ObjectiveTo summarize cardiopulmonary bypass (CPB) management experience in tetralogy of Fallot (TOF) infants weighing less than 8 kg. MethodsA total of 120 TOF infants weighing less than 8 kg received surgical repair in Wuhan Union Hospital from July 2009 to August 2013. There were 85 males and 35 females with their age of 1-18 months and body weight of 4-8 kg.The diagnosis of all the patients was made with echocardiography and diagnostic cardiac catheterization. Moderate hypothermia or profoundly hypothermic CPB with low-flow perfusion was used according to different surgical procedures. Imported membrane oxygenators and 4:1 cold blood cardioplegia were used. Zero-balance ultrafiltration during CPB and modified ultrafiltration during rewarming were performed. ResultsCPB time was 65-200 (115.3±9.6) minutes, and aortic cross-clamping time was 40-110 (60.3 ±10.2) minutes. A total of 112 patients received moderate hypothermia and low-or moderate-flow perfusion, and 8 patients received profound hypothermia and low-flow perfusion. Ultrafiltration volume was 780.5±50.3 ml, and hematocrit (HCT) increased to 0.35-0.40 after modified ultrafiltra-tion. Heart beat was automatically recovered in 114 patients (95%) after aortic unclamping. Weaning off CPB was successful in 119 patients, and 1 patient received extracorporeal membrane oxygenation because of difficult weaning from CPB. Postoperative mechanical ventilation time was 26.5±14.5 hours, and length of ICU stay was 121.5±16.5 hours. Five patients died of low cardiac output syndrome, and the other 115 patients were discharged successfully. ConclusionAppropriate hemodilution and colloidal pump priming solutions, perfusion methods suitable with surgical procedures, 4:1 cold blood-potassium cardioplegia, continuous zero-balance ultrafiltration during CPB and modified ultrafiltration during rewarming to maintain reasonable HCT and colloid osmotic pressure are all crucial factors in CPB management for surgical repair of TOF in infants.
Objective To study palliative surgical strategies for patients with complex congenital heart diseases， and improve their clinical outcomes and survival rate.?Methods We retrospectively analyzed clinical data of 95 patients with complex congenital heart diseases who underwent palliative surgical repair in Union Hospital of Tongji Medical College，Huazhong University of Science and Technology from January 2004 to May 2011. There were 68 male patients and 27female patients with their age ranging from 1 month to 37 years. Modified Blalock-Taussig shunt （B-T shunt） was performed in 12 patients， modified Brock’s procedure in 23 patients， bidirectional Glenn procedure in 55 patients and pulmonary artery banding in 5 patients. Surgical strategies and influential factors of treatment outcomes were analyzed.?Results There were 10 in-hospital death with the overall mortality of 10.5% （10/95）. All the surviving patients were discharged successfully. Main postoperative complications included low cardiac output syndrome， hypoxemia and pneumonia. All the surviving patients were followed up for 5 months to 6 years， and in New York Heart Association （NYHA） functional class ⅠorⅡduring follow-up. During follow-up， nine patients after modified Brock’s procedure received radical repair， and 6 patients after bidirectional Glenn procedure received total cavopulmonary connection.?Conclusion A considerable numberof patients with complex congenital heart diseases may miss their best timing for surgical repair， which significantlyinfluences their surgical outcomes. We need to choose best palliative surgical strategy for these patients according to their pulmonary artery development condition， heart malformation characteristics and final treatment goal.
ObjectiveTo analyze the effectiveness of in vitro fenestration versus bypass surgery techniques in the treatment of type B aortic dissection involving the left subclavian artery by thoracic endovascular aortic repair (TEVAR).MethodsAmong the 53 patients with type B aortic dissection involving the left subclavian artery admitted to our center from January 2017 to October 2020, 23 underwent in vitro fenestration + TEVAR (a fenestration group with 18 males and 5 females aged 53.6±5.3 years), and 30 patients underwent left common carotid artery-left subclavian artery bypass + TEVAR (a bypass group with 24 males and 6 females aged 51.8±3.8 years). The effectiveness and safety between the two groups were compared.ResultsThe surgical success rate was 100.0% in both groups. And there was no death within postoperative 30 days and during the follow-up. There was no endoleak immediately postoperatively and during 1-year follow-up in the two groups. The operation time and hospitalization expenses in the fenestration group was less or shorter than those in the bypass group (P<0.05). The reduction in blood pressure of the left upper limb in the fenestration group was greater than that in the bypass group (P<0.05). There was no symptom of left upper limb ischemia, dizziness or hoarseness in both groups.ConclusionThe two methods of reconstruction of the left subclavian artery are safe and effective. In vitro fenestration can reduce surgical trauma and costs, and bypass surgery can provide better forward blood flow for the left subclavian artery.
ObjectiveTo compare clinical results of different anticoagulation methods for patients with large left atrium in the early period after mitral valve replacement (MVR) in order to optimize anticoagulation therapy for them. MethodsA total of 144 patients with large left atrium who underwent MVR in Union Hospital of Tongji Medical College from January 2012 to September 2013 were included in this study. There were 76 male and 68 female patients with their age of 36-60 (47.4±7.0) years. All the patients were divided into 2 groups according to different anticoagulation methods after MVR. Group A patients received warfarin anticoagulation since the 2nd postoperative day. Group B patients received warfarin and aspirin (0.1 g daily) since the 2nd postoperative day. Morbidity and mortality during follow-up were compared between the 2 groups. ResultsInternational normalized ratio (INR) was 2.03±0.11 in group A and 2.01±0.11 in group B,and there was no statistical difference between the 2 groups (t=0.804,P>0.05). Twenty patients (13.9%) had hemorrhagic complications. There was no statistical difference in INR between patients with hemorrhagic complications in group A and B (t=0.496,P>0. 05) and there was no statistical difference in hemorrhagic rate between group A and B(P>0. 05). There was no thromboembolic complication in group B,and 9 patients (6.3%) in group A had thromboembolic complications. Three patients (2%) died of intracranial hemorrhage in group A during follow-up. Two patients died in group B,including 1 patient with recurrent pericardial effusion and pericardial tamponade who died 60 days after surgery,and another patient who died of unknown reason during follow-up. ConclusionFor MVR patients with large left atrium,anticoagulation with warfarin and aspirin can significantly decrease the incidence of thromboembolic complications but does not increase the incidence of hemorrhagic complications.