So far, there have been several kinds of valvuloplasty techniques for Ebstein's anomaly. Cone reconstruction which was developed by Da Silver and his coworkers has attracted much attention from worldwide cardiac surgeons. Because this technique could reconstruct the leaflet to leaflet coapatation which permits central blood flow during diastole period. It is probably the most efficient anatomical correction method. We make a comprehensive literature retrieval concerning the Cone reconstruction for Ebstein's anomaly. Its development, key points of technique skills and prognosis evaluation are reviewed meticulously.
ObjectiveIn order to correct left pulmonary artery (LPA) stenosis in tetralogy of Fallot (TOF), a technique for LPA reconstruction by widening pulmonary arterial posterior wall was devised. To evaluate its surgical technique as well as postoperative outcome. MethodsFrom January 2008 through August 2014 year, 1 142 consecutive patients underwent repair of TOF including 44 patients with TOF and LPA stenosis in our hospital. We used widening pulmonary arterial posterior wall for LPA reconstruction in 21 patients. The median age was 22.8 months (range, 1 month to 11 years), and the median weight was 9.1 kg (range, 3.8-29 kg). ResultsThere was one operative death. No death occurred during the follow-up period in the other 20 patients. There were 4 patients with complicate unbalanced pulmonary perfusion postoperatively. Echocardiography at 3-72 months follow-up demonstrated no obvious stenosis was found at LPA in 14 patients, and mild stenosis (32.8±12.7 mm Hg) in 6 patients. Only 1 patient required further interventions because of restenosis of LPA. ConclusionsLPA reconstruction by widening pulmonary arterial posterior wall is an effective method in the management of stenosis of LPA in the patients with TOF. We emphasize division of the arterial duct or ligamentum completely because it will tether and kink the LPA. This procedure retains the better growth potential by increasing autogenous tissue of native tissue.
Objective To investigate and compare the different surgical strategies for typeⅠpulmonary atresia with ventricular septum defect (PA/VSD) and the outcomes of postoperative prognosis in early stage. Methods We retrospectively analyzed the clinical data of 61 typeⅠPA/VSD patients (40 males, 21 females) with a median age of 249 days (range, 13 days-19 years) in Guangdong Cardiovascular Institute from January 2005 to December 2014 . Among them, 42 patients (27 males, 15 females) with a median age of 11.11 months, ranging from 0.80–211.70 months received radical surgery as a radical surgery group. And 19 patients (13 males, 6 females) with a median age of 2.96 months, ranging from 0.47–161.83 months underwent palliative surgery as a palliative surgery group. We compared the two surgeries and their early outcomes. Results The mean postoperative oxygen saturation was 88.08%±9.64%, which showed significant improvement compared with preoperative oxygen saturation of 74.08%±12.99% (P＜0.05). Patients in the palliative surgery group had a lower body temperature during cardiopulmonary bypass and more respiratory complications than those in the radical surgery group (24.69 °C±3.11 °C vs. 27.18 °C±2.10 °C). Conclusion Both radical and palliative surgeries are good for the increase of pulmonary blood volume and the development of pulmonary vessels. Surgeons must pay more attention to choosing radical surgery for the babies, which is only considerd for those with well developed pulmonary arteries.
Objective To review the clinical experience of one-stage repair of interrupted aortic arch(IAA) in neonate with cardiac anomalies. Methods We retrospectively analyzed the clinical data of 21 patients (18 males, 3 females) with IAA total repair in our hospital between May 2003 and September 2014. The average age of patients was 6–26 (15.9±5.8) days and the mean body weight was 3.3±0.4 kg. Fourteen patients belonged to IAA type A, and 7 patients to type B. All patients were complicated with ventricular septal defect, atrial septal defect, and patent ductus artefious. All patients with cardiac anomalies underwent one-stage repair through median sternotomy. The aortic continuity was reestablished by anastomosis between the descending aortic segment and aortic arch. Results CPB time was 92–174 (132.6±27.1) min, and aortic cross clamping time was 48-118 (70.9±18.8) min. Hospital day was 4-52 (28.0±12.1) d. There were 3 postoperative deaths. Causes of death included a cardiac arrest in one patient, hematosepsis in one patient, and a pulmonary hypertension crisis in one patient. Eighteen patients were followed up for 3 months to 11 years and the results were excellent. Conclusion One-stage repair of IAA in neonate with cardiac anomalies can improve life quality of patients and achieve good results.
