2017年 · 第33卷第09期

More than 200,000 patients worldwide undergo valve replacement surgery every year^[1]。 Among the heart valves widely used at present, mechanical valves account for about 70% in developing countries^[2]。 ON-X heart valve began to be used clinically in 1996 and was approved by the FDA in 2001. As a new type of double-leaf mechanical valve, through continuous research, the application of autologous heart valve can reach the same ideal degree as possible. Its structural characteristics are outstanding, but there is still a lack of large sample and long-term clinical verification in China.

Percutaneous coronary stenting (PCI) and coronary artery bypass grafting (CABG) are commonly used revascularization strategies in patients with complex coronary artery disease. Before the application of drug-eluting stents (DES), CABG was the gold standard for revascularization of complex coronary artery disease because of its high long-term patency rate and low revascularization rate^[1]。 With the widespread use of DES, the long-term patency rate and target vessel reconstruction rate after PCI have improved. At present, SYNTAX scoring is widely used in the world^[2]Is a scoring system designed for complex coronary artery lesions, focusing on the complexity of coronary artery lesions; While the EuroSCORE score^[3]It is a scoring system for predicting postoperative mortality in patients undergoing open heart surgery, and only considers patient clinical indicators. In this study, the two scoring systems were combined to form the GRC (global risk classification) system^[4]Comprehensively considering the clinical related indexes of patients and the complexity of coronary artery disease, the appropriate revascularization method is selected to provide a new reference for the treatment strategy of revascularization in patients with complex coronary arteries.

esophageal replacement with colon (ERC) is a common method for the treatment of benign esophageal diseases. Ischemic necrosis of the colon that replaces the esophagus is a common postoperative complication. Once colon necrosis occurs after operation, the mortality rate is extremely high. The key to reduce this complication is to ensure good blood supply to the colon^[1,2]。 The traditional method of establishing retrosternal tunnel often leads to ischemic necrosis of colon compression due to the insufficient patency of the retrosternal dense cord structure to the retrosternal tunnel. With the development of laparoscopic technology, our department adopted laparoscopic to establish the retrosternal tunnel from June 2014 to December 2015, which ensured the patency of the colon lifting tunnel and reduced the risk of colon compression ischemic necrosis. The summary report is as follows.

Female, 30 years old, gestation 3 delivered 1, 37 weeks +5 days gestation, singleton, fetal position left occipitocephalic anterior (LOA). On May 16, 2016, there was sudden severe chest pain without obvious trigger, pale complexion, sweating profusely, accompanied by weakness of both lower limbs, and no syncope. Chest CT examination at the local hospital showed "type A aortic dissection". After treatment with analgesia and blood pressure control, the chest pain was relieved. He was admitted to hospital at 18:50 on May 16. No previous history of hypertension, heart disease, no history of smoking or alcoholism, and no history of drug contact.

Male, 33 years old. Chest tightness after activity for more than 8 years, aggravated for 4 months. The previous history of hypertension was more than 3 years, the highest blood pressure was 155/88 mmHg (20.6/11.7 kPa), and no regular oral antihypertensive drugs were administered. Chest X-ray showed a small heart shadow with a cardiothoracic ratio of 0.45. The electrocardiogram showed right coronary artery ischemia, and there was no obvious abnormality in V3~ V6 ST segment. Echocardiography showed that the left coronary artery originated from the left coronary sinus of the aorta, and the left main trunk was about 7.5 mm wide. No right coronary artery originated from the right coronary sinus. A vessel echo could be detected in front of the aorta, about 7.0 mm wide, and the junction with the pulmonary artery was about 8.0 mm above the pulmonary valve. Blood flow to the pulmonary artery. Coronary CT showed abnormal opening of the right coronary artery, originating from the right side of the pulmonary trunk; Left coronary artery opening normal (Figure 1)。 Coronary angiography showed that the left and right coronary arteries communicated distally, and the right coronary artery opened abnormally, communicating with the pulmonary artery. Selective left coronary angiography showed the right coronary artery development, and the contrast medium flowed back into the pulmonary artery; No right coronary opening was observed at the root of the aorta (Figure 2)。 Preoperative diagnosis: congenital coronary artery malformation, right coronary artery abnormality originating in the pulmonary artery.

Male, 24 years old. Chest tightness and chest pain for 8 months. Complained of chest pain within one punch of the left front chest, without obvious squeezing sensation, mainly dull pain, occasional tingling sensation, paroxysmal, and intermittent attacks. The thorax is symmetrical, the skin of the chest wall is not wounded, the heart rhythm is uniform, and there is no murmur in each valve area of the heart. Electrocardiogram showed sinus rhythm, complete right bundle branch block. X-ray chest radiograph of the outer hospital showed a 1.3 cm metallic shadow at the base of the left heart (Figure 1)。 Cardiac echocardiography showed double light band echoes in the pericardium near the right atrial appendage. Chest CT examination showed that a long strip of high-density shadow, about 8 mm ×2 mm in size, was visible inside and below the apex, the adjacent structure was still clear, did not break through the pericardium outward, was closely related to the apex inward, and the myocardium was slightly compressed (Figure 2)。 The patient had no previous history of trauma, foreign body swallowing, and psychiatric illness. I have a history of intravenous drug injection. I once lost consciousness after injecting drugs. After waking up, I only found half of the needle tail. Since then, I have chest tightness and chest pain.