目的总结本中心合并冠状动脉壁内走行(intramural coronary artery, IMCA)的完全性大动脉转位(transposition of the great arteries,TGA)婴儿患者的手术经验,并分析其早期和中期临床结果。方法回顾性分析2010年6月—2018年12月于阜外...目的总结本中心合并冠状动脉壁内走行(intramural coronary artery, IMCA)的完全性大动脉转位(transposition of the great arteries,TGA)婴儿患者的手术经验,并分析其早期和中期临床结果。方法回顾性分析2010年6月—2018年12月于阜外医院接受大动脉调转术(arterial switch operation,ASO)384例TGA患儿的临床资料。根据手术记录,21例(5.5%)婴儿合并有IMCA,其中20例(95.2%)为男性,中位手术年龄为33(9~319)d。所有患者均采用壁内冠状动脉去顶及双纽扣法冠状动脉再植进行ASO。结果合并IMCA的患者与正常冠状动脉解剖的患者相比,ASO术后早期死亡率差异无统计学意义(9.5%vs. 3.0%,P=0.15)。IMCA组2例死亡患者首次开放循环后均出现冠状动脉灌注不良。此外,还有1例患者因心功能不全行体外膜肺支持治疗。19例存活出院的患者均得到随访,平均随访时间为29.0~120.0(74.8±27.3)个月。随访期间,所有患者均无明显症状,且未出现死亡、二次手术及冠状动脉并发症。其中1例患者出现肺动脉瓣中度反流,另1例患者出现右肺动脉远端狭窄。结论对合并IMCA的TGA婴儿患者,采用壁内冠状动脉去顶及双纽扣法冠状动脉再植进行ASO安全可靠,早期及中期结果满意。展开更多
目的探索左冠状动脉起源于肺动脉(anomalous left coronary artery from the pulmonary artery,ALCAPA)合并左冠状动脉壁内走行患者的手术方法,分析其早期和中期临床结果。方法纳入2014年1月—2020年9月于阜外医院接受手术矫治的ALCAPA...目的探索左冠状动脉起源于肺动脉(anomalous left coronary artery from the pulmonary artery,ALCAPA)合并左冠状动脉壁内走行患者的手术方法,分析其早期和中期临床结果。方法纳入2014年1月—2020年9月于阜外医院接受手术矫治的ALCAPA合并左冠状动脉壁内走行患儿。分析患儿的临床资料。结果共纳入10例患者,其中男8例、女2例,中位手术年龄7.5(3~46)个月。手术方式包括7例冠状动脉去顶,2例冠状动脉去顶+冠状动脉再植,1例冠状动脉去顶+左冠状动脉开口缝闭;共7例患儿同期行其他手术,包括5例二尖瓣成形术。术后2例患儿延迟关胸,全组患儿无手术死亡,无重大并发症发生。术后胸部X线片提示平均心胸比值低于术前(0.62±0.05 vs.0.67±0.06,P=0.006);术后超声提示平均左室射血分数较术前改善,但差异无统计学意义(38.7%±15.9%vs.30.0%±16.1%,P=0.066)。10例患儿出院后均得到有效随访,随访时间为13~92(46.6±25.0)个月。随访期间,患儿未出现明显症状,且无死亡、冠状动脉并发症和其他重大并发症。末次胸部X线片检查提示平均心胸比值较术后进一步下降(0.60±0.07 vs.0.62±0.05,P=0.024);末次心脏超声检查提示平均左室射血分数亦较术后进一步改善(60.1%±9.3%vs.38.7%±15.9%,P=0.002)。结论ALCAPA合并左冠状动脉壁内走行是一种罕见的畸形,根据不同的解剖类型可采用不同的手术方式进行解剖矫治,早期及中期结果满意。展开更多
Objective To evaluate repeat coronary artery bypass grafting (CABG) in 312 patients. Methods The data of 312 patients (average age 65±9 years) who had CABG operation in Hartford hospital were collected and analyz...Objective To evaluate repeat coronary artery bypass grafting (CABG) in 312 patients. Methods The data of 312 patients (average age 65±9 years) who had CABG operation in Hartford hospital were collected and analyzed. The mean duration follow up after the first CABG was 11.8±4.5 years. A total of 1069 bypass grafts were performed. Among them, 386 were arterial grafts such as internal mammary artery, radial artery and gastroepiploic artery; 682 were venous grafts and 1 Gore-Tex graft. Results The operative mortality was 4.5%. Fifteen patients ( 4.8%) had peri-operative myocardial infarction and 46 patients (15%) had low cardiac output syndrome. Intra-aortic balloon pump (IABP) was used in 131 patients before, during and after operation. One hundred and nineteen patients weaned off IABP and recovered. Conclusion Although the difficulties and risk factors were increased, the results of redo CABG were still good.展开更多
Objective:To compare the long-term patency and longevity of the single and sequential ve-nous graft.Methods:The coronary arterial angiographic data for 300 redo coronary bypass grafting(CABG) were collected.Among them...Objective:To compare the long-term patency and longevity of the single and sequential ve-nous graft.Methods:The coronary arterial angiographic data for 300 redo coronary bypass grafting(CABG) were collected.Among them 106 cases had both single(159) and sequential(118) grafts.Results:The oc-clusive and narrowness rate for the single grafts versus sequential grafts were:1 year,2% vs 2%;5 years,3% vs 4%;10years,18% vs 19%;15 years,60% vs 68%;and 23 years,76% vs 81% ,respectively.The differences were not significant in general.Conclusion:Sequential anastomosis itself does not has any adverse affects on short-term and long-term patency of the venous graft and its longevity in CABG operations in general.展开更多