Objective To analyze the clinical efficacy and mid-term outcomes of reimplantation of anomalous origin of left coronary artery from the pulmonary artery (ALCAPA), and to evaluate whether concomitant management of mitral regurgitation (MR) during ALCAPA repair is needed. Methods Between March 2005 and March 2015, 52 consecutive patients (20 males and 32 females with a median age of 10 months ranging 2-193 months) underwent reimplantation of ALCAPA at Department of Cardiac Surgery, Guangdong Cardiovascular Institute. There were 14 males and 21 females with a mean age of 35.4±42.8 months not receiving mitral valvuloplasty (a Non-MVP group), and 6 males and 11 females with a mean age of 13.5±11.0 months receiving mitral valvuloplasty (a MVP group). In order to facilitate the analysis, degree of MR was graded by number: 0.0=none, 1.0=trivial, 2.0=mild, 2.5=mild-moderate, 3.0=moderate, 3.5=moderate-severe and 4.0=severe. Results The left ventricular fractional shortening (LVFS) and left ventricular end diastolic diameter (LVEDD) demonstrated significant improvement between preoperation and discharge (28.6%±9.6% vs. 32.1%±10.1%, P=0.023; 38.4±5.6 mm vs. 30.5±5.7 mm, P<0.001), and there was also significant improvement in the mean MR grade between preoperation and discharge (2.9±1.2,vs. 2.4±1.2, P=0.001). There were 4 in-hospital deaths (7.7%). The median follow-up was 21.0 months (ranging 1.5-111.0 months). Three patients (5.8%) were lost to follow-up, 1 patient required reoperation for mitral valve replacement and there was no death during follow-up. Significant improvement was seen in LVFS between discharge and final follow-up (32.1%±10.1% vs. 38.0%±6.0%, P=0.001); however, there was no significant difference in the degree of MR between discharge and final follow-up (2.4±1.2 vs. 2.3±1.2, P=0.541). There was no significant difference in cardiopulmonary bypass time, aortic cross-clamping time, mechanical ventilation time or hospital stay between the two groups. Conclusion Creation of a dual coronary system with reimplantation of the left coronary artery results in complete recovery of left ventricular function. However, concomitant management of MR during ALCAPA repair remains controversial. Concomitant mitral valve repair for ALCAPA patients with moderate-severe and severe MR is helpful to early function recovery of mitral valve.
ObjectiveTo summarize and analyze the experience of subarterial ventricular septal defect (VSD) repaired with simple pulmonary artery approach.MethodsWe retrospectively anlyzed the clinical data of 102 patients with subarterial VSD repaired with simple pulmonary artery approach in our hospital from August 2015 to October 2018. There were 67 males and 35 females at median age of 3 years (ranging 4 months to 49 years).ResultsThe median operation time was 82 (54-136) min. Median cardiopulmonary bypass time was 36 (21-62) min. The median aortic cross-clamping time was 13 (7-32) min. Thirty two patients of tracheal intubation were removed from the fast-track operating room immediately after surgery. Of the 102 patients, 67 patients underwent a small incision in the lower sternum. The median postoperative ICU stay time was 26 (13-36) h. There was no planned reoperations and no early death.ConclusionSimple pulmonary artery approach for subarterial ventricular septal defect repair with less intracardiac procedures, short operation time, less trauma, quick postoperative recovery has certain advantages in the application of specific groups.
