Search

Surgical Strategy for Pulmonary Atresia with Ventricluar Septal Defect

Pulmonary atresia (PA) with ventricluar septal defect(VSD) is a complex congenital heart disease. The lack of knowledge on embryology, anatomy and pathophysiology of this disease with or without heterogenetic major aortopulmonary collateral arteries(MAPCA)leads to chaos of its surgical classification and management as well as poor results of surgical management. The operative technique in this field has been advancing a lot since the innovation of unifocalization. The surgical result is getting better and better, boosted by the updating of the principle and knowledge, but there is still a large room for progress. We reviewed the literatures on classification,surgical strategy, procedures and operationrelated issues and put them together here to delineate its past, present and future.

The Application of Palliative Operation in Staged Surgical Management of Pulmonary Atresia with Ventricular Septal Defect

Abstract： Objective To assess the effects of three different palliative procedures including modified BlalockTaussig (B-T) shunt, Waterston shunt, and reconstruction of right ventricularpulmonary artery (RV-PA) continuity for pulmonary atresia with ventricular septal defect (PAVSD). Methods We retrospectively analyzed the clinical data of 93 patients with PAVSD who had undergone palliative surgical procedures including modifie BT shunt, Waterston shunt, and RVPA econstruction in Fu Wai Hospital from September 1998 to September 2008. There were 53 males and 40 females, aged from 14.0 days to 14.4 years, with the body weight ranged from 3.6 to 33.0 kg (9.9±6.3 kg). According to International Congenital Heart Surgery Nomenclature and Database Project, these patients were categorized into 2 groups: 64 of type Ⅰ and 29 of type Ⅱ. The most common associated anomaly is rightsided aortic arch (except for ventricular septal defect). The application of the three kinds of palliative surgical procedures in staged management of PAVSD and the followup results were statistically analyzed. Results The corrective rate of the three palliative procedures were 28.12% (18/64) for modified BT shunt, 7.14%(1/14) for Waterston shunt, and 66.67% (10/15) for RV-PA reconstruction, respectively. RV-PA reconstruction had a significantly higher corrective 〖CM(1585mm〗rate than the other two surgical procedures (P=0.016). The percutaneous oxygen saturation (SpO2) increased by 4%59% and Nakata index by 31-104 mm2/m2. No tortuous pulmonary artery was found under echocardiogram or angiocardiography after palliative operation. The perioperative mortality of both surgical stages was 10 patients. Twostage radical surgery was successfully performed for 25 patients, among whom 20 were followed up till May 2009. During the followup, one died suddenly, 15 were classified as New York Heart Association (NYHA) Ⅰ, and 4 as NYHA Ⅱ. Conclusion The surgical management of PAVSD needs to be improved continuously. Compared with shunting procedures, the RVPA reconstruction is a better palliative operation method, and the modified B-T shunt is preferred in younger patients.

An introduction to Australian Thoracic and Cardiovascular Surgical Training System and Suggestion on the Establishment of a Thoracic and Cardiovascular Surgical Training system in China

三种手术矫治静脉窦型房间隔缺损的临床结果

目的 总结静脉窦型房间隔缺损（SVASD）合并部分性肺静脉异位连接（PAPVC）外科治疗的临床结果。 方法 回顾性分析 2000 年 1 月至 2016 年 12 月湖南省儿童医院 49 例 SVASD/PAPVC 患者的临床资料，其中男 21 例、女 28 例，年龄 5 个月～14 岁，平均年龄（4.7±2.1）岁。肺静脉异位连接位置位于右房者 9 例，位于右房与上腔静脉连接部者 12 例，位于上腔静脉者 28 例。根据手术方式分为三组，A 组 29 例采用单片心包补片修补，B 组 12 例采用双片心包补片修补，C 组 8 例将上腔静脉近心端引入左房、上腔静脉远心端与右心耳吻合（Warden 手术）进行矫治。 结果 手术效果满意，心内无残余分流，无手术死亡病例，无再手术者，无肺静脉回流梗阻病例出现。随访 6 个月至 15 年，术后 7 例上腔静脉流速增高，其中 A 组 4 例（13.8%），B 组 2 例（9.5%），C 组 1 例（12.5%）。术后 7 例窦房结功能异常，其中 A 组 3 例（10.3%，随访恢复窦性心律），B 组 4 例（19.0%，随访时 3 例恢复窦性心律，1 例为结性心律），C 组无窦房结功能异常病例出现。 结论 SVASD 多伴有右侧肺静脉异位连接，矫正 SVASD 时应注意防止上腔静脉和右侧肺静脉回流梗阻，并避免影响窦房结功能，选择适当的手术方式可以减少并发症的发生。Warden 手术能有效避免窦房结功能的影响，对于异位连接位置位于上腔静脉高位者，Warden 法应作为首选。