2017年 · 第33卷第05期

partial anomalous pulmonary venous connection (PAPVC) refers to the direct or indirect return of one or more pulmonary veins (not all) to the right atrium through systemic circulation veins, in which PAPVC drained into the superior vena cava is often combined with venous sinus atrial septal defect. The usual surgical methods include single-piece method and double-piece method^[1]。 However, no matter whether the single-piece or double-piece method may cause abnormal pulmonary venous reflux obstruction, even superior vena cava obstruction, and some children may also have abnormal sinus node function^[2]。 Since 2012, we have used Warden's surgery to correct partial anomalous pulmonary venous drainage into the superior vena cava with good results, as reported below.

arterial switch operation (ASO) is the first choice for the treatment of congenital heart disease with inconsistent ventricular-aortic connection. The survival rate of ASO is high and the reoperation rate is low, but postoperative neoaortic regurgitation has become an important complication affecting the curative effect of ASO^[1]。 The echocardiographic data of 83 children with ASO surgery in our hospital from March 2007 to October 2015 were analyzed, and the changes of the diameter and ratio of the neoaortic annulus, sinus and sinus junction were observed, so as to explore the causes of postoperative neoaortic regurgitation.

pulmonary atresia with intact ventricular septum (PA/IVS) and critical pumonary stenosis (CPS) are cyanotic congenital heart diseases with severe obstruction of right ventricular outflow tract and pulmonary circulation dependent ductus arteriosus. Because the disease is associated with different degrees of right ventricular dysplasia, some of which are associated with coronary artery abnormalities, the surgical methods and clinical outcomes are different^[1]。 Up to now, there is no uniform standard for the choice of first-stage surgery for newborns, and both traditional surgery and transcatheter interventional therapy have their limitations^[2,3,4,5,6]。 In recent years, some heart centers at home and abroad have used mosaic surgery to treat children with PA/IVS who can undergo right ventricular decompression, but few neonatal cases have been reported^{[7,8,9,10,11]}。 This study summarized the clinical efficacy of 17 neonates with PA/IVS and CPS who underwent mosaic surgery in our heart center from May 2013 to December 2015.

Esophageal foreign bodies are not uncommon, the incidence rate in adults can reach 19.4%, chest pain is the most common symptom, about 9.2% of patients may have secondary esophageal perforation^[1]。 Common esophageal foreign bodies include fish bones, jujube kernels, bones, etc. Some rare foreign bodies, such as fish hooks with bait^[2]melon^[3]And so on have been reported. We have treated 2 patients with copper strip esophageal foreign bodies, whose course and condition are different, and are reported below.

There is no uniform criterion for the choice of therapeutic modality in patients with left main coronary heart disease (LM) and/or three-vessel disease. Previous views suggest that percutaneous coronary stenting (PCI) is difficult to achieve complete revascularization in such patients, and the postoperative restenosis rate and revascularization rate are higher; Coronary artery bypass grafting (CABG) has become the preferred therapeutic strategy for patients with high-risk left main and/or three-vessel disease because of its high complete revascularization rate and low revascularization rate^[1]。 In recent years, with the widespread application of drug-eluting stents (DES) and the continuous improvement of stent placement technology, the proportion of postoperative adverse events has decreased compared with before. Whether PCI is used in the treatment of complex coronary artery disease has increased, and a large number of randomized prospective studies are needed.

At present, surgical resection is still the main method for radical cure of esophageal cancer. Despite the continuous progress of surgical techniques and instruments, the occurrence of postoperative esophagogastric anastomotic leakage is still inevitable, with an incidence rate of 3% ~25%^[1,2,3]The mortality rate is 5% ~40%^[4,5,6]Nowadays, conservative treatment is mostly adopted, including drainage, enteral nutrition, anti-infection and other methods. We used the "two-tube method" (nasal-fistula drainage tube, three-lumen feeding tube) combined with fibrin adhesive to treat anastomotic mediastinal fistula after esophageal cancer surgery, and the curative effect was satisfactory.

The patient was a 48-year-old female. Sudden needle-like pain in the left chest and back during sleep for 7 days, accompanied by chest tightness and shortness of breath, relieved by itself. CT examination of the chest showed an oval soft tissue density shadow in the posterior lower mediastinum of the left chest, with clear boundaries, spotty calcification foci inside, and the interstitial fat space with the mediastinum. After enhancement, the lesion enhancement was not obvious, and there were no enlarged lymph nodes in the mediastinum. MRI of the chest showed that the left paravertebral oval had shorter T1 and longer T2 signals, and DWI showed a slightly higher signal; Dynamic enhancement scan showed no enhancement, the lesion signal was uniform, and the boundary was clear. Coronary angiography showed no abnormalities in the coronary arteries.

