investigate the clinical characteristics of right atrial tumors and to analyze the experience and efficacy of surgical treatment. Methods The clinical data of 64 patients (37 females and 27 males, at a mean age of 47.0±16.4 years) with right atrial tumors admitted to our hospital from January 2009 to January 2021 were retrospectively collected and analyzed. The clinical features, surgery techniques adopted, postoperative complications and metastatic recurrence of patients were summarized in detail. Results Among all the 64 cases, benign tumors accounted for 78.1% and malignant tumors for 21.9%; while among the 53 patients who underwent surgical treatment, 83.0% of the tumors were benign and 17.0% malignant. The top 3 most common clinical symptoms involved fatigue, chest tightness and pain or precordial discomfort, and facial or lower limbs edema. And the most frequent preoperative complications were atrial fibrillation/flutter, followed by pulmonary embolism. Moreover, the overall in-hospital mortality rate was 3.1%, and the postoperative mortality rate 1.9%. Among the patients with benign tumors, 1 had residual tumor thrombus at the distal end of inferior vena cava, 1 occurred arrhythmia requiring surgical intervention, 3 developed moderate to severe tricuspid regurgitation, and 2 had metastatic recurrences. In the patients with malignant tumors who received surgery, 1 died early postoperatively, 6 developed metastatic recurrences between half a month and 2 years plus 7 months, and 2 cases were lost during follow-up. Conclusion Primary benign tumor is the major type of right atrial tumors. Surgical treatment for benign tumors is safe and effective, even in recurrent cases. Selective surgical treatment for malignant tumors can improve hemodynamics and clinical symptoms, though the overall prognosis tends to be poor.

Objective To investigate the clinical characteristics and surgical treatment experience of reoperation of aorta caused by connective tissue disease. Methods The perioperative and follow-up data of 45 patients with reoperation of aorta in our department from January 2010 to December 2019 were collected and retrospectively analyzed. They were 33 males and 12 females, at an age from 9~73 (46.0±14.1) years. There were 19 cases of connective tissue disease, including 9 cases of Behcet's disease, 4 cases of Marfan's syndrome and 6 cases of bicuspid aortic valve. Bentall operation was performed in 24 cases, Bentall+total aortic arch replacement+descending aortic stent elephant trunk operation in 6 cases, Bentall+mitral valve replacement in 5 cases, and other types of operation in 10 cases. All the patients were followed up for 17~113 (58.5±25.6) months. Results Reoperation of aorta was quite rare, only accounting for 7.3% of reoperation of cardiovascular surgeries in our department (45/617), while connective tissue disease took 42.2% (19/45) among the reoperation. There were 5 patients who died during perioperative period, including 2 cases due to cardiac arrest, 2 cases to persistent low cardiac output syndrome and 1 case to refractory hypoxemia. During the follow-up, 7 cases died, including 4 cases due to Behcet's disease, 1 case to Marfan's syndrome and 2 cases to aortic dissection. The outcomes of other cases were satisfactory. Kaplan-Meier survival analysis indicated the mortality rate of Behect's disease was the highest during follow-up period (Log rank test, P=0.0082). Conclusion Connective tissue disease is an important cause of aortic reoperation. Behcet's disease has the highest mortality and the worst prognosis.

Objective To summarize the clinical characteristics and surgical treatment experience of congenital heart disease complicated with infective endocarditis. Methods The clinical data including perioperative management and surgical approaches of 83 cases of congenital heart disease with active infective endocarditis admitted to the Department of Cardiovascular Surgery of our hospital between January 2015 and December 2019 were collected and retrospectively analyzed. Results Among the 83 patients enrolled, early postoperative death occurred in 2 cases, with an in-hospital mortality rate of 2.4%, 2 cases were discharged voluntarily due to abandonment by their family member, and the remaining 79 patients recovered well. The 2 most common postoperative complications were heart failure (16.9%) and grade Ⅲ atrioventricular block (8.4%). During the follow-up of 3 months to 5 years, residual shunt occurred in 4 cases, with 2 of them being confirmed closed spontaneously, and peak prosthetic velocity and mean gradient increase occurred in 6 cases. No endocarditis recurred and none of the above so far needed surgical reintervention. Conclusion Early detection and standard anti-infection treatment, multidisciplinary team cooperation, appropriate timing of surgery, and retinal surgical procedure are the key factors to achieve good clinical efficacy.

