目的:主动脉溃疡性病变临床上并不少见,本文报道11例主动脉溃疡性病变的诊治。方法:年龄49～81岁,突发胸痛5例,体检发现3例,术中遭遇3例。并发症高血压7例、冠心病6例、感染性心内膜炎2例,白塞氏病1例,多发动脉瘤1例。其中主动脉升段窦管交界处2例,主动脉弓部2例,降主动脉胸部4例,降主动脉腹部起始部2例,降主动脉肠系膜下动脉起始部1例。合并壁间血肿4例、下肢急性事件1例。病原体:金葡菌2例、草绿色链球菌1例、梅毒2例。结果:C-反应蛋白(CRP)和同型半胱氨酸,与同期收治的主动脉疾病患者(103例)相比,差异有统计学意义。11患者没有住院死亡,多发动脉瘤合并溃疡院外随访2 w死亡,其余患者随访期在3个月～4年,壁间血肿患者血肿均消失。梅毒感染诱发腹腔干开口上主动脉干虫蚀样溃疡患者随访1年,期间发生急性心肌梗死。结论:对于主动脉溃疡性病变要注意病原学检查与相应治疗,根据不同部位选择合理的治疗手段有利于患者长期生存。

患者,女,51岁,快步行走感心慌、气促2个月,伴颜面部、下肢水肿,时有夜间不能平卧,偶有咳嗽,无痰中带血、胸痛史,无吸烟史,7年前有交通事故伤史.查体:颈部、腋下未触及肿大淋巴结.心尖区闻及Ⅲ/6级收缩期杂音.超声心动图见二尖瓣后叶脱垂,重度关闭不全,LVEDd55mm,LVEF 0.6;胸片:右第3、4、6、7陈旧性肋骨骨折,左上叶舌段肿块1.8 cm,可见胸膜凹陷征.全身PET-CT检查未见远处转移.冠状动脉CTA未见异常.诊断:①左上肺周围型肺癌;②二尖瓣重度关闭不全,心功能(NYHA)Ⅲ级.手术方法:静脉复合麻醉,气管插管双肺通气.胸部正中切口,切开左侧胸膜,先行左肺上叶切除,并行肺门、纵隔淋巴结清扫,然后在中低温体外循环下经右心房-房间隔径路以机械瓣置换二尖瓣,保留后瓣叶.

Objective To review the experience of surgical treatment of total anomalous pulmonary venous return(TAPVR),to improve its treatment result.Methods In a total of 22 patients,there were 10 males and 12 females aged two to 14 years old.Correction of TAPVR was performed under moderate hypothermic cardiopulmonary bypass.8 patients had supracardiac return,13 patients had intracardiac return and one mixed.Results One patient died postoperatively because of severe low output syndrome.The postoperative complications include arrhythmia in 3 and respiratory infection in 2.Conclusion TAPVR should be surgically corrected early.In view of current improved surgical techniques,supracardiac anastomosis in treatment of supracardiac TAPVR is convenient to operate,and can reduce the risk of arrhythmia.Surgical treatment of TAPVR may expect a satisfactory result.

<正>红细胞葡萄糖6-磷酸脱氢酶(G6PD)缺乏症是一种遗传性缺陷,又叫蚕豆病,合并先心病需要心脏直视手术的报道很少。现将我院2011年11月收治的3例伴有G6PD缺乏症的先心病心脏直视手术病例进行分析。1资料和方法1.1一般资料本组3例均为男性,年龄22-30月。父母

Objective To summarize the experience in surgical treatment of infective endocarditis in adults. Methods Infected valves were replaced and associated cardiac abnormalities were corrected concomitantly in 38 patients with infective endocarditis. Antibiotics were given before and after operation. Results Aortic valve replacement was performed in 20 cases, mitral valve replacement in 11 cases, double valve replacement in 7 cases. The accompanying procedures include 5 cases of repair of ventricular septal defect, 2 cases of repair of atrial septal defect, 2 cases of repair of ruptured aneurysm of aortic sinus, 1 case of cutting and suture of patent ductus arteriousus, and 1 case of pulmonary valve repair. Early postoperative complications occurred in 4 cases, including 2 cases of re-exposure for bleeding and 2 cases of dehiscence of sternum. A late postoperative complication was mild aortic paravalvular leakage. No recurrence or death case was recorded during 1-9 years follow-up. Conclusions Satisfactory results could be obtained for infective endocarditis by early diagnosis, timely surgical operation and proper perioperative management.

