Objective To evaluate the effect of treating Ebstein ’s anomaly w ith tricuspid valve replacement (TVR), and analyze the indications and personali ze the surgical methods of TVR. Methods 35 TVR in 32 cases of Eb stein’s anomaly not amenable to repair from May 1993 to June 2007 in An zhen Hospital were retrospectively. The mortality and complication incidence wer e estimat ed and the KaplanMeier survival curves were constructed to estimate actual sur vival and freedom from thrombus embolism rate, and comparative studies were unde rtaken to e valuate the clinical effect between implanting the prosthesis in the original tr icu spid ring or above the coronary sinus, and between fold the atrialized ventricle or not, and between preserve the autologous tricuspid or not. The univariate an alysis and logistic regression were used to explore the early and late death ris k factors. Results There were 2 early hospital death (6.25%). Followup of 30 patients who survived 30 days ra nged up to 14 years (4.2±3.5years)，there were 3 TVR reoperation due to the pro sthesis deterioration. There were 2 late deaths（6.67%）, and the actuarial surv i val at 5,10 year was 92.1%±4.6%, 86.5%±5.8% respectively in KaplanMeier cu rve. There were 2 events of thrombus embolism that were cured through thromboly tic therapy, thus the freedom from thrombus embolism at 5 and 10 yers reached 91 . 3%±4.5%,82.3%±4.2% respectively. 24 late survivors were in New York Heart Ass ociation(NYHA) functional cl ass I, and 4 in NYHA functional class II. The incidence of atria ventricular nod e rhythm in patients with the prosthesis implanted in original tricuspid ring wa s statistically higher than that of prosthesis implanted above the coronary sinus,and the incidence of paradoxical ventricular septal motion in patients wi thout folding the atrialized ventricle was statistically higher that of with fol ding the atrialized ventricle, but the NYHA functional class was not affected by these factors.The univariate analysis and logistic regres sion revealed that preoperative functional right ventricle/atrialized ventriclelt; 1 and ascites were the independent risk factor for the early death (P=0.023, 0.025), whereas preoperative ascites and edema in lower extremities were the in dependent risk factors for late death (P=0.026, 0.019). Conclusion TVR is a good therapeutically option for Ebstein’s anomaly si nce the operative risk is low, the functional status improved in all patients an d the durability of prosthesis in tricuspid position has been good. In order to maximize the effect of the TVR in Ebstein’s anomaly, personalized procedure sho uld be adopted in deciding whether to fold the atrialized ventricle or not, to p reserve the autologous tricuspid valve or not, and to implant the prosthesis in the original tricuspid ring or above the coronary sinus.
目的进一步提高Ebstein心脏畸形外科治疗的效果，减少并发症，降低死亡率。 方法回顾性分析河南省胸科医院2010年1月至2013年3月10例Carpentier B型Ebstein心脏畸形患者行改良Carpentier术的临床资料，其中男5例、女5例，年龄15～47（25.0±6.2）岁；血氧饱和度 ＜90%者4例，＞91%者6例。手术在全身麻醉、低温体外循环下进行，术中首先探查清楚右室内结构及三尖瓣叶发育情况，确认有发育良好的三尖瓣前瓣，而后由内向外双层连续缝合纵形折叠房化右心室。旷置三尖瓣隔瓣及后瓣；根据患者年龄、体重选择适当型号的人工瓣膜成形环，间断缝合固定成形环；注水检查有无反流，根据情况再做适当修理，至注水无反流为准。其中2例患者右心室发育差，术毕中心静脉压达15 cm H2O，加行双向格林（Glenn）手术。 结果术中应用31号成形环1例，29号成形环6例，27号3例。主动脉阻断时间45～66（51.5±2.6）min。术后循环均平稳，无一例死亡，无低心排血量综合征发生。术后心脏彩色超声检查：三尖瓣无反流6例，轻度反流4例；心功能Ⅰ级6例，Ⅱ级4例。术后随访2个月至2年，1例患者1年后出现三尖瓣中量反流，强心利尿治疗后好转；余9例心功能（NYHA分级）Ⅰ级8例，Ⅱ级1例。 结论改良Carpentier术治疗B型Ebstein心脏畸形效果良好，方法简单实用，易于推广。
ObjectiveTo summarize the results of surgical treatment for 79 patients with coarctation of the aorta (CoA) combined with complex anomalies (CA) in recent years.MethodsThe data from 79 patients with CoA combined with CA admitted to Guangzhou Women and Children's Medical Center between January 19, 2010 and September 7, 2017 were collected and analyzed. There were 52 males and 27 females. The median age was 71 days, and the median weight was 4.3 kg. There were 26 patients combined with tracheostenosis and 7 patients with preoperative tracheal intubation. Extended end-to-side anastomosis was used to correct the CoA, and the associated cardiac abnormalities were treated simultaneously by an incision through median sternotomy. All operations were performed by the same group of surgeons.ResultsThe median deep hypothermic circulatory arrest was 18 (13-28) minutes, the median aorta cross-clamp time was 62 (15-199) minutes, the median cardiopulmonary bypass time was 145 (71-674) minutes, the median ventilation time was 72 (9-960) hours, the median length of ICU stay was 144 (12-1 944) hours, and the median length of hospital stay was 24 (2-93) days. Early death occurred in 9 patients and late death occurred in 5 patients. Reoperation occurred in 28 patients and recoarctation developed in 10 patients. After operation, transcoarctation gradient was reduced, and the transcutaneous oxygen saturation, C-reactive protein (CRP), lactate and creatinine were increased. Compared to the survival group, both preoperative and postoperative transcutaneous oxygen saturation were worse and the postoperative levels of plasma brain natriuretic peptide (BNP) and CRP were higher in the death group.ConclusionCorrecting the CoA and the associated CA simultaneously with extended end-to-side anastomosis by an incision through median sternotomy is effective and safe, and the outcomes of immediate and medial-term are satisfactory. Improving oxygenation and limiting elevation of BNP and CRP levels may reduce the death rate.