文摘目的总结本中心合并冠状动脉壁内走行(intramural coronary artery, IMCA)的完全性大动脉转位(transposition of the great arteries,TGA)婴儿患者的手术经验,并分析其早期和中期临床结果。方法回顾性分析2010年6月—2018年12月于阜外医院接受大动脉调转术(arterial switch operation,ASO)384例TGA患儿的临床资料。根据手术记录,21例(5.5%)婴儿合并有IMCA,其中20例(95.2%)为男性,中位手术年龄为33(9~319)d。所有患者均采用壁内冠状动脉去顶及双纽扣法冠状动脉再植进行ASO。结果合并IMCA的患者与正常冠状动脉解剖的患者相比,ASO术后早期死亡率差异无统计学意义(9.5%vs. 3.0%,P=0.15)。IMCA组2例死亡患者首次开放循环后均出现冠状动脉灌注不良。此外,还有1例患者因心功能不全行体外膜肺支持治疗。19例存活出院的患者均得到随访,平均随访时间为29.0~120.0(74.8±27.3)个月。随访期间,所有患者均无明显症状,且未出现死亡、二次手术及冠状动脉并发症。其中1例患者出现肺动脉瓣中度反流,另1例患者出现右肺动脉远端狭窄。结论对合并IMCA的TGA婴儿患者,采用壁内冠状动脉去顶及双纽扣法冠状动脉再植进行ASO安全可靠,早期及中期结果满意。
文摘目的探索左冠状动脉起源于肺动脉(anomalous left coronary artery from the pulmonary artery,ALCAPA)合并左冠状动脉壁内走行患者的手术方法,分析其早期和中期临床结果。方法纳入2014年1月—2020年9月于阜外医院接受手术矫治的ALCAPA合并左冠状动脉壁内走行患儿。分析患儿的临床资料。结果共纳入10例患者,其中男8例、女2例,中位手术年龄7.5(3~46)个月。手术方式包括7例冠状动脉去顶,2例冠状动脉去顶+冠状动脉再植,1例冠状动脉去顶+左冠状动脉开口缝闭;共7例患儿同期行其他手术,包括5例二尖瓣成形术。术后2例患儿延迟关胸,全组患儿无手术死亡,无重大并发症发生。术后胸部X线片提示平均心胸比值低于术前(0.62±0.05 vs.0.67±0.06,P=0.006);术后超声提示平均左室射血分数较术前改善,但差异无统计学意义(38.7%±15.9%vs.30.0%±16.1%,P=0.066)。10例患儿出院后均得到有效随访,随访时间为13~92(46.6±25.0)个月。随访期间,患儿未出现明显症状,且无死亡、冠状动脉并发症和其他重大并发症。末次胸部X线片检查提示平均心胸比值较术后进一步下降(0.60±0.07 vs.0.62±0.05,P=0.024);末次心脏超声检查提示平均左室射血分数亦较术后进一步改善(60.1%±9.3%vs.38.7%±15.9%,P=0.002)。结论ALCAPA合并左冠状动脉壁内走行是一种罕见的畸形,根据不同的解剖类型可采用不同的手术方式进行解剖矫治,早期及中期结果满意。
文摘Objective To evaluate repeat coronary artery bypass grafting (CABG) in 312 patients. Methods The data of 312 patients (average age 65±9 years) who had CABG operation in Hartford hospital were collected and analyzed. The mean duration follow up after the first CABG was 11.8±4.5 years. A total of 1069 bypass grafts were performed. Among them, 386 were arterial grafts such as internal mammary artery, radial artery and gastroepiploic artery; 682 were venous grafts and 1 Gore-Tex graft. Results The operative mortality was 4.5%. Fifteen patients ( 4.8%) had peri-operative myocardial infarction and 46 patients (15%) had low cardiac output syndrome. Intra-aortic balloon pump (IABP) was used in 131 patients before, during and after operation. One hundred and nineteen patients weaned off IABP and recovered. Conclusion Although the difficulties and risk factors were increased, the results of redo CABG were still good.
文摘Objective:To compare the long-term patency and longevity of the single and sequential ve-nous graft.Methods:The coronary arterial angiographic data for 300 redo coronary bypass grafting(CABG) were collected.Among them 106 cases had both single(159) and sequential(118) grafts.Results:The oc-clusive and narrowness rate for the single grafts versus sequential grafts were:1 year,2% vs 2%;5 years,3% vs 4%;10years,18% vs 19%;15 years,60% vs 68%;and 23 years,76% vs 81% ,respectively.The differences were not significant in general.Conclusion:Sequential anastomosis itself does not has any adverse affects on short-term and long-term patency of the venous graft and its longevity in CABG operations in general.
