Background Left main coronary artery （LMCA） stenosis has been recognized as a risk factorfor early death among patients undergoing coronary artery bypass grafting （CABG）. This study aimed to assess if LMCA lesions pose an additional risk of early or mid-term mortality and/or a major adverse cardiac and cerebrovascular event （MACCE） after off-pump coronary artery bypass grafting （OPCABG）, compared with non-left main coronary artery stenosis （non-mainstem disease）.
位于肺动脉的肺小细胞癌（pulmonary small cell carcinoma,PSCC）是临床上极其罕见的肺恶性肿瘤,临床上极易误诊为肺动脉血栓栓塞症（PTE）或肺动脉肉瘤（PAS）,从而使患者失去早期诊治的机会。现报道我院1例初诊为PTE/PAS,后经手术病理证实为以肺动脉占位为主要表现的肺小细胞癌的患者临床资料,并结合国外相关文献进行分析,以提高对PSCC的认识及相关鉴别诊断。
Background Pulmonary thromboendarterectomy （PTE） has evolved as a treatment of choice for chronic thromboembolic pulmonary hypertension （CTEPH）. This study aimed to characterize if pulmonary oligemia maneuver （POM） can alleviate pulmonary artery injury during PTE procedure. Methods A total of 112 cases of CTEPH admitted to Beijing Anzhen Hospital from March 2002 to August 2011 received PTE procedure. They were retrospectively classified as non-POM group （group A, n=55） or POM group （group B, n=57）. Members from group B received POM during rewarming period, whereas members from group A did not. Results There were three （5.45%） early deaths in group A, no death in group B （0） （Fisher＇s exact test, P=0.118）. Six patients in group A needed extracorporeal membrane oxygenation （ECMO） as life support after the PTE procedure, no patients in group B needed ECMO （Fisher＇s exact test, P=0.013）. The patients in group B had a shorter intubation and ICU stay, lower mean pulmonary arterial pressure （mPAP） and pulmonary vascular resistance （PVR）, higher partial pressure of oxygen in artery （PaO2） and arterial oxygen saturation （SaO2） and less medical expenditure than patients in group A. With a mean follow-up time of （58.3 ± 30.6） months, two patients in group A and one patient in group B died. The difference of the actuarial survival after the procedure between the two groups did not reach statistical significance. Three months post the PTE procedure, the difference of residual occluded pulmonary segment between the two groups did not reach statistical significance （P=0.393）. Conclusion POM can alleviate pulmonary artery injury, shorten ICU stay and intubation time, and lower down the rate of ECMO after PTE procedure.
GAN Hui-liZHANG Jian-qunLU Jia-kaiDONG Xiu-huaHou Xiao-tongGAO Yuan-mingZHU Guang-fa