The patient was a 25-year-old male. Pain in left chest wall for 10 days. Physical examination: Protrusion can be seen in the posterior segment of the left 8th rib, and the surface of the rib is rough and uneven, with local tenderness. CT examination of the chest showed a fusiform expansive destruction of the left 8th rib with cortical rupture (On Figure 1)。 "Left 8th rib tumor resection" was performed under general anesthesia in July 2015. Postoperative pathology showed a shell-like structure composed of bone and cartilage tissue with foam cells in it, considering Erdheim-Chester disease (Under Figure 1)。 The patient's incision healed in stage I and was successfully discharged 5 days later. After 10 months follow-up, no recurrence and other organ involvement were observed.

The patient was a 24-year-old male. Heart murmur for more than 20 years accompanied by chest tightness for 3 weeks. Physical examination: growth and development are slightly worse than those of peers. The blood pressure was 137/80 mmHg (1 mmHg =0.133 kPa) in the left upper limb, 135/75 mmHg in the right upper limb, 111/65 mmHg in the left lower limb, and 114/54 mmHg in the right lower limb. Transthoracic echocardiography showed supramitral stenosis (Figure 1), congenital unilobar aortic valve malformation (Figure 2), subaortic coarctation ring (Figure 3), the aortic sinus was widened, the descending aortic arch was narrowed, and the peak systolic pressure difference was 29 mmHg. Three-dimensional esophageal echocardiography showed a strong echo fiber cord attached to the left atrial surface of the mitral valve (Figure 4)。 Aortic CTA showed dilatation of the ascending aorta and narrowing of the diameter at the boundary with the descending aorta (Figure 5)。 Diagnosis: Congenital heart disease, Shone syndrome, supramitral stenosis, aortic stenosis, subaortic stenosis, aortic root tumor, descending aortic coarctation.

The patient was a 73-year-old female. Paroxysmal chest tightness and chest pain for 3 days. History of hypertension, diabetes. The electrocardiogram at the time of attack showed borderline rhythm, some ST segment changes (Ⅰ, aVL, V2-V6), and no obvious abnormalities were observed at rest. CT of the coronary artery showed calcification and non-calcified plaque infiltration in the proximal and middle segment of the left anterior descending artery, and segmental eccentric stenosis of the lumen of different degrees, the narrowest part was located in the proximal segment of the anterior descending artery, the degree of stenosis<50%。 Echocardiography showed no mass attached to the tip of the coronary valve 1.2 cm ×0.9 cm, with moderate echo, lobulated shape, large range of mobility, and no abnormality in the opening and closing of the aortic valve, suggesting that the aortic valve occupied space (Figure 1)。 Cardiac MR showed that an irregular abnormal signal focus 0.9 cm above the aortic valve protruded into the aortic lumen, with low signal in T1WI, high confounding signal in T2WI, and high confounding signal in SPIR. The surface was smooth. With the opening and closing movement of the aortic valve, the surrounding blood flow showed vortex changes, and enhancement could be seen after enhancement, suggesting aortic valve neoplasms (Figure 2)。 Preoperative diagnosis of coronary heart disease and aortic valve mass occupation.

The patient was a 25-year-old female. Intermittent chest tightness and palpitations for more than 1 month. The heart rate was 108 beats/min, the intensity of heart sounds varied, and no murmur was heard in the auscultation area of each valve. 24 h Holter examination showed: ectopic rhythm, persistent atrial fibrillation, occasional premature ventricular beats, R-R interval>2.0 s detected 11 times, the longest lasting 2.14 s. Echocardiography showed that the left atrium was posterior, superior, right and anterior to the descending aorta with a medium-hypoechoic solid mass of approximately 4.5 cm ×3.5 cm (Figure 1)。 MRI examination showed that the posterior and inferior part of the left atrium (front of the spine) occupied a mass, showing isot1 mixed with long T2 signal shadow, with clear boundary, about 4.5 cm ×4.1 cm ×3.3 cm in size, and delayed enhancement showed strip-like mild enhancement.