1病例介绍
患者女,67岁,首次因左下肢肿胀12 h入院治疗,肿胀消退后出院。再次因双下肢肿胀疼痛4 d入院。既往冠状动脉粥样硬化性心脏病史10余年,脑梗9月余,无高血压、糖尿病病史,绝经年龄52岁。查体Bp：110/70 mm Hg（1 mm Hg=0.133 kP...1病例介绍
患者女,67岁,首次因左下肢肿胀12 h入院治疗,肿胀消退后出院。再次因双下肢肿胀疼痛4 d入院。既往冠状动脉粥样硬化性心脏病史10余年,脑梗9月余,无高血压、糖尿病病史,绝经年龄52岁。查体Bp：110/70 mm Hg（1 mm Hg=0.133 kPa）,腹部平坦,未触及腹部包块,肝脾肋下未触及,胃泡鼓音区略缩小,振水音（-）,移动性浊音（-）,肠鸣音正常,3～4次/分。展开更多
Objective.To assess the feature of pulmonary blood flow distribution after total cavopulmonary connection(TCPC)of different types,and to provide the selection of the best type.Methods. Thirty-two consecutive survival ...Objective.To assess the feature of pulmonary blood flow distribution after total cavopulmonary connection(TCPC)of different types,and to provide the selection of the best type.Methods. Thirty-two consecutive survival patients after TCPC underwent radionuclide lung perfusion imaging. According to the radionuclide counts in the left and right lungs,analyses of the distribution of blood flow from superior venous cava(SVC) and inferior venous cava(IVC)and the whole pulmonary blood flow in both lungs were made. All patients were divided into 4 groups by the the anastomosis between IVC and pulmonary artery.Results. GroupⅠ:The flow ratio of the IVC to left lung was greater than that to the right lung,P≤0.01;the flow ratio of the SVC to right lung was greater than that to the left lung,P≤0.01;and the whole pulmonary blood flow went dominantly to the left lung,P≤0.05,which is not in line with physiological distribution. GroupⅡ:the flows from the SVC and IVC were mixed in the middle of the junction and ran evenly into the right and left lungs,the whole pulmonary blood flow went to both lungs,P≥0.05. Group Ⅲ:the flow ratio of the SVC to both lungs were the same,P≥0.05,and major part from IVC went to the right lung,P≤0.01;the pulmonary blood flow go dominantly to the right lung,P≤0.05,which is in accord with physiological distribution. Group Ⅳ:the flows from the right SVC went to right lung by 100%,P≤0.01,and that from the left SVC went to left lung by 100% too,P≤0.01;the flows from IVC went dominantly to the left lung,with little part to the right lung ,P≤0.05.Conclusions. Different types of TCPC can result in different pulmonary blood distributions. The best flow distribution between the left and right lungs can be obtained by an offset of the IVC anastomosis toward the RPA with widening anastomosis for the patients without persist left superior venous cava(PLSVC).展开更多
文摘1病例介绍
患者女,67岁,首次因左下肢肿胀12 h入院治疗,肿胀消退后出院。再次因双下肢肿胀疼痛4 d入院。既往冠状动脉粥样硬化性心脏病史10余年,脑梗9月余,无高血压、糖尿病病史,绝经年龄52岁。查体Bp：110/70 mm Hg（1 mm Hg=0.133 kPa）,腹部平坦,未触及腹部包块,肝脾肋下未触及,胃泡鼓音区略缩小,振水音（-）,移动性浊音（-）,肠鸣音正常,3～4次/分。
文摘Objective.To assess the feature of pulmonary blood flow distribution after total cavopulmonary connection(TCPC)of different types,and to provide the selection of the best type.Methods. Thirty-two consecutive survival patients after TCPC underwent radionuclide lung perfusion imaging. According to the radionuclide counts in the left and right lungs,analyses of the distribution of blood flow from superior venous cava(SVC) and inferior venous cava(IVC)and the whole pulmonary blood flow in both lungs were made. All patients were divided into 4 groups by the the anastomosis between IVC and pulmonary artery.Results. GroupⅠ:The flow ratio of the IVC to left lung was greater than that to the right lung,P≤0.01;the flow ratio of the SVC to right lung was greater than that to the left lung,P≤0.01;and the whole pulmonary blood flow went dominantly to the left lung,P≤0.05,which is not in line with physiological distribution. GroupⅡ:the flows from the SVC and IVC were mixed in the middle of the junction and ran evenly into the right and left lungs,the whole pulmonary blood flow went to both lungs,P≥0.05. Group Ⅲ:the flow ratio of the SVC to both lungs were the same,P≥0.05,and major part from IVC went to the right lung,P≤0.01;the pulmonary blood flow go dominantly to the right lung,P≤0.05,which is in accord with physiological distribution. Group Ⅳ:the flows from the right SVC went to right lung by 100%,P≤0.01,and that from the left SVC went to left lung by 100% too,P≤0.01;the flows from IVC went dominantly to the left lung,with little part to the right lung ,P≤0.05.Conclusions. Different types of TCPC can result in different pulmonary blood distributions. The best flow distribution between the left and right lungs can be obtained by an offset of the IVC anastomosis toward the RPA with widening anastomosis for the patients without persist left superior venous cava(PLSVC).
