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find Author "崔虎军" 18 results
  • Application of End-to-side Anastomosis for Coarctation of the Aorta with Cardiac Lesions in Neonates and Infants

    Objective To compare the advantages of reconstructing the aorta by end-to-side anastomosis with extended end-to-end anastomosis for aortic coarctation (CoA) with cardiac lesions in neonates and infants. Methods There were 63 neonates and infants who underwent median full sternotomy for correction of CoA and cardiaclesions from January 2008 to July 2011 in Guangzhou Women and Children’s Medical Center. These patients were divided into two groups: extended end-to-end anastomosis was performed in 24 patients (end-to-end group, 17 males and 7 females with their mean age of 4.6±2.9 months)and end-to-side anastomosis in 39 patients (end-to-side group, 24 males and 15 females with their mean age of 3.4±2.6 months). We compared the two groups with regard to postoperative mortality, morbidity and difference in blood pressure between the lower and upper extremities. Results The percentage of newborn patient(23.1% vs. 4.2%; χ2=3.979, P=0.045)and presence of pre-operative acidosis(15.4% vs. 0%; χ2=4.080, P=0.048)were significantly higher in end-to-side group than those in end-to-end group. There was no postoperative death in end-to-end group and 1 patient died after surgery in end-to-side group(2.6%). The average duration of circulatory arrest in end-to-side group was significantly shorter than that in end-to-end group (18.6±2.7 min vs.23.4±3.7 min, F=14.617, P=0.000). At the time back to cardiac intensive care unit, the percentage of patients whose difference in systolic pressure between radial and femoral artery < 5 mm Hg, 5-15 mm Hg, and> 15 mm Hg was 20.8%, 45.8% and 33.3% respectively in end-to-end group, and 97.4%, 2.6% and 0% respectively in end-to-side group(χ2=40.380,P=0.000). Twenty-four hours after surgery, the percentage of patients whose difference in systolic pressure between radial and femoral artery< 5 mm Hg, 5-15 mm Hg, and> 15 mm Hgwas 45.8%, 41.7% and 12.5% respectively in end-to-end group, and 100%, 0% and 0% respectively in end-to-side group (χ2=26.620, P=0.000). All the surviving 62 patients were followed up for 2-36 months, and there was no patient with angeioma or re-stenosis needing intervention in either group during follow-up. Conclusion End-to-side anostomosis is a safe and effective method for treating CoA with cardiac lesions and eliminating residual stenosis in neonates and infants.

    Release date:2016-08-30 05:49 Export PDF Favorites Scan
  • 双主动脉弓合并法洛四联症同期矫治一例

    Release date:2016-08-30 06:04 Export PDF Favorites Scan
  • Nikaidoh手术的临床应用

    目的 总结Nikaidoh手术治疗右心室双出口(DORV)和大动脉转位(TGA)患者的临床经验,以提高手术疗效。 方法 3例先天性心脏病患者中DORV 1例,TGA 2例(平均年龄11.6岁),均行Nikaidoh手术,术中行Lecompte操作,Gore-tex人工血管补片修补室间隔缺损并重建左心室流出道,18#带单瓣牛心包片补片重建肺动脉及右室流出道。 结果 术后无早期死亡,平均住院时间13.6d。发生低心排血量综合征1例,肝功能损害2例,二次开胸止血1例,均经相应的处理治愈。随访3例,随访时间3~5个月,复查超声心动图未发现左、右心室流出道梗阻;其中2例发现轻度至中度主动脉瓣关闭不全,但定期随访未发现继续加重。 结论 采用Nikaidoh手术治疗DORV和TGA患者,术后可获得良好的血流动力学效果,早期临床结果满意。

    Release date:2016-08-30 06:10 Export PDF Favorites Scan
  • Effect of intraoperative autotransfusion on erythrocytes in coronary artery bypass grafting

