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find Author "杨盛春" 6 results
  • 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
  • Early- and mid-term outcomes of surgical repair of persistent truncus arteriosus in children

    ObjectiveTo evaluate the early- and mid-term outcomes of surgical repair of persistent truncus arteriosus in children in a single institution of China.MethodsThe clinical data of 27 consecutive patients with persistent truncus arteriosus undergoing surgical repair in Guangzhou Women and Children’s Medical Center from November 2009 to May 2018 were retrospectively reviewed. There were 14 males and 13 females. Median age was 3.0 months (range: 13 days -11 years), of whom 10 (37.0%) were older than 6 months. ResultsThere were three early deaths with a mortality of 11.1%. The main complications included VSD partial repair in 2 patients, complete atrioventricular block in one patient. The mean follow-up time was 24.5±19.3 months (range: 1–76 months). There were three late deaths, and two patients lost follow. Echocardiology showed seven patients of right heart outflow tract obstruction, including three in pulmonary artery trunk, and four of pulmonary artery branches. One patient showed moderate aortic valve regurgitation. None required re-intervention during the follow-up. Survival estimates for the entire cohort following surgery were both 76.1% (95%CI 59.2% to 92.9%) at 1 year and 5 years.ConclusionThe surgical repair of persistent truncus arteriosus (PTA) remains challenges. The early- and mid-term outcomes of surgical repair of persistent truncus arteriosus are acceptable. For older children with severe pulmonary artery hypertension and/or trunk valve regurgitation, the risk of death is still higher. Some children have the higher risk of late right heart obstructive lesions.

    Release date:2019-03-29 01:35 Export PDF Favorites Scan
  • Ross-Konno 手术治疗儿童主动脉瓣及瓣下狭窄的临床疗效

    目的评价 Ross-Konno 手术治疗儿童主动脉瓣及瓣下狭窄的早期临床疗效。方法2018 年 12 月至 2019 年 12 月,共 12 例患儿因主动脉瓣及瓣下狭窄在我科接受手术治疗,其中男 8 例、女 4 例,接受手术时中位年龄 4 岁(11 个月~12 岁)。Ross-Konno 手术 11 例,单纯 Ross 手术 1 例。主动脉瓣重度狭窄 8 例,主动脉瓣关闭不全 2 例,狭窄合并关闭不全 2 例。合并主动脉二瓣化畸形 6 例,瓣下流出道显著狭窄 4 例,合并二尖瓣病变 4 例,合并弓部病变 3 例。手术采用自体肺动脉带瓣管道移植于主动脉瓣位,同期采用 Konno 法扩大左室流出道。采用牛颈静脉或带瓣 Gore-tex 人工血管重建右室流出道,并同期矫治心内合并畸形。所有患者均经多普勒彩色超声心动图定期进行随访评估。结果全组无手术死亡。术后中位随访时间 5.5(1~12)个月,1 例患儿残余左室流出道中度狭窄,其余患儿无显著左室流出道残余梗阻或复发梗阻,无新主动脉瓣显著反流。1 例患儿肺动脉带瓣管道主干中度狭窄,余重建右室流出道血流通畅,无明显瓣膜反流及赘生物形成。结论对于不适合瓣膜成形或置换术的儿童主动脉瓣膜病变,Ross-Konno 手术早期结果满意。

    Release date:2020-04-26 03:44 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
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