2017年 · 第33卷第12期

From January 2012 to December 2016, we performed endovascular interventional treatment on 113 patients with Stanford thoracic aortic dissection. First, a guide wire and a gold-labeled catheter were punctured through the left brachial artery, and the catheter was placed in the ascending aorta. Then, the pigtail catheter punctured through the femoral artery was indwelling in the descending thoracic aorta. Full arch and descending thoracic aorta angiography were performed through the gold-labeled catheter to confirm whether the pigtail catheter traveled within the true lumen, and satisfactory results were achieved.

Female, 6 months, weight 5.4 kg. He was seen in a hospital due to congenital heart disease. The diagnosis was: double outlet of right ventricle, ventricular septal defect, atrial septal defect, and pulmonary hypertension. Preoperative chest X-ray showed enlarged heart shadow and thickened lung texture, which was in line with congenital heart disease (Figure 1)。 Right ventricular double outlet correction and atrial septal defect repair were performed under general anesthesia and cardiopulmonary bypass. The procedure was smooth, and the ventilator was disengaged 16 h after operation. On the 4th day after operation, shortness of breath and cyanosis suddenly appeared. X-ray chest radiograph showed that the left side of the chest cavity was squeezed and occupied space, and it seemed that an intestinal tube entered the chest cavity (Figure 2)。 Emergency chest CT showed left pneumothorax, lung compression of about 70%, partial incomplete expansion of the left lower lung, high-density shadow of the left chest cavity, enlarged heart shadow, and a little gas accumulation in the anterior and inferior mediastinum (Figure 3)。 Conservative treatments such as fasting, anti-infection, intravenous nutrition, oxygen inhalation, cardiotonic diuresis and vasodilatation were given. The child's dyspnea and hypoxic cyanosis were not improved, and dynamic chest X-ray showed that intestinal hernia was aggravated. On the 10th day after surgery, we asked our hospital for consultation, and considered that diaphragmatic hernia could not be ruled out.

Female, 27 years old. Due to repeated cough and hemoptysis for more than 2 months. Chest CT examination on admission showed that the left upper lung occupied space near the hilar, suspected malignant tumor, involving the left main bronchus, and accompanied by left upper lung obstructive pneumonia (Figure 1)。 Bronchoscopy showed a round mass at the opening of the lingual segment of the left upper lobe. Pathological biopsy was taken. Microscopically, fibrous tissue proliferation of bronchial mucosa was observed, accompanied by lymphocyte and plasma cell infiltration, multinucleated giant cell reaction was observed in focus, and no neoplastic lesions were observed.

Female, 24 years old, weight 53 kg. After arguing with his family, he was admitted to a local hospital 2 h after taking about 50 ml of 20% paraquat orally. He was treated with gastric lavage, catharsis, activated charcoal and antioxidants. He was given cyclophosphamide (500 mg Qd) and methylprednisolone (1.0 g Qd) for 3 days and performed three blood perfusions, but his symptoms did not improve significantly.

Female, 47 years old. Sudden severe pain in the left chest for 2 h. History of left spontaneous pneumothorax 2 years ago, cured by closed thoracic drainage in external hospital. His mother and sister were cured by thoracocentesis or closed thoracic drainage for spontaneous pneumothorax many times, and all had more than two attacks. On physical examination, the respiratory sound of the left lung was significantly reduced, but there was no abnormality. Emergency chest CT showed left pneumothorax, multiple bullae in the left lung, partially fused, and cystic cavity in the right lung (Figure 1)。 After admission, the left thoracic cavity was punctured and pumped the next day, and the chest X-ray examination the next day still showed left pneumothorax, and the lung tissue was compressed by about 50%.

Male, 6 years old. Physical examination revealed cardiac murmur for 2 years. Two years ago, the child went to the local hospital due to dizziness and fatigue. Echocardiography showed congenital heart disease and severe pulmonary stenosis. He underwent balloon dilatation of pulmonary valve. After operation, the child's symptoms improved, but his activity was mildly limited. One year ago, the child fainted during activity and lost consciousness. He woke up after tens of seconds, and then no syncope occurred again. Physical examination at admission: There was no cyanosis of the lips, and a loud and rough jet systolic murmur of grade 3/VI could be heard in the second intercostal area at the left margin of the sternum, which was conducted to the left neck or left subclavian area, and no tremor was palpable. Electrocardiogram showed sinus rhythm, occasional atrial premature contraction, heart rate 68 beats/min. Chest X-ray showed a cardiothoracic ratio of 0.50, and the texture of both lungs was not heavy. Echocardiography (Figure 1、Figure 2) It indicates that the right heart is enlarged, the atrioventricular septum is intact, the echo of the pulmonary artery is enhanced, and it shows a quadrilobar valve, junctional adhesion, and the opening is limited. The main pulmonary artery can be seen to dilate after stenosis, the left and right pulmonary arteries are well developed, and the pulmonary valve is moderately stenotic with moderate regurgitation. CDFI showed significant acceleration of anterior pulmonary valve blood flow and moderate pulmonary valve regurgitation; The maximum forward velocity of the pulmonary valve was 3.5 m/s, the maximum regurgitation velocity of the pulmonary valve was 2.2 m/s, and the systolic transvalvular pressure difference between the right ventricle and the pulmonary artery was 50 mmHg (6.67 kPa) by CW (Figure 3)。 No significant regurgitation was observed in the remaining valves. Preoperative diagnosis: Congenital heart disease, pulmonary stenosis with regurgitation, aortopulmonary artery dilatation, cardiac function grade III (NYHA).