ObjectiveTo summarize clinical outcomes of atrial septal defect (ASD)occlusion for patients with ASD and tricuspid regurgitation (TR). MethodsBetween July 2006 and January 2012, 98 patients with ASD and TR under-went ASD occlusion in Xinhua Hospital, Shanghai Jiaotong University School of Medicine. There were 36 male and 62 female patients with their age aging from 2 months to 80 years. All ASD were secundum ASD with their diameter of 3-23 mm. There were 60 patients with mild TR, 28 patients with moderate TR, and 10 patients with severe TR. All the patients received ASD closure without specific management for TR, including 51 patients under digital subtraction angiography (DSA), 46 patients via a minithoracotomy approach, and 1 patient guided by transthoracic echocardiography. All the patients were followed up with echocardiography to evaluate changes of TR after ASD closure. ResultsThere was no in-hospital death. ASD occlusion was not successful in 1 patient who was found to have residual ASD shunt on the third postoperative day. Another patient underwent reexploration for abnormal bleeding on the third postoperative day. All the other patients had uneventful postoperative recovery. Eighty-four patients were followed up for 1-64 (26.56±21.35)months. During follow-up, the patient who have residual ASD shunt on the third postoperative day received open chest repair 6 months after discharge. TR of 73 patients (86.90%)improved in different degrees. Preoperative severe TR in 10 patients changed into mild TR in 8 patients, moderate TR in 1 patients and still severe TR in 1 patient. Preoperative moderate TR in 26 patients changed into none TR in 6 patients, mild TR in 18 patients and still moderate TR in 2 patients. Preoperative mild TR in 48 patients changed into none TR in 40 patients and still mild TR in 8 patients. ConclusionFor patients with ASD and TR, conservative treatment strategy is recommended. Simple ASD closure can provide satisfactory clinical outcomes, and also avoid adverse complications of cardiopulmonary bypass including myocardial injury and lung injury.
ObjectiveTo analyze the effect of modified B-T shunt for the treatment of complex congenital heart disease. MethodsWe retrospectively analyzed the clinical data of 150 B-T case times performed in 143 patients with complex congenital heart disease in Shanghai Xinhua Hospital between July 2006 and January 2013.There were 100 case times for male patients and 50 case times for female patients with age of 2-756 (20.17 ±80.37) months and weight of 4-63 (8.86 ±9.69) kg. ResultsThere were 5 in-hospital deaths (mortality at 3.50%). Three patients occurred abnormal bleeding (2.10%). Five patients (3.50%) performed the second B-T because of shunt occlusion. And the other patients recovered uneventfully. A total of 129 case times were followed up for 6-48 (14.38±10.05) months. Seven B-T case times (5.43%) were performed in 6 patients again because of shunt occlusion during the follow-up. Three patients died during the follow-up (mortality at 2.33%). A total of 88 patients of survival underwent corrective surgery or stage Ⅱ palliative surgery (68.22%). Main pulmonary artery have a significant increase in diameter during the follow-up(t=-15.18, P=0.00). Postoperative diameters of left pulmonary artery (t=-13.27, P=0.00), right pulmonary artery (t=-15.94, P=0.00), and right pulmonary artery (t=2.44, P=0.02) increased with statistical differences compared with preoperative values. Growth in ipsilateral pulmonary of B-T is better than that of the contralateral pulmonary (t=2.44, P=0.02). McGoon ratio increased significantly after B-T (t=10.10, P=0.00). Ejection fraction value was slightly lower than the preoperative value (t=2.77, P=0.00). Left ventricular mass index increased significantly compared with the preoperative value(t=-9.26, P=0.00). ConclusionsThe modified B-T shunt has been proved to be safe and effective in treating for complex congenital heart disease. It can significantly promote the development of pulmonary artery, especially the ipsilateral pulmonary of B-T. Small McGoon ratio and pulmonary atresia are the risk factors for limiting the further development of pulmonary. Appropriate diameter of B-T shunt choice according to preoperative pulmonary diameter and the weight of the patients is the basis to ensure successful operation and a good prognosis.
ObjectiveTo explore the midterm therapeutic effect of modified Blalock-Taussing shunts (MBTs) in the treatment of tetralogy of Fallot. MethodsWe retrospectively analyzed the clinical data of 69 children with tetralogy of Fallot undergoing MBTs in Shanghai Xinhua Hospital between July 2006 and January 2013. There were 44 males and 25 females with mean age of 17.97±24.73 months (ranged from 2 months to 10 years). The patients weighted from 4 to 24 (9.00±4.03) kg. All the MBTs between subclavian artery and pulmonary artery were performed through right or left posterior lateral incision. ResultsThe patients were followed up for 6-36 months including 57 patients with 6 months following-up, 33 patients with 6 months and 12 months following-up, 16 patients with 12 months and 24 months following-up, and 11 patients with 24 months and 36 months following-up. There was significant growth in McGoon ratio during the first 12 months follow-up (preoperative vs. 6 months:1.09 ±0.33 vs. 1.40 ±0.40, P=0.00; 6 months vs. 12 months:1.29±0.31 vs. 1.36±0.33, P=0.00). There was no obvious growth in McGoon ratio after 12 months (12 months vs. 24 month:1.22±0.31 vs. 1.19±0.32, P=0.14; 24 months vs. 36 months:1.22±0.23 vs. 1.23±0.20, P=0.45). The left ventricular end diastolic volume index (LVEDVI) increased significantly in 6 months after MBTs (preoperative vs. 6 months:29.60±10.12 ml/m2 vs. 49.18±11.57 ml/m2, P=0.00), but there was no significant growth after 6 months. There was no significant decline in left ventricular ejection fraction (LVEF) after MBTs. ConclusionThe MBTs can significantly promote the growth of McGoon ratio in 12 months of patients with tetralogy of Fallot, but there is no obvious growth of McGoon ratio after 12 months. MBTs can significantly improve left ventricular development within 6 months, and it won't lead to excessive expansion of the left ventricle when we extend follow-up time. The MBTs affects little on cardiac function of patients with tetralogy of Fallot.
ObjectiveTo summarize the experience of applying trans-upper-sternal approach in resection of cervicothoracic junction tumors. MethodsWe retrospectively analyzed the clinical data of 32 patients with cervicothoracic junction tumors received surgical resection through the trans-upper-sternal approach in our hospital from March 2012 through March 2015. There were 20 males and 12 females at age of 18 to 76(44.8±11.3) years. ResultsAll patients successfully underwent tumor resection through trans-upper-sternal approach. No patient required to convert to full sternotomy during the surgery. There was no early death, re-operation, or incision infection in the perioperation. Hornor syndrome occurred in 1 patient, hoarseness in 3 patients, and lymphatic leakage in 1 patient in the early postoperative time. Postoperative in-hospital time ranged from 3 to 7 days. No patient needed blood transfusion. Pathological examination showed that 17 patients had malignant tumor. Among them, 15 patients received postoperative radiotherapy or chemotherapy. Follow-up duration ranged from 6 to 42 months. All patients were alive, and no limbs disturbance occurred. ConclusionApplying trans-upper-sternal approach is safe, feasible and effective for the resection of cervicothoracic junction tumor with satisfactory outcome, less trauma, better cosmetolgy, and faster recovery.