<正>二叶主动脉瓣(bicuspid aortic valve,BAV)是一种很常见的先天性瓣膜疾病,可以为散发性,但有很强的家族遗传性[1]。BAV与主动脉瓣功能障碍和主动脉壁病变密切相关。BAV可以单独存在,患者也常合并有主动脉缩窄、动脉导管未闭、室间隔缺损、主动脉瓣上狭窄、主动脉瓣下狭窄、二尖瓣瓣上环、先天性二尖瓣狭窄等其他心血管畸形。一、发病率最早对先天性二叶主动脉瓣发病率的调查是基于尸检研究,发病率为0.5%~1.4%。几个大组尸检的

Objective To evaluate the therapeutic effect of minor median sternotomy for congenital heart surgery.Methods 52 patients with congenital heart diseases were operated by median minor incision.The incision was made from the xiphoid process to the second intercostal level and it was only 5-10 cm long.Routine cardiopulmonary bypass was used in 52 cases of open heart surgery and compared the surgical results with 55 cases of routine incision operations.Results The cardiopulmonary bypass time and clamping time did not prolonged significantly in the minor incision group compared with the routine incision group(P>0.05),but the drainage bleeding volume in the minor incision group was less than the routine group(P<0.05).All cases were cured and no sever complications and infection occurred.Conclusion The median minor sternotomy for many congenital open heart surgery is safe.Cosmetic effects and fewer traumas could be achieved satisfactorily.

Objective:We aim to evaluate the clinical characteristics and outcome of infective endocarditis in our hospital.Methods:A retrospective review of all 41 cases of infective endocarditis(IE) was undertaken,male 33,female 8.There was 2.38% in all inpatient(1682) at same time.The spectrum of diagnostic was aortic valve disease(AVR,7),mitral valve disease(MVR,6),pulmonary(2),aneurysms of the sinus of Valsalva(1),abscesses in root of artery(1),concomitant with congital heart diseas(CHD,17),postoperation IE(8).In all patients treated by operation,there are acute IE 3,subacute IE 5 and stable 25.There were 9 cases positive blood culture results.There were 15 neoplasms and 1 abscesses found in operation.There were 10 positive tissue culture results for these samples.For the patients dentified as primary IE,a course of intravenous(Ⅳ) antibiotic therapy and improving heart function were started except for 4 emergency operation.Results:2 patients died during postoperation since heart failure.Another patient gived up therapy for leak of perivalve with serious heart failure during follow-up.In all other follow-up in out-patients,heart function were normal excluding one serious heart failure in long term.Conclusion:Individual of antimicrobial treatment schemes and operation programme,as well as both reasonable coordinate,were critical for outcome of IE.

AIM: To review the results and methods of surgical treatment and perioperative management of congenital heart disease(CHD) with severe pulmonary hypertension(PH).METHODS: Thirty-six patients(17 males,19 females,aging from 1-41 years) of congenital heart disease with severe pulmonary hypertension were included in the study,among whom were 9 cases of atrial septal defect and 20 cases of ventricular septal defect.The saturation of artery oxygen ranged from 0.85-0.94 and echocardiography showed left to right slow velocity shunt in 23 cases,double direction shunt in 10 cases and no shunt in 3 cases.The pulmonary pressure was 80 to 130 mmHg(1 mmHg=0.133 kPa),the pulmonary pressure/systemic pressure varied from 0.75-1.0 and the pulmonary resistance was 8-27.2 Wood unit.All the patients were treated with corrective surgery,and one way shunt valve(size 0.5-0.6 cm) from right to left shunt on the repaired patch was created especially for the treatment of extremely severe pulmonary hypertension.The therapy of oxygen inhalation,oral intake of captopril and sildenafil,and intravenous injection of sodium nitroprusside and prostaglandin E1 were routinely administrated perioperatively to reduce pulmonary hypertension.Nitric oxide and sildenafil were applied especially for the treatment of extremely severe pulmonary hypertension or pulmonary hypertension crisis.RESULTS: Only one early postoperative death occurred due to low output syndrome,and the other 35 patients were recovered and discharged from the hospital.The 0.5-7 years follow-up showed that the patients were well recovered with NYHA Ⅰ heart function.CONCLUSION: Satisfactory outcome can be achieved in surgical treatment of CHD with severe pulmonary hypertension by meticulous preoperative analysis of surgical indications,selection of appropriate operative procedures and multiple perioperative therapies.