    Objective To explore ability of deformation ,small deformation, orientation and in vivo half-life of erythrocytes following intraoperative autotransfusion by ZITI-3000 cell saving system (Jingjing medical facility corporation, Beijing). Methods Twenty consecutive patients undergoing scheduled off-pump coronary artery bypass grafting (CABG) were divided into two groups according to intraoperative autotransfusion, experimental group(n=10): intraoperative autotransfusion was performed; control group (n=10): intraoperative autotransfusion wasn’t used. Laser diffractometer was used to measure deformation index(DI), small deformation index[(DI)d.max], and orientation index [(DI)or.max],and chromium51 istope labeling technique was used to measure half-life of erythrocytes (51C1/2) of processed and unprocessed in vivo. Results There were no significant difference in DI, (DI)d.max, (DI)or.max and 51C1/2 in vivo between experimental group and control group. Conclusion Intraoperative autotransfusion has no significant effect on erythrocytes’s ability of DI, (DI)d.max, (DI)or.max and 51C1/2 in vivo in off-pump CABG.

    Release date:2016-08-30 06:28 Export PDF Favorites Scan
  • 术中自体血液回收对体外循环术后全身性炎性反应的影响

    目的 探讨在体外循环手术中使用洗涤式自体血液回收机(ATS)对术后全身性炎性反应的影响.方法 将择期体外循环冠状动脉旁路移植术(CABG)的12例患者随机分为两组(每组6例),实验组:将手术野渗血和停机后机血混合经ATS处理后回输;对照组:将停机后机血直接回输.于围手术期测定两组补体终末复合物(sC5b-9)、白细胞介素-6(IL-6)等炎性因子指标.实验组分别测定ATS处理前后炎性因子指标. 结果 实验组回收血经ATS处理后红细胞压积(HCT)明显升高(Plt;0.01),sC5b-9、肿瘤坏死因子-α(TNF-α)和IL-6水平显著降低(Plt;0.05).停机6小时、24小时和48小时,实验组sC5b-9变化率均低于对照组(Plt;0.05),停机48小时,实验组IL-6变化率低于对照组(Plt;0.05),术后两组TNF-α水平以及变化率差别无显著性意义;停机48小时,实验组中性粒细胞(PMN)显著低于对照组(Plt;0.01). 结论 在体外循环手术中使用ATS回收术野渗血和停机后机血可以去除绝大部分炎性介质,回输后可以降低术后部分炎性介质的水平,减轻体外循环术后的炎性反应.

    Release date:2016-08-30 06:32 Export PDF Favorites Scan
  • 复杂先天性心脏病右心室流出道重建困难的处理

    目的 探讨复杂先天性心脏病在纠治过程中右心室流出道(RVOT)重建困难的处理方法和其适应证、手术方法、应用中的注意要点。 方法 回顾性分析2008年1月至2010年12月广州市妇女儿童医疗中心26例复杂先天性心脏病患者行手术治疗的临床资料。其中男14例,女12例;年龄(2.9±2.0)岁;体重(12.2±6.0) kg。所有患者在纠治过程中RVOT重建困难,分别采用以下方法进行处理: (1)肺动脉从根部切断与主动脉交叉后吻合于右心室切口; (2)肺动脉从根部切断直接下拉吻合于右心室切口; (3) 肺动脉切断后远心端与右心室切口间的后壁用左心耳或右心耳做后壁,人工补片做前壁,重建RVOT; (4)肺动脉与右心室切口间用自体心包做成的心包卷管道连接。 结果 无手术死亡,无Ⅲ°房室传导阻滞。10例患者因尿少行腹膜透析治疗,心脏压塞和/或胸腔出血开胸止血4例。所有患者随访0.5~3.0年复查:应用肺动脉从根部切断与主动脉交叉后吻合于右心室切口和肺动脉从根部切断直接下拉吻合于右心室切口两种方法的7例患者中肺动脉血流速度加快3例,2.5~3.0 m/s;残留中度以上肺动脉高压5例;中至重度肺动脉反流6例,其中肺动脉血流速度增快2例,残留中度肺动脉高压4例。 结论 以上4种RVOT重建方法在复杂先天性心脏病RVOT重建中应用得当有良好的手术效果;前2种方法有肺动脉血流速度增快的可能性;肺动脉瓣反流与术后肺动脉高压或肺动脉梗阻有关。

