Objective To summarize clinical characteristics and treatment results of adult patients with coronary heart disease and ventricular aneurysm，and evaluate surgical outcomes. Methods Clinical data of 86 adult patients with coronary heart disease and ventricular aneurysm who underwent surgical treatment in Fu Wai Hospital from January 2011 to November 2012 were retrospectively analyzed. There were 70 male and 16 female patients with their average age of 57.7±10.6 years and average body weight of 71.7±10.5 kg. Preoperative echocardiography or left ventriculography showed left ventricular thrombus in 22 patients. Coronary angiography showed 47 patients with 3 vessel disease，29 patientswith 2 vessel disease，and 10 patients with single vessel disease. Sixteen patients underwent direct linear suturing of theaneurysm off pump，39 patients underwent simple linear suturing under cardiopulmonary bypass，15 patients received endoventricular purse-string reconstruction，and 16 patients received endoventricular purse-string reconstruction and patch plasty. Three patients underwent reexploration for bleeding. Sixty-four patients received concomitant coronary artery bypass grafting（CABG）. Results Postoperatively 2 patients（2.3%） died of refractory ventricular fibrillation and multiple organ dysfunction syndrome respectively. Patients undergoing concomitant CABG received 2.3±1.2 grafts on the average. Seventy-eightpatients （92.9%） were followed up for 2-24 months after discharge. During follow-up，patients’ angina symptoms significantlyresolved，heart function improved in varying degrees，and no new sign of myocardial ischemia was found on electrocardiogram.Left ventricular ejection fraction （LVEF） was significantly higher than preoperative LVEF（51%±7% vs. 41%±9% ，t=6.20，P=0.00），and left ventricular end-diastolic diameter （LVEDD） was significantly smaller than preoperative LVEDD （54.2±6.2 mm vs. 56.0±6.8 mm，t=4.60，P=0.00） . Conclusion Ventricular aneurysm repair and concomitant CABG （or ventricular septal perforation repair，mitral valvuloplasty et al） are positive and effective treatment strategies for postinfarction ventricular aneurysm. Satisfactory clinical outcomes can be achieved by individualized treatment based on appropriate surgical strategies according to the size of ventricular aneurysm.
Abstract： Objective To optimize surgical treatment for children with patent ductus arteriosus （PDA） and mitral regurgitation （MR） and evaluate its midterm to longterm outcome in terms of MR. Methods Between Jan. 2008 and Jan. 2011， 25 children with PDA and MR underwent surgical treatment in Shanghai Children’s Medical Center. There were 14 male patients and 11 female patients with average age of 26.36±40.75 （1.72-142.83）months and average weight of 8.98±6.85 （3.80-36.00） kg. The average diameter of PDA was 7.84±3.10 （3-15）mm. There were 22 children with duct-type PDA and 3 children with window-type PDA. There were 5 children with severe MR， 18 children with moderate MR， and 2 children with mild MR. Except one child with mitral stenosis who underwent PDA ligation plus mitral valvuloplasty supported with cardiopulmonary bypass， all other 24 children only underwent PDA ligation through left posterolateral thoracotomy without any management for the mitral valve. Results There was no in-hospital death. The average ventilation time in ICU was 6.70±4.39 （3-24） hours. Except one child was reintubated because of asthma， all other children recovered uneventfully without any postoperative complication. All the 25 children were followed up for 329.23±288.39 （29-967） days. During follow-up， 23 children （92.00%） had their MR level ameliorated in different degree. Preoperative severe MR in 5 children changed into moderate MR in 2 children and mild MR in 3 children. Preoperative moderate MR in 16 children changed into none MR in 5 children, trivial MR in 5 children and mild MR in 6 children. Preoperative mild MR in 2 children changed into none MR in 1 child and trivial MR in another child. Two children with preoperative moderate MR had no improvement during follow-up. Conclusion For infants and children with PDA and MR， conservative treatment strategy should be carried out. Simple PDA ligation can provide satisfactory clinical outcome， which may also avoid negative complications including myocardial injury caused by cardiopulmonary bypass.
Abstract： Objective To investigate the clinicopathological characteristics, improve the accuracy of clinical diagnosis， and reduce postoperative complications of thoracic hemangioma. Methods Clinical records of 9 patients with thoracic hemangioma who underwent surgical resection in West China Hospital of Sichuan University from January 2006 to August 2012 were retrospectively analyzed. There were 2 males and 7 females with their average age of 47.9±19.3 （18-71）years. Six patients underwent thoracotomy， 1 patient underwent complete video-assisted thoracoscopic surgery （VATS）， 1 patient underwent video-assisted mini-thoracotomy， and 1 patient underwent staged operations which were performed by neurological surgeons and thoracic surgeons separately. Imaging characteristics, intraoperative gross tumor features, and pathological characteristics of resected hemangioma specimens were analyzed. Clinical outcomes of different surgical strategies for the treatment of hemangioma were compared. Results Nine patients with thoracic hemangioma were included in this study. Imaging studies showed the tumor as a round-shaped mass in 66.7% （6/9） of these patients and a lobulated mass in the remaining 33.3% （3/9） patients. Magnetic resonance imaging （MRI） assessment was helpful for preoperative diagnosis of hemangioma， with T2 weighted imaging tumor enhancement as the main MRI feature. Thoracic operation time was 106.3±60.1 （60-192） min， and intraoperative blood loss was 91.1±43.7 （30-150） ml. All the patients were followed up for 3-6 years except 1 patient who was followed up for 1 month. None of the patients had hemangioma-related death， recurrence or metastasis during follow-up. Conclusions Thoracic hemangiomas are usually benign entities and often locate in the mediastinum. Surgical strategies should be determined by the size and location of the tumor as well as the surgeon’s technique level. VATS has the advantages of being minimal invasive, causing less intraoperative blood loss and shorter length of hospital stay for the treatment of hemangioma. Resection of a dumbbell-type hemangioma may need cooperation between neurological and thoracic surgeons.