Real-time free breathing cardiac cine imaging is a reproducible method with shorter acquisition time and without breath-hold for cardiac magnetic resonance imaging. However, the detection of end-diastole and end-systole frames of real-time free breathing cardiac cine imaging for left ventricle function analysis is commonly completed by visual identification, which is time-consuming and laborious. In order to save processing time, we propose a method for semi-automatic identification of end-diastole and end-systole frames. The method fits respiratory motion signal and acquires the expiration phase, end-diastole and end-systole frames by cross correlation coefficient. The procedure successfully worked on ten healthy volunteers and validated by the analysis of left ventricle function compared to the standard breath-hold steady-state free precession cardiac cine imaging without any significant statistical differences. The results demonstrated that the present method could correctly detect end-diastole and end-systole frames. In the future, this technique may be used for rapid left ventricle function analysis in clinic.
ObjectiveTo investigate the risk factors for prolonged postoperative mechanical ventilation patients with total anomalous pulmonary venous connection (TAPVC). MethodsWe retrospectively analyzed the clinical data of 97 survived TAPVC patients in our hospital between June 2011 and December 2013. There were 55 males and 42 females with age of 4.4 (2, 12) months. The patients ventilated longer than mean time were as a prolonged ventilated group (n=50) and the others as a normal group (n=47). Perioperative variables between the two groups were compared and selected, then put into logistic regression analysis. ResultsFor the 97 survived patients, the mean ventilation time is 49 (25, 90) hours. Age, weight, pre-operative left ventricular end-diastolic dimension, atrial septal defect (ASD) caliber, inotropic drug dosage, postoperative left ventricular end-diastolic dimension, maximum pulmonary venous velocity (P < 0.01), and cardio-pulmonary bypass (CPB) time (P < 0.05) were statistically different between the two groups. In logistic regress analysis, age (OR=0.804 with 95%CI 0.71 to 0.91) and maximum pulmonary venous velocity (OR=1.016 with 95%CI 1.00 to 1.03) were risk factors for prolonged postoperative mechanical ventilation. ConclusionAge and maximum pulmonary venous velocity are the risk factors associated with prolonged postoperative mechanical ventilation in patients with TAPVC.
Objective To summarize the method and outcomes of surgical treatment for 21 patients with congenital anomalous left coronary artery from the pulmonary artery (ALCAPA). Methods We retrospectively analyzed the clinical data of 21 patients with ALCAPA underwent surgical treatment in our center from January 2010 to January 2015. There were 11 males and 10 females with a mean age of 4.3 years (ranging from 0.5 to 16.0 years) and a mean weight of 19.3 kg (ranging from 5.0 to 97.0 kg). All of 21 patients underwent surgery under cardiopulmonary bypass and corrected malformations. Results There were 2 perioperative deaths and the mortality rate was 9.5%. The mean cardiopulmonary bypass time was 116.6 minutes ranging from 109.0 to 388.0 minutes and the mean aortic cross clamping time was 82.9 minutes ranging from 62.0 to 129.0 minutes. The mean time of hospital stay was 11.1 days ranging from 1.0 to 25.0 days. After surgery, cardiac function improved significantly in all patients. The mean left ventricular ejection fraction (EF), left ventricular fractional shortening (FS), and left ventricular end-diastolic diameter (LVEDD) have significantly improved after surgery (P < 0.05). Conclusions Once patients with ALPACA are diagnosed, they should be treated with surgery and most of them will achieve a satisfactory long term clinical result.
Objective To summarize the experience of the superior vena cava and pulmonary connection surgery for functional single ventricle (SV) with total anomalous pulmonary venous (TAPVC). Methods We retrospectively analyzed the clinical data of 10 patients with SV and TAPVC in our hospital from January 2012 through June 2014. There were 7 males and 3 females at average age of 90.33±86.53 months. The 10 patients were with right atrial isomerism, 9 with heterotary and asplenia syndrome. Five patients were anatomic single ventricle and others were with functional uni-ventricle. Nine patients were with supracardiac pattern TAPVC and one was with intracardiac TAPVC. All patients were operated unilateral or bilateral bidirectional Glenn procedure with TAPVC correction. Results The arterial oxygen saturation (SaO2) increased prominently after operation (86%±6% vs. 79%±6%, P<0.01). There were 3 patients with low cardiac output syndrome, one patient with severe arrhythmia, 4 patients with serious pleural effusion, 4 patients with hospital-acquired infection, and 3 patients with central nervous system complications (epilepsy or hemiplegia). One died because of hemorrhage and pulmonary thrombosis, and the other died of hypoxemia and mutiple organ dysfunction syndrome (MODS). Conclusion Glenn is one of palliated procedure choice for SV/TAPVC patients. The indication for surgery and perioperative management individually is crucial.
ObjectiveTo summarize clinical experience and results of surgical treatment of subaortic membrane (SM). MethodsClinical data of 32 SM patients who underwent surgical resection of SM between March 2009 and September 2013 in Beijing Anzhen Hospital were retrospectively analyzed. There were 22 male and 10 female patients with their age of 0.5-14.0 (3.6±3.2)years and body weight of 5.5-43.0 (17.2±9.5)kg. Among the 32 patients, 7 patients had isolated SM, and 25 patients had other intracardiac lesions including ventricular septal defect in 21 patients, mitral regurgi-tation in 1 patient, patent ductus arteriosus (PDA)in 1 patient, SM occurrence after PDA occlusion in 1 patient and surgical correction for coarctation of the aorta in another patient. Eighteen patients had aortic insufficiency (AI)in different degree. ResultsSM diagnosis was missed by preoperative echocardiography in 1 patient. Mean cardiopulmonary bypass time was 71.7±21.7 minutes, aortic cross-clamping time was 48.7±15.1 minutes, ICU stay was 2.2±1.7 days, and postoperative hospital stay was 7.9±2.5 days. There was no in-hospital death in this group. Postoperatively, 1 patient had second-degree atrioventricular block which returned to sinus rhythm 6 days after the operation. All the patients were followed up for 2-54 months after discharge. During follow-up, AI of 6 patients with isolated SM was relieved, and AI of 5 SM patients with other intracardiac lesions was relieved (P=0.003). Among the 7 patients with isolated SM, preoperative moderate AI in 4 patients changed to mild AI in 3 patients and trivial AI in 1 patient, and preoperative mild AI in 3 patients changed to trivial AI in 2 patients. Among the 25 patients with other intracardiac lesions, preoperative mild AI in 8 patients changed to trivial AI in 3 patients, and preoperative moderate AI in 3 patients changed to mild AI in 1 patients and trivial AI in another patient. There was no SM recurrence during follow-up in this group. ConclusionSM diagnosis may be missed by preo-perative echocardiography, and early surgical correction is needed once the diagnosis is established. Meticulous surgical techniques are necessary during the operation. Postoperative SM recurrence may happen, so regular follow-up is required after discharge.