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • Efficacy of Humidified High Flow Nasal Cannula for Respiratory Failure after Ventilator Weaning in Post-operative Children with Congenital Heart Disease

    Objective To explore the efficacy of humidified high flow nasal cannula ( HHFNC) for respiratory failure after ventilator weaning in post-operative newborns and infants with congenital heart disease. Methods FromJanuary 2010 to August 2010, 33 newborns and infants [ ( 7. 8 ±8. 4) months, range 3 days to 36 months; weight ( 6. 6 ±3. 6) kg, range 2. 2 to 19. 6 kg] were treated with HHFNC ( 22 cases) and routine oxygen therapy ( 11 cases) for respiratory failure following ventilator weaning after operation of congenital heart disease. Symptoms, blood oxygen saturation ( SpO2 ) , partial pressure of oxygen( PaO2 ) , partial pressure of carbondioxide ( PaCO2 ) , incidence rate of re-intubation, duration of ICU, and hospital stay were assessed and compared between the HHFNC group and the routine oxygen therapy group.Results There were no statistical significance in the duration of ICU, hospital stay, duration of mechanical ventilation, or infection rate between the HHFNC group and the routine oxygen therapy group ( P gt; 0. 05) . But the incidence rate of re-intubation was lower in the HHFNC group than that in the routine oxygen therapy group. Meanwhile SpO2 and PaO2 increased and PaCO2 decreased significantly in the HHFNC group ( P lt;0. 05) . Conclusion HHFNC shows a clinical improvement rapidly and efficiently in preventing respiratory failure after ventilator weaning in post-operative newborns and infants with congenital heart disease.

    Release date:2016-09-13 04:07 Export PDF Favorites Scan
  • Modified Fontan Procedure for Complex Congenital Heart Diseases

    ObjectiveTo review our clinical experience of modified Fontan procedure for complex congenital heart disease (CHD) in children. MethodsClinical data of 62 children with complex CHD who underwent modified Fontan procedure in Guangzhou Women and Children's Medical Center from May 2008 to December 2013 were retrospectively analyzed. There were 41 male and 21 female patients with their median age of 4 years(range, 16 months to 14 years) and body weight of 12.5 (8.9-49.5) kg. Diagnosis included functional single ventricle in 45 patients, transposition of the great arteries (TGA) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) in 6 patients, corrected TGA with VSD and LVOTO in 6 patients, double outlet right ventricle with severe pulmonary stenosis in 4 patients, and right ventricular dysplasia in 1 patient. Previous procedure included pulmonary artery banding in 10 patients, unilateral bidirectional Glenn shunt in 37 patients, and bilateral bidirectional Glenn shunt in 8 patients. Seventeen patients received single-stage modified Fontan procedure, and 45 patients received two-stage modified Fontan procedure. Extracardiac conduit was used in 56 patients, and lateral tunnel was used in 6 patients. Concomitant procedures included fenestration in 41 patients, atrioventricular valvuloplasty in 6 patients, and pulmonary artery angioplasty in 3 patients. ResultsTwo patients in both single-stage and two-stage groups died postoperatively with mortality of 11.8% and 4.4% respectively (P=0.299). Postoperative mechanical ventilation time, length of ICU stay, chestdrainage duration, postoperative hospital stay and morbidity were not statistically different between single-stage and two-stage group. Mean follow-up was 2.0 ±0.5 years (range, 3 months to 5 years). There were 2 late death in the singlestage group but no late death in the two-stage group. Growth of all survival children was good, and their exercise capacity significantly improved. Percutaneous oxygen saturation was higher than 90%. Echocardiography showed patent superior and inferior vena cava anastomosis without thrombosis, stenosis, atrioventricular valve regurgitation aggravation or pulmonary venous return obstruction. All survival patients were in New York Heart Association class Ⅰ or Ⅱ. None of the patients had arrhythmia, chronic effusion or protein losing enteropathy. ConclusionEarly and mid-term results of modified Fontan procedure were satisfactory for children with complex CHD. For children with high risk factors, staged Fontan procedure can reduce surgical mortality.

