2018年 · 第34卷第11期

congenital diaphragmatic hernia (CDH) is a common diaphragmatic defect in pediatric surgery and one of the critical diseases in neonatal surgery, with an incidence of 1/2 000~4 000^[1]。 In recent years, more and more pediatric surgery centers have applied thoracoscopic surgery to treat neonatal diaphragmatic hernia. However, when the trailing edge of the diaphragm defect is minimal or absent, it is very difficult to repair the defect^[2]。 From September 2014 to September 2016, we applied a syringe needle with thread to repair the anterior edge of the diaphragm defect and the ribs by mattress suture, and the clinical results were satisfactory, which are reported below.

The incidence of cardiac tumors is extremely low, of which malignant cardiac tumors account for about 10%^[1,2]。 Patients with malignant heart tumors mostly have chest tightness and shortness of breath as the first symptoms, and the symptoms generally have progressed to the middle and late stages. If the treatment is not active, the patient's conservative survival period is only 6 to 12 months^[3]。 Although active surgery can prolong the survival time of patients appropriately, the outcome is not ideal.

Male, 34 years old. Chest tightness, palpitations and discomfort after recent activities. I reported that my chest hit the handlebar of a motorcycle 5 years ago, and I felt chest tightness and shortness of breath 2 weeks later, especially after activities. Auscultation in the local hospital found cardiac murmur, blister sound at the floor of both lungs, and echocardiography showed ventricular septal perforation. Due to economic reasons, no surgical treatment was performed, and cardiotonic diuresis was given, which improved and was discharged. In March 2017, I was admitted to the cardiac surgery department of our hospital, and I smelled a systolic blow-like murmur of grade 4 to 6 in the 3rd to 4th intercostal areas on the left margin of the sternum. Electrocardiogram examination showed no obvious abnormalities; Echocardiography and contrast-enhanced echocardiography revealed ventricular septal perforation near the apex, ventricular aneurysm formation, and reverse abnormal movement (Figure 1)。 Coronary CTA showed no coronary abnormalities. Chest CT showed ventricular septal perforation (Figure 2)。 Myocardial ECT revealed partial myocardial necrosis (Figure 3)。

Female, 9 years old. Heart murmur was found for more than 3 months. The growth and development of the children are retarded compared with those of the same age. Echocardiography showed enlarged right atrium and ventricle, central atrial septal defect about 10 mm ×12 mm, enlarged tricuspid annulus with poor closure, left-to-right atrial shunt, and estimated pulmonary systolic pressure about 38 mmHg (5.07 kPa). Dual-source CT showed that the pulmonary veins in the upper and middle lobes of the right lung merged into the right atrium through the superior vena cava, and the pulmonary veins in the lower lobe of the right lung and the upper and lower lobes of the left lung all merged into the left atrium (Figure 1)。 X-ray chest film showed excessive blood in both lungs.

The patient was a 9-year-old 2-month-old male with a body weight of 30.2 kg. Physical examination revealed a slow heart rate. No dizziness, black history. Electrocardiogram showed III-degree atrioventricular block, borderline rhythm, ventricular arrest (46 beats>2.0 s, maximum 4.2 s,Figure 1)。 On physical examination, the heart sounds were low and dull, the rhythm was irregular, and there was no heart murmur. Preoperative laboratory tests showed no abnormalities. Echocardiography showed left ventricular enlargement, a small amount of mitral and tricuspid valve regurgitation, and normal overall left ventricular systolic function.