Abstract Objective: The purpose of this study was to evaluate the mid-term outcome of aortic valve replacement for bicuspid aortic valve and tricuspid aortic valve and the related risk factors. Methods: From January 2014 to June 2019, 177 tricuspid aortic valve patients and 101 bicuspid aortic valve patients who underwent aortic valve replacement in our hospital were collected. 1:1 propensity score matching analysis was used to control the bias in patient selection. The perioperative and follow-up data between the two groups were compared. Independent risk factors which were associated with the continued dilatation of the ascending aorta were identified by univariate or multivariate logistic regression analysis. Results: After the matching procedure, 160 patients were included in the analysis (80 in each group). Baseline characteristics, intraoperative, and perioperative outcomes were similar between the two groups (all p > 0.05). Moreover, 67 patients in the tricuspid aortic valve group and 70 in the bicuspid aortic valve group completed the follow-up. The ascending aorta change, annual change rate, and the proportion of continuous dilation of ascending aorta in bicuspid aortic valve group were significantly higher than those in the tricuspid aortic valve group (p < 0.05). Multivariate logistic regression analysis showed that type 1 in bicuspid aortic valve (OR 5.173; 95% CI 1.772, 15.101; p = 0.003), aortic regurgitation (OR 3.673; 95% CI 1.133, 11.908; p = 0.030), and aortic valve stenosis with regurgitation (OR 6.489; 95% CI 1.726, 24.404; p = 0.006) were independent risk factors for the continued dilatation of the ascending aorta in all AV patients. Furthermore, the multivariate logistic regression analysis showed that type 1 in bicuspid aortic valve (OR 5.157; 95% CI 1.053, 25.272; p = 0.043), age ≥ 40 years (OR 6.956; 95% CI 1.228, 39.410; p = 0.028), and aortic regurgitation (OR 4.322; 95% CI 1.174, 15.911; p = 0.028) were independent risk factors for the continued dilatation of the ascending aorta in bicuspid aortic valve patients. Conclusion: Compared with tricuspid aortic valve patients, the ascending aorta of bicuspid aortic valve patients is more likely to continue to enlarge after aortic valve replacement. Type 1 in bicuspid aortic valve, age ≥ 40 years, and aortic regurgitation were the independent risk factors.

目的 探讨晚期妊娠合并急性A型主动脉夹层的多学科诊疗管控.方法 回顾性分析陆军军医大学第二附属医院2018～2019年收治的3例晚期妊娠合并急性A型主动脉夹层患者的临床资料,年龄27～32岁,孕周34～37周.突发胸骨后疼痛是术前的主要临床症状.3例患者均在全身麻醉下行剖宫产后再行Bentall手术,其中2例加行全主动脉弓置换+支架象鼻术,1例加行冠状动脉旁路移植术.结果 围手术期无死亡病例,新生儿均顺利娩出并健康存活.术后ICU停留时间3～5d,术后住院时间为15～18 d.随访时间250～751 d,无复发、死亡患者.1例出现自发性气胸和液气胸,于我中心治愈出院.结论 多学科联合诊疗策略对于挽救晚期妊娠合并A型主动脉夹层患者的生命至关重要.

Pheochromocytoma is a rare and usually benign tumor of the adrenal glands. We report a case of a 40-year-old woman with recurrent pheochromocytoma and catecholamine cardiomyopathy. She had no history of other types of tumors or connective tissue disease. She had already undergone surgery twice to remove the pheochromocytoma, which had now recurred for the second time. A thrombus in the left ventricle was also noted upon imaging examination, which dissipated after anticoagulation therapy using dabigatran, allowing the patient to opt for an elective third surgery. This paper describes the clinical outcome of using the anticoagulant dabigatran to treat left ventricular thrombosis in this rare case of recurrent pheochromocytoma, and thus further contributing to the knowledge of the clinical management of this rare and complicated disease.

Atrial natriuretic peptide (ANP) is a type of peptide hormone secreted by atrial cells, which has many important biological functions and roles. In the current study, we studied the effect of ANP on the activity of epidermal growth factor (EGF). Furthermore, we also explore the cellular properties of EGF in adult retinal pigment epithelial cell line-19 (ARPE-19). For this, we firstly analyzed the cellular properties of EGF on adult retinal pigment epithelial cell line-19 (ARPE-19), the results indicated that EGF/EGFR (epidermal growth factor receptor) internalized into the ARPE-19 cells in a time-dependent manner. In addition, we also found that EGF/EGFR can be transported into the cell nuclei of ARPE-19 in a time-dependent manner in ARPE-19 cells. Furthermore, we analyzed the effect of ANP on EGF's activity, and found that EGFR-mediated signaling was activated with EGF stimulation in a dose-dependent manner, but the intracellular signaling pathways were inhibited by ANP treatment. Additionally, we further analyzed the potential mechanism by which ANP affects the EGF signaling pathway, and the results showed that ANP alone has no effect on total EGFR expression by Western-blot assay. Next, we further evaluated the EGFR stability on the cell membrane, and the results indicated that membrane-localized EGFR expression was significantly down-regulated under ANP treatment, although the total EGFR expression was not changed. In short, the current research lays the foundation for studying the regulatory relationship between ANP and EGF.

