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完全性大动脉转位伴左心室流出道梗阻患者接受解剖修复后的预后
Outcomes After Anatomic Repair for D-Transposition of the Great Arteries With Left Ventricular Outflow Tract Obstruction
Emani SM, Beroukhim R, Zurakowski D  2010/1/13 11:12:35 
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Circulation, 2009,
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★★★
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C
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Background:
D-transposition of the great arteries (TGA) with left ventricular outflow tract obstruction (LVOTO) may be treated with arterial switch operation (ASO) with or without LVOT intervention, as well as non-ASO anatomic repairs, such as aortic translocation or Rastelli procedure. We evaluated midterm results of repair for TGA/LVOTO at our institution.

Methods and Results:
Eighty-eight patients with TGA/LVOTO who underwent anatomic repair were retrospectively reviewed. LVOTO was defined as pulmonary valve (PV) z-score≤−2.0 or LVOT gradient ≥20mmHg in the presence of anatomic subvalvar stenosis. Risk factors for LVOT reintervention were determined by logistic regression. There was no hospital mortality and 1 late mortality. Patients undergoing Rastelli procedure were more likely to require surgical reintervention for LVOTO compared to the other groups (P=0.015). Patients undergoing ASO alone had a higher rate of late LVOT reintervention compared to those who had concomitant ASO/LVOT intervention (P=NS). In those undergoing Rastelli, a larger PV z-score was a predictor of LVOT reintervention (P=0.012). PV z-scores significantly decreased before repair in patients undergoing delayed repair (P=0.005); however, they increased significantly after neonatal ASO (P<0.001).

Conclusions:
Patients with TGA/LVOTO who undergo Rastelli repair have a high rate of LVOT reintervention. Higher preoperative PV z-score is a risk factor for reintervention in this group. Patients with mild/moderate LVOTO undergoing ASO alone without LVOT intervention may have an increased risk of LVOT reintervention. In neonates who are candidates for ASO, delay of repair is associated with diminution in size of PV, which may subsequently reduce their suitability for ASO.
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8年肺部结节1例
 胡家安   徐志红
 
上海交通大学医学院附属瑞金医院老年病科
 
此为疑难病例，希望借此机会在网友中展开讨论，以明确诊断和确定正确的治疗方案。
 
患者，老年男性，约8年前体检时胸片示肺结节，进一步胸部CT示（图1）右上肺结节病灶，直径约0.75cm。后每年复查X线胸片或胸部CT病灶均无明显变化（图2，图3）。2008年6月复查胸部CT示（图4，图5）右上肺结节略增大，大小约1.46cm×1.10cm，边缘可见细小毛刺，邻近胸膜粘连凹陷；右肺中叶外侧段见片状模糊影；两肺散在多个类圆形小结节影；纵隔淋巴结显示。
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