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  • Risk Factors for Delayed Sternal Closure in Operation for the Neonates with Congenital Heart Disease

    ObjectiveTo analyze the risk factors for delayed sternal closure (DSC) in the operation for the neonates with congenital heart defects. MethodsWe retrospectively analyzed the case notes of the 203 neonates with congenital heart defect in our hospital between January 2010 and June 2014. There were 152 males and 51 females at age of 0-28 (17.68±8.62) days. The relative factors were analyzed by univariate and multivariate logistic regression. ResultsThese factors significantly correlated with DSC in univariate analysis:age at operation, premature, low weight (weight≤2.5 kg) at operation/weight at operation, RACHS-1, mechanical ventilation before operation, continuous use of intravenous cardiovascular drugs before operation, CPB time, aortic clamping time, total circulatory arrest with profound hypothermia. The results of logistic regression analysis showed that weight at operation/low weight, pre-operative mechanical ventilation, total circulatory arrest with profound hypothermia were independent risk factors for DSC. ConclusionWeight at operation/low weight, pre-operative mechanical ventilation, and total circulatory arrest with profound hypothermia are the independent risk factors for DSC in the operation for the neonates with congenital heart defects.

    Release date:2016-10-02 04:56 Export PDF Favorites Scan
  • Application of bidirectional Glenn procedure in adult congenital heart disease

    Objective To analyze the feasibility of bidirectional Glenn procedure (BDG) in treatment of adult congenital heart disease (ACHD). Methods From December 2004 to December 2015, 42 ACHD patients received BDG in our hospital. There were 23 males and 19 females with a mean age of 24.6±8.5 years (range: 18 to 49 years). There were functional single ventricle (FSV) in 14 patients, Ebstein’s anomaly in 11, corrected transposition of great arteries in 7, transposition of great arteries in 5, double outlet of right ventricle in 3 and tricuspid atresia in 2. Twenty patients suffered moderate or severe atrioventricular valve regurgitation (AVVR). Half of the patients were operated upon with cardiopulmonary bypass (CPB) and the others with off-pump coronary artery bypass grafting (OPCABG). Thirty-four patients underwent unilateral BDG shunt and eight bilateral BDG shunts. Concomitant procedures included correction of Ebstein’s anomaly (7 patients), atrioventricular valve replacement (7), atrial septostomy (3), ligation of patent ductus arteriosus (3), ligation of major aortopulmonary collateral arteries (2), correction of total anomalous pulmonary venous connection (1) and mitral valve repair (1). Results The early operative mortality was 9.5% (4/42). FSV and moderate or severe AVVR were risk factors for BDG in ACHD. Early postoperative oxygen saturation increased from 78.8%±11.2% to 89.3%±6.6% (P<0.05). The follow-up time was 6-132 (41.4±33.1) months. There was no death. The heart function improved (2.7±0.5 vs. 1.9±0.4, P<0.05). Conclusion The BDG shunt can be applied to ACHD. Although the early mortality is relatively high, the middle- and long-term results are satisfactory. The oxygen saturation increases and the heart function improves. The life quality of patients will also improve. FSV and moderate or severe AVVR are risk factors for BDG in ACHD.

    Release date:2017-09-04 11:20 Export PDF Favorites Scan
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