Introduction: The cervix is a rare site of metastasis from advanced lung adenocarcinoma. Driven gene detection is particularly important for the treatment of advanced lung adenocarcinoma. Patient concerns: A 49-year-old Chinese female was sent to our hospital because of lumbago and sacroiliac joint pain; she was unable to walk and had vaginal bleeding. The following examinations were performed: imaging, colposcopy, bronchoscopy, immunohistochemistry and next-generation sequencing. Diagnosis: According to the clinical manifestations and the examination results, the diagnosis was lung adenocarcinoma with cervical, brain, adrenal gland and bone metastases. More importantly, EGFR gene mutations (del19) were detected in both the primary lung lesion and uterine cervical biopsy specimen. Interventions: Osimertinib was chosen as the first-line treatment. Outcomes: Lumbago and sacroiliac joint pain were significantly relieved. The levels of tumor markers decreased. Primary injuries and metastatic sites were significantly reduced. Conclusion: Physicians should be alert to the signals of vaginal bleeding and consider that primary lung adenocarcinoma may metastasize to the uterine cervix.

目前认为高脂血症胰腺炎的发生与血胆固醇无关,而与血三酰甘油(triglyceride,TG)密切相关[1].血TG>11 . 3 mmol/L或血TG为5 . 65～11 . 30 mmol/L且血清呈乳状的胰腺炎称为高三酰甘油血症性胰腺炎,血TG为1 . 7～5 . 65 mmol/L称为伴高三酰甘油血症性胰腺炎.高三酰甘油是继胆源性和酒精性因素外重症急性胰腺炎(severe acute pancreatitis,SAP )发病的第三大致病因素,高三酰甘油血症相关性 SAP由Klatskin于1952年首次报道[1],临床实践发现,该病具有病情进展快、并发症多、复发率高、病死率高的特点[2].

目的 探讨应用自体心包瓣叶成形治疗严重三尖瓣病变的临床疗效.方法 31例严重三尖瓣病变患者,均采用自体心包行三尖瓣瓣叶修复,联合人工瓣环成形,观察临床疗效及手术前后的心脏彩超指标.结果 31例患者均顺利实施手术,无严重围手术期并发症及死亡病例,术后心脏超声显示,轻度三尖瓣返流5例(16.13％);术后1年心脏彩超显示2例轻度返流的患者返流加重至中度(6.45％);出院前、术后3月、术后1年心脏彩超的三尖瓣返流面积、右心房、肺动脉收缩压(PASP)均较术前明显改善,差异有统计学意义.结论 对于三尖瓣复杂严重病变,使用三尖瓣瓣叶的自体心包重建并结合三尖瓣瓣环成形可显著改善三尖瓣返流和右心功能,降低PASP,临床效果理想.

Objective To investigate the risk factors for post-operative severe hypoxemia in patients with Stanford A aortic dissection. Methods Clinical data of 162 patients with Stanford A aortic dissection undergoing surgical treatment in our hospital from January 2016 to March 2019 were collected and retrospectively analyzed in this study. According to their oxygenation index(PaO2/FiO2) within 72 h after operation, they were divided into severe hypoxia group (≤100 mmHg) and non-severe hypoxemia group(>100 mmHg). The perioperative clinical indexes were compared between the 2 groups, and the risk factors of severe hypoxemia were analyzed. Results The incidence of severe hypoxemia was 50.6%(82/162) in the cohort. The severe hypoxia group had significantly longer time of mechanical ventilation, postoperative length of ICU stay and hospital stay when compared with the non-severe hypoxia group(all P < 0.05). The total mortality rate was 11.7%(19/162), with that in the severe group obviously higher than that of the other group. Multivariate regression analysis showed that BMI>24 kg/m2(OR=2.604, 95%CI: 1.055~6.427, P=0.038), preoperative PaO2/FiO2≤300 mmHg(OR=2.963, 95%CI: 1.283~6.841, P=0.011) and cardiopulmonary bypass(CPB) time >195 min(OR=1.007, 95%CI: 1.000~1.014, P < 0.044) were independent risk factors for post-operative severe hypoxemia after surgery. Conclusion BMI>24 kg/m2, preoperative PaO2/FiO2≤300 mmHg and CPB time>195 min are independent risk factors for post-operative severe hypoxemia after surgery of Stanford type A aortic dissection.

