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Fontan血液动力学：肺动脉直径的重要性
Fontan hemodynamics: Importance of pulmonary artery diameter
Dasi LP, KrishnankuttyRema R, Kitajima HD  2009/5/31 18:19:25 
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J Thorac Cardiovasc Surg, 2009,
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★★★
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C
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Objective:
We quantify the geometric and hemodynamic characteristics of extracardiac and lateral tunnel Fontan surgical options and correlate certain anatomic characteristics with their hemodynamic efficiency and patient cardiac index.

Methods and Results:
The study was conducted retrospectively on 22 patients undergoing Fontan operations (11 extracardiac and 11 lateral tunnel operations). Total cavopulmonary connection geometric parameters such as vessel areas, curvature, and offsets were quantified using a skeletonization method. Energy loss at the total cavopulmonary connection junction was available from previous in vitro experiments and computational fluid dynamic simulations for 5 and 9 patients, respectively. Cardiac index data were available for all patients. There was no significant difference in the mean and minimum cross-sectional vessel areas of the pulmonary artery between the extracardiac and lateral tunnel groups. The indexed energy dissipation within the total cavopulmonary connection was strongly correlated to minimum cross-sectional area of the pulmonary arteries (R2 value of 0.90 and P<.0002), whereas all other geometric features, including shape characteristics, had no significant correlation. Finally, cardiac index significantly correlated with the minimum pulmonary artery area (P=.006), suggesting that total cavopulmonary connection energy losses significantly affect resting cardiac output.

Conclusions:
The minimum outlet size of the total cavopulmonary connection (ie, minimum cross section of pulmonary artery) governs the energy loss characteristics of the total cavopulmonary connection more strongly than variations in the shapes corresponding to extracardiac and lateral tunnel configurations. Differences in pulmonary artery sizes must be accounted for when comparing energy losses between extracardiac and lateral tunnel geometries.
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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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