[Interventional treatment and early-stage follow-up of pulmonary atresia with intact ventricular septum].

Objective: To explore the application value of percutaneous peripheral interventional therapy in pulmonary atresia with intact ventricular septal (PA-IVS). Methods: Retrospective case summary. The data was collected from 25 children who were hospitalized at the Children's Hospital,Zhejiang University School of Medicine from August 2019 to August 2022, had been diagnosed with PA-IVS by echocardiography, and underwent interventional treatment. The sex, age, weight, operation time, radiation exposure time, and radiation dose of the patients were collected. The patients were divided into the arterial duct stenting group and the non-stenting group. Preoperative tricuspid annular diameters and Z scores, right ventricular length diameters, and right ventricular/left ventricular length-diameter ratios were compared by paired t-tests. Right ventricular systolic pressure difference, oxygen saturation, lactic acid before and after the surgery were compared for 24 children who received percutaneous balloon pulmonary valvuloplasty. Right ventricular improvement in 25 children after operation was analyzed. The correlation between postoperative oxygen saturation and postoperative right ventricular systolic blood pressure difference, the degree of pulmonary valve opening and the Z value of tricuspid valve ring in the non-stenting group were analyzed. Results: A total of 25 patients with PA-IVS were enrolled in the study, of whom 19 were males and 6 females, with an age at surgery of 12 (6, 28) days and a weight of (3.7±0.5) kg. One of them underwent only stenting of the arterial duct; 20 children underwent only percutaneous pulmonary valve perforation and balloon angioplasty; 4 children underwent both procedures. The Z-value of the tricuspid ring was -1.5±1.2 in the group with arterial duct stenting, and -0.1±0.4 in the group without stenting (t=2.77, P=0.010). The tricuspid regurgitant flow rate 1 month after surgery was significantly lower than the preoperative ((3.4±0.6) vs. (4.8±0.9) m/s, t=6.62,P<0.001). In the 24 children with percutaneous pulmonary valve perforation and balloon angioplasty, the preoperative right ventricular systolic blood pressure was (110±32) mmHg, and the postoperative systolic blood pressure was (52±19) mmHg (1 mmHg=0.133 kPa) (F=59.55, P<0.001). The factors that may affect postoperative oxygen saturation in 20 cases of non-stenting group were analyzed. The results suggested that the pre and post-operative right ventricular systolic blood pressure differences (r=-0.11, P=0.649), and the pulmonary valve orifice opening (r=-0.31, P=0.201) and tricuspid annulus Z value (r=-0.18, P=0.452) at 1 month after the operation were not significantly correlated with the postoperative oxygen saturation. Conclusions: Interventional therapy can be used as the first choice for one-stage operation of PA-IVS. Percutaneous pulmonary valve perforation and balloon angioplasty are more suitable for children with well-developed right ventricles, tricuspid annulus, and pulmonary arteries. While the smaller the tricuspid annulus, the more dependent it is on the ductus arteriosus and thus patients are more suitable for arterial duct stenting.

Single coronary artery with fistula, right aortic arch, bicuspid aortic valve, and pulmonary stenosis: a rare combination.

We report a case of a 10-month-old Chinese girl with single left coronary artery, left coronary artery-to-right ventricle fistula, pulmonary stenosis, and right aorta arch with bicuspid aortic valve. The diagnosis was made by transthoracic echocardiography and confirmed by angiography. A surgical repair was performed with closure of the fistula at the point where it drained into the right ventricle plus a pulmonary valvulotomy.

[Pathologic study of precancerous lesion of the gallbladder].

Precancerous lesions of the gallbladder in 150 consecutive cholecystectomy specimens resected from the patients with cholelithiasis or cholecystitis are studied. Of these specimens, 80% had simple epithelial hyperplasia, 16% atypical hyperplasia, 1.3% carcinoma in situ and 2.7% invasive carcinoma. Atypical hyperplasia was observed in the mucosa adjacent to carcinoma in situ which, in turn, was found in the mucosa adjacent to invasive carcinoma. This finding suggests that some of simple hyperplasia of the gallbladder evolve towards atypical hyperplasia, carcinoma in situ which finally becomes invasive carcinoma. In addition, the authors put forward a morphologic criteria for grading the atypical hyperplasia of the gallbladder.