目的 探讨经左房顶部径路矫治心上型完全性肺静脉异位引流的体会.方法 2005年1月至2008年1月经左房顶部径路矫治心上型完全性肺静脉异位引流5例,女性3例,男性2例,年龄2～13(7.00±3.85)岁,在全麻体外循环下经左房顶部径路进行矫治.结果 均治愈出院,随访0.5～2.5年,生长发育良好,无心律失常和吻合口狭窄.结论 经左房顶部径路矫治心上型完全性肺静脉异位引流,手术方便,显露好,减少心律失常和吻合口狭窄的发生.

Objective To review the surgical treatment of supracardiac total anomalous pulmonary venous return (TAPVR) via superior approach. Methods Five patients (2 males and 3 females, aged from 2 to13 with an average of 7.0±3.9 years) with supracardiac TAPVR underwent surgery from Jan. 2005 to Jan. 2008. All patients showed cyanosis at resting state with the SaO2 of femoral artery ranged from 0.89 to 0.93; cardiac auscultation revealed 2-3/6 degree of systolic murmur and split second heart sound; EEG showed sinus rhythm, right auricle enlargement, right ventricle hypertrophy; echocardiography revealed supracardiac total anomalous pulmonary venous return, atrial septal defect (13-17mm), and 73.8±5.3mmHg of pulmonary artery pressure. The direct anastomosis of the top of left atrium and common pulmonary venous trunk were performed under general anesthesia and extracorporeal circulation in the 5 patients, of whom tricuspid valvuloplasty was performed simultaneously in 2 patients with tricuspid regurgitation. The aortic cross-clamping time was (55.6±8.7) min, cardiopulmonary bypass time was (86.8±12.9) min, artificial respiration time was (17.8±3.5) hours. Nitroprusside sodium, prostaglandin E and dopamine were used in the early postoperative period to 4 patients with severe pulmonary hypertension. Results All the 5 patients were cured and discharged, grew well and no arrhythmia or anastomotic block was found during the follow-up period of 5 months to 2.5 years. Conclusion The treatment of supracardiac TAPVR via superior approach can afford a better exposure and easy for operating, and decrease the incidence of postoperative arrhythmia and anastomotic block.

<正>2005年3月～2008年7月,我院对现役空勤人员常规体检或改装体检行超声心动图检查时发现4人患有无症状的先天性心脏病,其中房间隔缺损1例,卵圆孔未闭1例,二叶主动脉瓣伴主动脉瓣轻—中度关闭不全、主动脉窦部扩张1例,冠状动

Objedtve To investigate whether the lose of heterozygosity of microsatellite present in tumor tissues of patiente with esophageal cancer could be detected in the serum sample,and its clinical significance.Methods 68 tumor specimens and their matched serum DNAs were analyzed for LOH at 13microsatellites by using PCR and fluorescence-based DNA sequencing technology. Serum samples form 100 healthy persons served as nonmal controls.The association of LOH with the clinicopathological phenotype was compared. 64(94.1I%)patients(94.1%) were detected to have LOH at least one microsatellite site in tumor tissue,and 66(97.O%)in serum samples.The detection rate for LOH was not significantly associated with the clinical stage of esophageal can-cer.There was a tendency toward more frequent LOH in the serum in patients with lymph node involvement and higher histological grade.Conclusion The presence of tumor can be determined by microsatellite analysis in the serum of patients with esphageal can-cer,andserum microsatellite anaysis will be hilpful of the early detection of esophageal cancer in high-risk populations. Key words: Esophageal cancer Serum Microsatellite instability Chromosome deletion