目的 探讨主动脉腔内支架修复术治疗急性创伤性主动脉夹层(TAD)的治疗策略及疗效.方法 回顾性分析2016年7月至2017年12月我院收治的8例急性创伤性主动脉夹层患者的临床资料.所有患者均行胸腹主动脉计算机体层摄影血管造影(CTA)明确诊断为Stanford B型,采用主动脉腔内支架修复术(EVAR)治疗.收集并分析各患者术前临床特点、术中手术资料、术后随访结果 .结果手术时间(61.2±25.6)min,住院时间(12.7±6.3)d;围手术期无死亡病例,术后无左侧锁骨下动脉盗血、截瘫、肝肾功能衰竭及脑梗死等并发症.出院后随访3～23个月,平均(13.2±9.8)个月,复查CTA均显示破口封闭良好,支架无内漏、移位.结论 与传统体外循环下人工血管置换相比,EVAR手术具有微创、便捷、安全有效等特点,是治疗急性创伤性主动脉夹层安全有效的方法.

目的 观察del Nido停搏液在急性Stanford A型主动脉夹层外科手术中的心肌保护临床效果,探讨del Nido停搏液在成人大血管手术中应用的安全性和有效性。方法 回顾性分析2018年5月至2019年5月因急性Stanford A型主动脉夹层在本院行心脏外科手术的50例病例,按照术中心肌保护灌注液的不同分为两组:del Nido停搏液组(del Nido组,即DN组,24例)和高钾全血停搏液组(whole blood组,即WB组,26例)。对两组患者术前一般资料、体外循环时间、主动脉阻断时间、停循环时间、停搏液用量、体外循环最低血红蛋白浓度、自动复跳率、术前术后血清肌钙蛋白I(troponin I,cTnI)浓度、机械通气时间、监护室停留时间、术后并发症及预后情况等进行比较。结果 两组患者术前资料无统计学差异。两组术后各1例患者出现死亡,其中1例死于多器官功能衰竭,1例死于神经系统并发症DN组患者术中停搏液晶体总量显著高于WB组[(1568±230)ml比(43±12)ml,P<0.05],DN组停搏液灌注次数显著低于WB组[(1.80±0.72)次比(5.23±0.81)次,P<0.05],DN组总灌注时间显著低于WB组[(6.23±0.39)min比(12.49±1.02)min,P<0.05],其余各项术中、术后指标两组比较未见统计学差异。结论 del Nido停搏液在急性Stanford A型主动脉夹层外科手术中可以提供较好的心肌保护作用,临床效果良好。

目的 探讨肺动脉血栓切除术在急性危重肺动脉栓塞症（pulmonary embolism,PE）治疗中的作用。方法 收集我院2010年1月至2018年12月行肺动脉血栓切除术的45例急性危重PE患者的临床资料,比较患者术前、术后及随访期间的超声心动图右心室直径、右心房直径、三尖瓣反流压差、肺动脉直径,比较术前、术后的动脉血氧分压（arterial partial pressure of oxygen,PaO 2 ）、动脉血氧饱和度（arterial oxygen saturation,SaO 2 ）。结果 45例急性危重PE患者中,3例术前心脏骤停的患者术后因严重缺血缺氧性脑病、多器官功能衰竭死亡或放弃治疗。其余42例患者均生存,随访期间无死亡病例（生存率93.3%,中位随访时间32个月）。术后患者的PaO 2 [（86.9±7.5）mm Hg比（61.3±5.3）mm Hg]、SaO 2 [（96.9±2.7）%比（86.3±3.1）%]均高于术前（P<0.05）;术后、随访期间末次超声的右心房直径、右心室直径、三尖瓣反流压差、肺动脉直径均较术前明显减小（P<0.05）。结论 对于急性危重PE患者,肺动脉血栓切除术是一种安全的手术方式,病死率低,可显著改善患者右心室功能及肺动脉压力,中远期效果良好对于大面积PE的危重患者,应该更为积极的考虑进行肺动脉血栓切除术。

目的 探讨妊娠期行心内直视手术的方法与策略,改善孕妇及胎儿的预后.方法 回顾性分析2016 年1 月至2018年12月我院7例妊娠期合并心脏病患者的临床资料,并对孕妇及婴儿进行随访.结果 7例孕妇中有4例为瓣膜病或先天性心脏病合并亚急性感染性心内膜炎,1例风湿性瓣膜病,2例急性主动脉夹层( A型).术前心功能分级(纽约心脏病协会,NYHA)Ⅲ级2例,Ⅳ级5例.接受心脏手术时间是24～37孕周(中位数29孕周). 3例同期接受剖腹产及心内直视手术;3例先进行心内直视手术,然后继续妊娠到足月后剖腹产取胎;1例孕妇在24孕周时接受心脏手术,胎儿在手术前已宫内死亡,术后2 d自然娩出,孕妇术后15 d死亡;其余孕妇及胎儿随访1～23个月(中位数9个月),孕妇生活质量改善,心功能恢复到Ⅰ级,所有新生儿均存活.结论 孕期行心内直视手术安全可行,手术时机的选择是决定孕妇及胎儿预后的重要因素.