2017年 · 第33卷第02期

Many complicated congenital heart diseases are accompanied by severe pulmonary stenosis or pulmonary atresia, and pulmonary artery reconstruction is often required when surgically corrected. The main materials for reconstructing pulmonary artery are as follows: artificial blood vessels, homograft aorta or pulmonary artery, bovine jugular vein and valved artificial blood vessels, etc. Each of these reconstruction materials has its advantages and disadvantages. Allogeneic aorta or pulmonary artery is closest to autologous pulmonary artery tissue, and with one-way valve, it is a good reconstruction material, but its biggest disadvantage is that long-term calcification after surgery leads to valve failure, stenosis or insufficiency. The surgical data of patients with long-term pulmonary restenosis after the same type of aortic reconstruction pulmonary artery surgery admitted to our hospital in recent years are retrospectively summarized, and reported as follows.

Atrial fibrillation is one of the common clinical arrhythmias. Mainly occurs in organic heart disease and elderly people^[1]。 Eliminating atrial fibrillation can reduce the risk of postoperative heart failure and long-term cerebrovascular accident, and improve the long-term survival rate of patients after operation^[2]。 We compared the results of two different surgical radiofrequency ablation procedures for atrial fibrillation to investigate its efficacy and safety.

Atrial fibrillation (AF) is the most common persistent arrhythmia, which is more common in the elderly, with high morbidity, disability and mortality. There are 33 million AF patients worldwide. In the past 11 years, the number of AF patients in China has increased by 20 times, and the number of AF strokes has increased by nearly 13 times^[1,2]。 In recent years, radiofrequency ablation (RF) technology has made a breakthrough in the treatment of chronic AF. From January 2012 to May 2014, 128 consecutive patients with valvular heart disease complicated with chronic AF underwent modified maze surgery with valve replacement and bipolar radiofrequency ablation in our hospital, with good results. The experience is summarized as follows.

ChildMale, born 6 h. Physical examination: The lower end of the sternum shows that the apex is covered with a hyaline membrane, beating with the cardiac cycle, and there is a ligament link between the heart and the umbilical cord (Figure 1)。 A systolic murmur of grade 2/6 was heard in the third intercostal at the left margin of the sternum. Cardiac CT examination showed: ventricular septal defect (VSD), atrial septal defect (ASD) (Figure 2、Figure 3), three-dimensional reconstruction showed the absence of the lower part of the sternum body and the xiphoid process, and the absence of muscles in the corresponding area in the middle of the thorax and abdomen (Figure 4)。 Preoperative diagnosis: Cantrell's pentalogy.

PatientMale, 38 years old. Chest tightness with subxiphoid pain for 3 days. Physical examination at admission: consciousness was clear, heart rate 112 beats/min, rhythm was uniform, heart sounds were low and dull, and no obvious pathological murmur was heard. CT examination of skull + chest showed that the right atrium occupied huge space without metastasis (Figure 1)。 Echocardiography showed moderate volume of pericardial effusion, occupying a 6.3cm ×4.5cm space in the right atrium, pedicled and attached to the anterior valve annulus, with a large range of mobility (Figure 2)。

PatientMale, 45 years old. Intermittent chest tightness for more than 1 year, aggravated with edema for half a month. Admission physical examination: weak first heart sound at the apex of the heart, grade 2/VI systolic blow-like murmur, 10 cm under the costs of the liver, and severe edema of both lower limbs. Echocardiography showed: left ventricular ejection fraction 0.14. Coronary angiography showed middle right coronary artery occlusion, subtotal proximal left anterior descending artery occlusion, and 90% proximal circumflex artery stenosis. After 2 months of active treatment, cardiac function improved, and left ventricular ejection fraction was 0.24. Myocardial radionuclide scan showed that the myocardial perfusion of each wall of left ventricle was reduced to varying degrees, and there was viable myocardium.

PatientFemale, 45 years old. Physical examination revealed anterior mediastinal mass 9 days ago. After admission, chest enhanced CT showed a huge mass in the anterior mediastinum, which showed uneven enhancement after enhancement, and multiple enhanced vascular shadows were visible inside. The upper boundary of the lesion reached the upper edge of the aortic arch, and the lower boundary reached the level of T8 vertebral body, about 10.0 cm ×6.9 cm ×9.7 cm in size. The lesion surrounded some branches of the left upper lobe artery and pushed the main trunk of the pulmonary artery to deform. CT-guided puncture biopsy of mediastinal tumor was performed on the 3rd day of admission. Pathological examination showed thymoma type B2, Masaoka clinical stage Ⅲ (Figure 1)。 CT-guided descent through the Treatment Planning System (TPS) on Day 9 of admission¹²⁵Ⅰ Radioactive particle implantation, a total of 110 radioactive particles were implanted. CT examination at the first and third months after operation showed that the tumor was gradually reduced compared with the previous, and the size of the anterior mediastinal mass was about 6.2 cm ×4.9 cm ×6.0 cm at the third month.