Objective To investigate the loss of heterozygosity at 17 microsatellites of 10 chromosome arms in 68 resected specimens of esophageal cancer, and the relationship to the clinicopathological phenotypes of patients. Methods 68 tumor specimens (20 well-differentiated squamous carcinomas, 30 moderately differentiated carcinomas and 18 poorly differentiated carcinomas) and their matched blood samples were analyzed for LOH at 17 microsatellites by using PCR and fluorescence-based DNA sequencing technology, and the association of LOH with the clinicopathological phenotypes of patients was compared statistically. Results The lowest detection frequency of LOH in our subjects was observed at D8S261 with 33. 3%, and the highest frequency was at D9S125 with 85. 2%. There were 12 markers with the frequency of LOH higher than 50.0%, and 3 markers (D3S1597, D3S1285 and D9S125) with the frequency higher than 75. 0%. There was a significant difference in the frequency of LOH at D9S111 and D13S153 between tumors with different histological grades. LOH at D9S111 was observed in 2 of 12 tumors with well differentiation in 14 of 20 tumors with moderate differentiation, and in 14 of 16 tumors with poor differentiation. LOH at DI3S153 was observed in 2 of 8 tumors with well differentiation, in 12 of 28 tumors with moderate differentiation, and in 11 of 12 tumors with poor differentiation. There was a significant difference in the frequency of LOH at D8S261 between tumors with lymph node metastasis and without lymph node metastasis. LOH at D8S261 was found in 1 of 14 tumors with lymph node metastasis, and in 12 of 22 tumors without lymph node metastasis. Conclusions The widespread and frequent loss of heterozygosity may exist in esophageal cancer, and the candidate genes located in the site of frequent LOH may be involved in the development of this cancer; LOH at D9S11 and D13S153 are more commonly observed in the patients with higher histological grades, the tumors with LOH at D8S261 may have a low tendency to lymph node involvement.

Objective To report the experiences of minor median sternotomy for congenital open heart surgery.Methods 26 patients with congenital heart diseases were operated by median minor incision.The incision was made from the xiphoid process to the second intercostal level and it was only 6~9 cm long.Results All cases were cured and no sever complications and death occurred.The patients recovered quickly and were satisfied with their cosmetic incisions very much.Conclusion The minor median sternotomy for many congenital open heart surgery is safe.Cosmetic effects and less trauma could be achieved satisfactorily.

Objective To evaluate the effect of several operative methods on the correction of partial atrial ventricular canal.Methods 36 patients were operated under the systemic anesthesia and moderate hypothermia with cardiopulmonary bypass.The cleft of mitral anterial leaflet was sutured interruptedly.If the mitral valves remained insufficiency after suture,we adopted double orifice mitral valve repair.The congenital double orifice of mitral valves in two patients were preserved.When the downside of the primary atrial septal defect was sutured,the suture line was posteroinferior to the coronary sinus in 13 patients,anterosuperior to the coronary sinus in 10 patients and in another 13 patients,the suture line at the mitral valve's bottom far from the coronary sinus.Results There are no deaths in these patients.No regurgitation or stenosis occurred in the patients with artificial or congenital double orifice mitral valve.Permanent atrioventricular block happened in 1 case at early stage.Conclusion Mitral valve repair and prevention of atrioventricular block are the key points for the correction of patial atrial ventricular canal.

我院自1997年3月～2007年4月应用国产华利康可吸收线及进口Dexon可吸收线行食管黏膜-胃黏膜连续缝合,吻合口瘘、狭窄、食管胃反流发生率低,取得了较好的临床效果,现报告如下.

OBJECTIVE To observe the variations of the function of endothelial cell and coronary artery resistance(CAR) during heart arrest with warm blood cardioplegia with or without aprotinin.METHODS 40 patients suffered rheumatic heart disease were selected randomly.20 of them were administered aprotinin during extracorporeal circulation(ECC) as group B(study group),others without apotinin as group A(control group).The blood samples were taken at aortic clamping,30min,60min after aortic clamping,and end warm blood perfusion.The tissue-plasminogen activator(t-PA),the qlatelet granulate membrane protein 140(GMP140) and the 6-keto-PGF1α(6-K-F1α),circulating endothelial cell(CEC)were observed.The pressure and flux were recorded during warm blood cardioplegia.RESULTS ECC led CEC to increase,which peaked at 60min after aortic crossclamp.The EC related proteins increased at that time,but the peak of 6-K-F1 in group A delayed than that in group B.CAR of group B was significantly lower than that of group B at 60 min after aortic crossclamp.CONCLUSION ECC leads to excessive activation,injury and dysfunction of EC,while aprotinin can attenuate this process.

Objective To analyse a rare malformation of absent right superior vena cava with persistent left superior vena cava in congenital heart diseases.Methods Two patients with clinically diagnosed persistent left superior vena cava in congenital heart disease were operated.Results Two cases were successfully cured by operation withour heart arrhythmia.Conclusion Finding the rarity congenital anomaly,the clinical and surgical implications were discussed.

Objective To analyse a rare malformation of absent right superior vena cava with persistent left superior vena cava in congenital heart diseases.Methods Two patients with clinically diagnosed persistent left superior vena cava in congenital heart disease were operated.Results Two cases were successfully cured by operation withour heart arrhythmia.Conclusion Finding the rarity congenital anomaly,the clinical and surgical implications were discussed.