ObjectiveTo analyze the effect of modified Blalock-Taussig shunt on the treatment of cyanotic congenital heart diseases in neonates.MethodsThe clinical data of 33 neonates undergoing modified Blalock-Taussig shunt between January 1, 2013 and December 31, 2017 were reviewed, including 28 males and 5 females with the age of 3.0-28.0 (18.0±6.1) d and weight of 1.9-3.7 (2.9±0.5) kg.ResultsThere were 3 (9.1%) in-hospital deaths. Ten (30.3%) patients required early unplanned reoperations after surgery. Five (15.2%) patients were lost to follow-up. In the multivariate analysis, preoperative acidosis, emergency operation and postoperative bedside thoracotomy were independent risk factors of early death. During the follow-up of 18.0-93.0 (40.2±22.5) months, there was no death and 9 (36.0%) survival patients underwent corrective surgery and stage-two palliative surgery. In the multivariate analysis, preoperative hyperhemoglobinemia was an independent risk factor of nonadministration of the corrective surgery and stage-two palliative surgery. Receiver operating characteristic curve showed that preoperative hyperhemoglobinemia was significant in determining whether secondary surgery was possible.ConclusionThe modified Blalock-Taussig shunt is effective in promoting development of pulmonary arteries and preparing for the secondary surgery. The rate of mortality and postoperative complications after the neonatal modified Blalock-Taussig shunt remains high. The rate of secondary surgery is still low during follow-up.
ObjectiveTo compare the efficacy of additional tricuspid valve annuloplasty (TVP) and isolated closure for atrial septal defect (ASD) with moderate to severe tricuspid regurgitation (TR). MethodsClinical data of the patients diagnosed with ASD combined with secondary moderate to severe TR and treated in our hospital from January 2009 to June 2020 were retrospectively analyzed. Patients were divided into a TVP group and a non-TVP group based on whether TVP was performed simultaneously. The baseline data of two groups were matched with a ratio of 1∶1 propensity score. ResultsA total of 32 pairs from 257 patients were successfully matched. In the TVP group, there were 24 females and 8 males with an average age of 44.0±13.1 years. In the non-TVP group, there were 28 females and 4 males with an average age of 44.5±11.6 years. The TR area and estimated pulmonary artery pressure in the two groups were significantly decreased compared with preoperation (all P<0.001). The TR area (P=0.001) and the estimated pulmonary artery pressure (P=0.002) were decreased more significantly in the TVP group than those in the non-TVP group. Linear regression analysis showed that age and preoperative TR area had a positive correlation with TR area at follow-up (β=0.045 and 0.259, respectively, both P<0.05), while additional TVP had a negative correlation (β=–1.542, P=0.001). ConclusionAdditional TVP can significantly reduce the TR area and pulmonary artery pressure, and elderly patients with severe TR before surgery should actively receive TVP.
ObjectiveTo investigate pulmonary artery growth, valvular regurgitation and right heart function after right ventricle-pulmonary artery (RV-PA) anastomosis for right ventricle outflow (RVOT) reconstruction in patients with different types of pulmonary atresia and ventricle septal defect (PA/VSD). MethodsClinical data of 31 PA/VSD patients who underwent right ventricle-pulmonary anastomosis for RVOT reconstruction from November 2002 to September 2012 in Guangdong General Hospital were retrospectively analyzed. There were 20 male and 11 female patients with their age ranging from 14 days to 14.50 years (47.90±53.84 months). Patients were followed up after discharge to evaluate the anastomasis, pulmonary artery growth, pulmonary artery and tricuspid regurgitation and their relationship with follow-up duration. Right ventricular strain and other echocardiography indexes were used to evaluate right heart function. ResultsThree patients died postoperatively. Twenty-seven patients (27/31, 87.1%)were followed up for 4-129 (35.97±28.24)months. There was no late death during follow-up. There was no anastomotic restenosis in patients who received radical surgery. Four patients who received palliative surgery had comparative anastomotic restenosis. The diameters of RV-PA anastomasis, left and right branches of the pulmonary artery during follow-up were significantly larger than early postoperative diameters (P < 0.05). Echocardiography showed that pulmonary artery and tricuspid regurgitation were aggravated, which was not correlated to follow-up duration. Overall right heart function was good during follow-up. ConclusionsClinical outcomes of RV-PA anastomosis for RVOT reconstruction in patients with PA/VSD are satisfactory. RV-PA anastomasis, left and right branches of the pulmonary artery can keep their growth and development. Mid-term and long-term right heart function is good.